The term
This paper aims to establish a clear definition for Medicine 2.0 and delineate literature that is specific to the field. In addition, we propose a framework for categorizing the existing Medicine 2.0 literature and identify key research themes, underdeveloped research areas, as well as the underlying tensions or controversies in Medicine 2.0’s diverse interest groups.
In the first phase, we employ a thematic analysis of online definitions, that is, the most important linked papers, websites, or blogs in the Medicine 2.0 community itself. In a second phase, this definition is then applied across a series of academic papers to review Medicine 2.0’s core literature base, delineating it from a wider concept of eHealth.
The terms
This paper is distinguished from previous reviews in that earlier studies mainly introduced specific Medicine 2.0 tools. In addressing the field’s definition via empirical online data, it establishes a literature base and delineates key topics for future research into Medicine 2.0, distinct to that of eHealth.
O’Reilly defines Web 2.0 by a series of case examples, noting the characteristics of a Web 2.0 company, such as (1) hard-to-recreate data sources that get richer as more people use them, (2) harnessing collective intelligence, and (3) levering the “long tail” through customer self service [
However, we argue that Medicine 2.0 has certain characteristics that warrant analysis distinct from eHealth. First, there is the number of online references to Web 2.0, Health 2.0, and Medicine 2.0 (187-224 million, 0.5-1.7 million, and 0.1-0.4 million, respectively, depending on the search engine used). Second, there is extensive literature loosely associated with O’Reilly’s definition, such as Wikinomics [
We employ data garnered from practising online communities to answer the following research questions:
Can a clear definition of Medicine 2.0 be established across practitioner and academic literature that distinguishes this field from eHealth?
Is there agreement between online discussions and academic communities in their use of the term
What are the major tensions between the main stakeholders in Medicine 2.0 communities as identified by research?
Toward this aim, we used Google’s PageRank system to identify the most popular online discussions and delineate key themes through thematic analysis. We started by clarifying the Web 2.0 definition as some researchers suggest that aspects of its application to medicine cannot be assumed [
In a second phase, we applied these salient themes as a definition to the academic literature associated with Medicine 2.0 to broadly delineate the field. In doing this, we found four major tensions in the field. Moreover, we determined that academic literature does not explore personalized or customized health care in the detail that this theme is treated online. Finally, as could be expected, we found a gray area with papers that clearly have implications for Medicine 2.0 but do not correspond to many of the salient themes associated with it.
This paper makes a distinct contribution to the Medicine 2.0 field by empirically demarcating its thematic boundaries and differentiating it from Web 2.0 and Health 2.0, as well as online versus academic perspectives.
Medicine 2.0 focuses strongly on the use of Web 2.0 tools. However, as a term only four years old and constantly evolving as new tools emerge, academic literature is unlikely to have achieved consensus on its scope as quickly as 2008. For this reason, we used Google’s PageRank system to identify the tools or benefits most important to Web 2.0. Google’s PageRank relies on the democratic nature of the Web’s vast link structure to indicate an individual page’s value. Google interprets a link from page A to B as a vote by page A for page B. Google looks at more than the sheer volume of votes; if the page that casts the vote also has many links to it, this vote cast by that page weighs more heavily [
To refine the approach, and to enable a contrast to Medicine 2.0’s salient themes, we started with Web 2.0. We searched with Google for “Web 2.0” to identify the most linked pages with the term. These pages were coded using thematic analysis [
Democratized Collaborations; a collaboration enabled by web technology that promotes learning and innovation. Democratized collaborations work by connecting participants to harness network effects and knowledge in an open and interactive manner.
A similar approach was used to delineate Medicine 2.0, but no assumption was made that identifying terms such as
In a second phase, carried out in step 7, the original sample of 2405 academic papers identified as being potentially related to Web 2.0 and health was reduced to 56 papers after excluding those not directly addressing Medicine 2.0, duplicate search results, or papers not available in English. The initial number of papers and those selected for the review are shown in brackets in step 1 of the methodology outlined in
Methodolocial steps
Step | Purpose | Description |
1 | Determine the field’s identifying terms from academic literature | We examined journals through search tools including PubMed (170:16), Blackwell Synergy (159:3), Science Direct (52:2), Emerald Insight (21:1), SpringerLink (20:1), JAMA (10:1), Wiley Interscience (109:0), and Google Scholar (1864:32). Any paper with a combination of “web” and “2.0” and restricted to medicine or health science journals was considered. The Google Scholar search was based on “Web 2.0” and “medicine” or “health.” All key “2.0” terms found in these paper titles or abstracts were identified (eg, “Medicine 2.0”). This and subsequent use of literature covers papers up to the end of March 2008. |
2 | Determine the popularity of academic literature’s identifying terms online | These terms were used to search Google to determine the support for the particular term (eg, the number of references matching “Health librarian 2.0”) online. |
3 | Determine the most popular pages associated with the identifying terms | Identifying terms with the most online references (eg, “Health 2.0” and “Medicine 2.0”) were used as a search term in Google to identify the most popular associated pages. Google’s PageRank system returns the most popular and most viewed pages as denoted by the richer-get-richer phenomena noted by a number of authors [ |
4 | Identify salient themes using thematic analysis | The online discussions in the popular pages were analyzed by two researchers using thematic analysis [ |
5 | Identify order of importance of pieces of exact phrases associated with salient themes | As noted in step 3, the most popular pages do not necessarily make the only important contributions to define the field, even though they do potentially play a more important role than other pages. The exact phrases associated with the different salient themes identified were re-entered into four different search engines to understand their frequency of use online or their relative ranking.By ranking, we mean the frequency of use as indicated by the count function of the search engine compared to other phrases using the same search engine. The search text included the identifying term as set out in |
6 | Identify further salient themesuntil saturation | Additional online descriptions continued to be coded until saturation (eg, nine online articles were examined for Health 2.0, and the next two examined did not identify any phrases with over a 1000 counts online). At this point, the independent coders compared and returned to step 3, where required, to address interrater reliability and integrity. |
7 | Define field scope and review academic literature to determine related publications and key tensions | This understanding of salient themes and the frequency of use of exact pieces of text online was used to provide an updated definition of Medicine 2.0 and structure the academic literature into key themes. The original set of academic papers identified in step 1 was critically examined to determine if the papers were, in fact, Medicine 2.0, to clearly delineate between Medicine 2.0 and eHealth literature. Two researchers independently assessed the literature to determine if it was specific to Medicine 2.0. The differences were resolved by discussion between the two researchers. Key tensions were identified via discussions with the whole research team. |
The abstracts and titles of the 2405 papers indicated that “2.0” was associated with Health 2.0, Medicine 2.0, Physician 2.0, Nursing Education 2.0, Medical Librarian 2.0, and Physician Learning 2.0.
Online use of “2.0” terms identified in academic literature
Search Term | Google Count |
“health” and ”web 2.0” or “health 2.0” | 1,617,000 |
“medicine” and “web 2.0” or “medicine 2.0” | 474,900 |
“physician 2.0” or “physician” and “web 2.0” | 126,000 |
“medical librarian 2.0” or “medical librarian” and “web 2.0” | 9560 |
“nursing education 2.0” or “nursing education” and “web 2.0” | 5612 |
“physician learning 2.0” or “physician learning” and “web 2.0” | 271 |
For both terms, open coding of the top online descriptions quickly lead to saturation, in the case of Medicine 2.0, after seven articles (articles coded: [
Medicine 2.0: relative frequency of use of associated text
Salient Theme | Associated Exact Phrase | Ranking (relative frequency of use online) | ||||
Yahoo! | MSN | Ask.com | Average Rank | |||
Participants | Doctors, physicians | 1 | 1 | 1 | 1 | 1 |
Patients | 2 | 2 | 2 | 2 | 2 | |
Scientists | 3 | 3 | 3 | 3 | 3 | |
Nurses | 4 | 4 | 4 | 4 | 4 | |
Medical students | 5 | 5 | 5 | 5 | 5 | |
Medical librarians | 6 | 6 | 6 | 6 | 6 | |
Tools | Podcast | 1 | 1 | 1 | 1 | 1 |
Blog | 2 | 2 | 2 | 2 | 2 | |
Bookmarking, tagging | 3 | 3 | 5 | 4 | 3.75 | |
Search engine | 4 | 4 | 6 | 5 | 4.75 | |
Wiki | 5 | 5 | 3 | 6 | 4.75 | |
RSS feed | 6 | 6 | 4 | 3 | 4.75 | |
Methods | Commons, open access | 1 | 1 | 1 | 1 | 1 |
Wisdom of crowds, network effects | 2 | 2 | 3 | 4 | 2.75 | |
User generated content | 3 | 3 | 4 | 3 | 3.25 | |
Accuracy | 4 | 4 | 2 | 2 | 3 | |
Expert community | 5 | 5 | 5 | 5 | 5 | |
Purpose/ Objectives | Collaborate, facilitate collaboration | 1 | 1 | 1 | 1 | 1 |
Personalized, customized information | 2 | 2 | 2 | 2 | 2 | |
Medical education | 3 | 3 | 3 | 3 | 3 | |
Free access, free services | 5 | 4 | 4 | 4 | 4.25 | |
Stay informed | 6 | 5 | 5 | 5 | 5.25 | |
Communication tool | 4 | 6 | 6 | 6 | 5.5 | |
Create knowledge | 7 | 7 | 7 | 7 | 7 |
Health 2.0: relative frequency of use of associated text
Salient Theme | Associated Exact Phrase | Ranking (relative frequency of use online) | ||||
Yahoo! | MSN | Ask | Average Rank | |||
Participants | Doctors, physicians | 1 | 1 | 1 | 1 | 1 |
Patients, citizens | 2 | 2 | 2 | 2 | 2 | |
Scientists | 3 | 3 | 3 | 3 | 3 | |
Medical students | 4 | 5 | 6 | 4 | 4.75 | |
Nurses | 5 | 4 | 4 | 5 | 4.5 | |
Clinicians | 6 | 6 | 5 | 6 | 5.75 | |
Health professionals | 7 | 7 | 7 | 7 | 7 | |
Caregivers | 8 | 8 | 8 | 8 | 8 | |
Medical librarians, health librarians | 9 | 9 | 9 | 9 | 9 | |
Tools | Blog | 1 | 1 | 1 | 1 | 1 |
Podcast | 2 | 2 | 2 | 2 | 2 | |
Tagging, bookmarking, social search | 3 | 3 | 6 | 3 | 3.75 | |
Search engine | 4 | 4 | 4 | 4 | 4 | |
RSS feed | 6 | 6 | 3 | 5 | 5 | |
Wiki | 5 | 5 | 5 | 6 | 5.25 | |
Mashup | 7 | 7 | 7 | 7 | 7 | |
Methods | Open source, open platforms | 1 | 1 | 1 | 1 | 1 |
User generated, user innovation | 2 | 2 | 2 | 2 | 2 | |
Participation, power of networks | 3 | 3 | 3 | 3 | 3 | |
Aggregation | 4 | 4 | 4 | 4 | 4 | |
Taxonomy | 5 | 6 | 6 | 5 | 5.5 | |
Reliable information, medical errors | 6 | 5 | 5 | 6 | 5.5 | |
Virtual communities, social groups | 7 | 7 | 7 | 7 | 7 | |
Purpose/Objectives | Long tail, personalized | 1 | 1 | 1 | 1 | 1 |
Collaboration | 2 | 2 | 3 | 2 | 2.25 | |
e-learning, medical education, mobile learning, health education, active learning | 3 | 3 | 2 | 3 | 2.75 | |
Community | 4 | 4 | 5 | 4 | 4.25 | |
Online services | 5 | 5 | 4 | 5 | 4.75 | |
Knowledge sharing | 6 | 6 | 6 | 6 | 6 | |
Information infrastructure | 7 | 7 | 8 | 7 | 7.25 | |
Reference tool | 8 | 8 | 7 | 8 | 7.75 |
Given the similar definitions of Health 2.0 and Medicine 2.0, and as suggested by other authors to encapsulate research [
Medicine2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education.
Supporting this are five salient or structuring themes that we more accurately define as follows:
Participants: the different stakeholders in Medicine 2.0
Method/tools: the manner by which Medicine 2.0 information is created and owned (eg, its accuracy from user generation, open source or ownership, and the use of specific tools such as wikis)
Collaboration and practice: Medicine 2.0 as a tool to promote participant’s interests as a reader (staying informed) or to communicate and collaborate collectively for his or her own practice
Medical education: Medicine 2.0’s educational use for the general public, training new health professionals, or ongoing education for specialists (different than collaboration and practice in its promotion of general skills, as opposed to examining and collaboration on a patient’s particular case)
Personalized health: Medicine 2.0 as a mechanism to provide customized health care, such as connecting patients with rare conditions, and to improve an individual’s value from health care
Can a clear definition of Medicine 2.0 be established across practitioner and academic literature that distinguishes this field from eHealth? Examining this question, we found common salient themes for both Health 2.0 and Medicine 2.0 that describe Web 2.0’s application to health. Its application to health and medicine is not as straightforward as the rule “Medicine 2.0 = Medicine + Web 2.0,” particularly in its emphasis on personalized health care and its participants (not observed in the Web 2.0’s democratized collaborations [
In addition, earlier in this paper we highlighted the issue that the technology based view of Medicine 2.0 (ie, the use of Web 2.0–like tools) could not clearly distinguish eHealth from Medicine 2.0. For example, we could conclude that every Internet health search using Google becomes a Medicine 2.0 search as the search algorithm is based on user-generated links. However, our definition implies that this cannot be taken for granted as Google does not meet many criteria of the Medicine 2.0 definition. First, it is not open; users do not have transparency on the algorithm or the ability to change it. Second, users do not have an intention to collaborate using Google or to help Google when assigning a link within a page. Rather, Google has commercialized a feature of Internet collaboration for its search and has not created a Medicine 2.0 collaborative platform. Despite this, other authors have argued that Google is the quintessential Web 2.0 company [
Applying this definition to the original set of articles identified via key word searches on health and Web 2.0, we found that fewer papers were associated with the field. One main driver was the fact that the search terms (eg, “Medicine 2.0”) often found identified papers that had no relevance to the subject, though we did not bottom at the root cause of this effect. Others were relevant to eHealth in general, but not Medicine 2.0. For example, the study “Influences, usage, and outcomes of Internet health information searching: multivariate results from the Pew surveys” by Rice [
Finally, we noted that rapid saturation in coding was achieved to obtain the salient themes used online. And while we believe this reflects a certain amount of common language used by the Health 2.0 or Medicine 2.0 online community, this does not mean all relevant themes were identified. For instance, social networking is only encapsulated in the “power of networks,” even though some authors would identify this as a very important separate trend and term. As such, this definition only identifies core or salient themes, not excluding other concepts, as being part of Medicine 2.0. We believe any compact definition will have difficulty in precisely delineating its complete scope.
Is there agreement between online discussions and academic communities in their use of the term
Despite the fact that personalized or customized health is a key objective or benefit of Medicine 2.0 (based on online discussions such as those typified by [
By contrast, research responding to the tools and methods is the most extensive. In this theme, papers looked at the implications of a particular tool or method, such as the errors in user-generated content or the implications of open-source methods. For example, Deshpande and Jadad [
Overall, there is a call for research in many areas, and Potts [
In addition to this call for research, we would expect publications on Medicine 2.0 to continue to grow in this theme for two further reasons. First, Web 2.0 tools are constantly evolving, and hence the impact of new tools will continue to require assessment. Second, two major tensions or research discussions exist that will also require investigation: information inaccuracy, and information privacy and ownership. We return to these tensions in the discussion on research question 3, and detail them in
Medicine 2.0 literature organized by themes and participants
Salient Theme | Year | Author | Principle Participant | Tensions |
Over-arching or unclassified | 2006 | Skiba [ |
Researchers/scientists | Field’s existence |
2007 | Manhattan Research [ |
Doctors | n/a | |
Ferguson [ |
Patients/public health | Doctor’s concerns |
||
2008 | Eysenbach [ |
Various | Field’s existence | |
Versel [ |
Various | Field’s existence | ||
Guistini [ |
Various | Field’s existence | ||
Tools and methods | 2002 | Burk [ |
Researchers/scientists | n/a |
2003 | Killion et al [ |
Researchers/scientists | n/a | |
2004 | Boyle et al [ |
Researchers/scientists | n/a | |
2005 | Boulos et al [ |
Various | n/a | |
Hope [ |
Researchers/scientists | n/a | ||
2006 | Boulos et al [ |
Various | Information inaccuracy | |
Boulos and Honda [ |
Various | n/a | ||
Castel et al [ |
Various | n/a | ||
Johnson et al [ |
Various | n/a | ||
Guistini [ |
Doctors | n/a | ||
Barsky [ |
Medical librarians | n/a | ||
Barsky [ |
Medical librarians | n/a | ||
Barsky and Purdon [ |
Medical librarians | n/a | ||
Karkalis and Koutsouris [ |
Patients/public health | Privacy and ownership | ||
Esquivel et al [ |
Patients/public health | Information inaccuracy | ||
2007 | Boulos and Wheeler [ |
Various | n/a | |
Liesegang [ |
Various | n/a | ||
Yang et al [ |
Researchers/scientists | n/a | ||
Saval et al [ |
Doctors | n/a | ||
Adams [ |
Patients/public health | n/a | ||
Boulos and Burden [ |
Patients/public health | Privacy and ownership | ||
Boulos et al [ |
Patients/public health | n/a | ||
Van den Brekel [ |
Patients/public health | n/a | ||
Barsky and Cho [ |
Medical librarians | n/a | ||
Barsky and Guistini [ |
Medical librarians | n/a | ||
Cho [ |
Medical librarians | n/a | ||
Connor [ |
Medical librarians | n/a | ||
2008 | Eysenbach [ |
Patients/public health | Information inaccuracy | |
Collaboration and practice | 2004 | Eysenbach et al [ |
Patients/public health | n/a |
2006 | Guistini [ |
Doctors | n/a | |
Atreja et al [ |
Doctors | n/a | ||
Navarro et al [ |
Patients/public health | n/a | ||
Altmann [ |
Various | n/a | ||
2007 | Bonniface et al [ |
Patients/public health | n/a | |
Steyn and de Wee [ |
Medical librarians | n/a | ||
Mclean et al [ |
Doctors | n/a | ||
Potts [ |
Researchers/scientists | Field’s existence | ||
Medical education | 2006 | Goh [ |
Patients/public health | Doctor’s concerns |
Boulos et al [ |
Various | n/a | ||
2007 | Heller et al [ |
Patients/public health | n/a | |
Crespo [ |
Patients/public health | n/a | ||
Skiba [ |
Nurses | n/a | ||
Skiba [ |
Nurses | n/a | ||
Skiba [ |
Nurses | n/a | ||
Skiba [ |
Nurses | n/a | ||
Sandars and Schroter [ |
Medical students | Doctor’s concerns | ||
Sandars and Haythornthwaite [ |
Medical students | n/a | ||
2008 | McGee [ |
Medical Students | n/a | |
Sandars [ |
Medical Students | Privacy and ownership |
What are the major tensions between the main stakeholders in Medicine 2.0 communities as identified by research? In relation to research question 3, four key areas of debate or tension between stakeholders were identified by our literature review:
The field’s existence: The definition of Medicine 2.0 and its existence as a legitimate research field, which this paper addresses, is an overarching issue, but it mostly concerns researchers.
Doctors’ concerns with patients’ use of Medicine 2.0, even if the information is accurate: This tension will mostly play out between doctors and patients in regular practice.
Information inaccuracy and potential risks associated with inaccurate Medicine 2.0 information: While this will concern all participants, it will be researchers, doctors, and patients who will have to understand the risks and techniques involved.
Privacy and ownership issues with Medicine 2.0–generated information: This may include such things as patient groups driving research agendas in addition to those sought by doctors and scientists.
The first main area of debate, an overarching theme, is related to the lack of agreement on what Web 2.0 is, and if it really exists [
The second main debate surrounds collaboration and practice by doctors and patients. Separate to the issues of information inaccuracy, it encompasses resistance by some doctors to their patients’ use of Medicine 2.0. Their concerns arise from Medicine 2.0 causing unwanted behaviors in patients, such as not consulting a physician, consulting a physician too late, or coming to wrong conclusions about their disease management even if the information available to them online is accurate. The issue is not new and arose with eHealth. Ferguson [
The third main discussion, based on the methods used to generate Medicine 2.0 information, is the risk of inaccurate online information. Misinformation has long been identified as a hazard of eHealth. However, studies have found little support for this concern [
The fourth and final debate is related to the consequences of the methods used to generate Medicine 2.0 information. Authors note that in addition to accuracy of information, privacy, ethical, legal, and ownership issues are also critical due to the nature of health information [
Our study has several limitations that warrant attention. Clear risks arise from using Google and other search engines to define Medicine 2.0. First, in step 3 of the method, Google’s PageRank system may only identify popular self-referencing communities, which as noted by some researchers has bias against newer online content [
We mitigated the first risk via the iterative manner in which the definitions and themes were identified by comparing academic and online definitions for inconsistencies and by searching for theme rankings across all pages online to reduce the bias toward the popular pages. We did not find any major inconsistencies, even though the small differences in Medicine 2.0’s scope online and in academic publications were established. Examples include the online focus on personalized health and the lack of online focus on social networking, which has been identified as an important trend by other authors [
We also examined the specific criticisms, such as Google returning inconsistent results below 1000 counts or Microsoft Live Search being inconsistent below 8000 counts and hence only ranked exact phrases above these levels. However, the use of different search engines further emphasizes that only the top exact phrases (eg, Blog or Podcast rather than Mashup) can be used with confidence to identify the salient themes as there was good agreement between search engines. Hence, we mitigated this risk by only using the top two to three and commonly ranked phrases, avoiding the bias that a term has been ranked highly only due to a particular search engine’s internal mechanisms.
Following the updated definition of Medicine 2.0, the literature describes five major themes: (1) the participants involved; (2) the impact on different collaborations and practice; (3) the ability to provide personalized health care; (4) the use in medical education; (5) its associated methods and tools.
There is now an emerging body of research into Medicine 2.0; in addition to the 56 papers we identified that address it directly, there are also many eHealth papers that have indirect implications for Medicine 2.0. Overall, they suggest that Medicine 2.0 will have a large impact on all areas of medical practice. Most of these publications are recent, since 2004, and call for more empirical research on various topics.
We expect research to continue to focus on the four major tensions between stakeholders that were found in the literature: the scope of the field including its definition and existence, the patient-doctor relationships impacted by Medicine 2.0, the methods and tools relating to information accuracy, and the methods and tools related to ownership and privacy. These issues are also found in eHealth; however, Medicine 2.0 is accentuating their impact. While touched on by some overarching publications, the lack of research into personalized health does not indicate that its importance is overstated by online discussions. Rather, we concur with other researchers who suggest that research currently lags behind practice in understanding the implications of Medicine 2.0.
None declared.