Open Wiki Style Medical Decision Making

The pace and expanding scope of medical information growth increasingly challenges the ability of doctors to keep up to date. A shortage of health care workers also necessitates that these doctors do more with less time. These two trends combine to increase the risk of less than optimum medical decisions and practice.

Extending an open innovation approach to the medical decisions space may offer a way to mitigate the impact of this problem and achieve new gains. Medical records could be placed anonymously on a web site along with doctors decisions. Visitors to the web site could then review the patient information at their leisure and suggest better diagnosis or treatment options while citing the research that supports their position. It would be somewhat like a wiki of diagnosis and treatment with a means to present conflicting views and allow consensus building.

Patients and their doctors could then review the wiki. Patients could look at it as often as they wish while doctors may want to be alerted only once certain thresholds are reached in terms of consensus on differing diagnosis and treatment and the significance of the difference. Such thresholds could help ensure that the time that doctors spend on this new task is likely to have significant value.



This sort of approach would also allow insight into the most common errors by doctors which could be used as basis for a national effort to communicate best practices to physicians.


Key Challenges

Increased patient interaction with inexpert health commentary could lead to unnecessary further taxing of health care resources as these patients seek to present to their doctors such commentary. Thus it may be necessary to restrict patient access to the wiki in some way if it is found that patients report to their doctor with wiki information that is of no value and based on anecdotal evidence or poorly understood personal experience.

The popularity and success of wikipedia and other open innovation platforms may not transfer to a wiki of medical decision making because of some clear differences. First and foremost perhaps is that the "experts" are already over tasked so this program would likely not be able to piggy back off of their efforts, particularly MD's. It may be that Ph.D.'s involved in medical research may have sufficient expertise to quickly and efficiently review and contribute to medical records with characteristics within their scope of expertise. These experts may be more inclined to exam medical records.

Novices face larger hurdles to making good contributions than with Wikipedia. Where for Wikipedia one could find several pieces of corroborating information and include them in a relevant article with an intuitive sense of their significance, the experience with a wiki of medical diagnosis and treatment would be different. The diversity of medical conditions and their presentations make it much harder for a novice to first understand enough to evaluate the information and then know when they know enough to suggest a differing diagnosis or treatment path. It would seem feasible that, for a great many conditions, after the novice has command of human physiology not much more than is often covered in high school health classes, they may be able to work their way through a diagnosis or treatment decision tree when presented with such a tree and with access to resources like wikipedia within a handful of hours or days. This claim seems worth evaluating.

A second key difference between this sort of wiki of medical decisions and say wikipedia is that persons with a limited scope of interest or expertise may find it more difficult to find patients with the conditions they are expert in particularly if their aim is to ensure proper diagnosis and seek out misdiagnosis. It would seem easy enough to make records searchable by physician diagnosis, but making symptoms, lab work, and certainly diagnostic imagery effectively searchable seems a much more difficult task.