Something strange is happening to your local community. Depending on how "connected" you are, you might not even know it yet. Instead of (or in addition to) meeting at the local café or community center, individuals increasingly are staying at home and connecting, sharing and learning from each other -- through the Internet. And it's just beginning to make waves in health care.
Though we're still in the early days of understanding the dynamics and long-term viability of online communities, it's clear that the movement is gaining momentum and promises to be a force in reshaping health care knowledge and delivery. Will the movement be completely disruptive to the health system and obviate the need for clinicians altogether? Believe it or not, there are several smart individuals who believe that scenario may be the case.
The Converging Force of Communities
Ask anyone today where they go for research and it's increasingly not the library. It's on Internet communities such as Wikipedia where the content is entirely written, edited and managed by its users. Though skeptics have constantly raised concerns about the content's validity, various studies -- including one conducted by Nature in 2005 -- have found the accuracy of Wikipedia to be fairly comparable with traditional sources.
Once unleashed, the force of users converging on a Web site can be breathtaking. The breadth and timeliness of topics posted in Wikipedia; the fantastical personalities and worlds created in Second Life; and the voracious connections and growth generated by Facebook all exhibit the unexpected power of decentralizing knowledge, creativity and connectivity. And, of course, the growth of online communities has also proven to be big business. Mainstream community sites such as MySpace, LinkedIn and Facebook have generated potential value that could hit several billion dollars.
Converging on Health
It's not hard to see why companies large and small would be interested in taking a similar approach to health care. Medical information today remains largely unavailable and difficult to access. It's also one of the most searched areas on the Internet. Just a few years ago, consumers first turned to their doctor and family for trusted information. Now, they turn to the Internet first.
Sites like Daily Strength and Patients Like Me utilize extensive historical and anecdotal information from patients themselves. They provide a supportive and knowledgeable infrastructure where physical connections are hard to make. And they allow patients to potentially self-diagnose and/or talk with their physicians about possible misdiagnoses.
But can online health communities go as far as making doctors obsolete? Though some would argue yes, most would probably agree that's a bit of a stretch. For one thing, the analogue doesn't exist outside of health care. Online friendships mostly are an extension of existing relationships. By nature, human beings rely on some physical contact, even if for a short bit of time. Existing physical relationships persist despite the evolving variety of online utilities that support them.
Disconvergent Fluidity
While online communities can appear in just a matter of months, they can also dissipate just as rapidly if a better alternative appears. In the U.S., Friendster was the first hot community site but was overtaken by MySpace just two years later. Now, it seems like Facebook could be the next successor. This ebb and flow process of convergence and "disconvergence" of community members appears to reflect the current natural state of affairs in online communities.
Part of the fluidity in online communities is reflective of the increasingly low costs required to develop and support innovative online applications and substitutes. Sophisticated hardware and software options now are available for little to no cost, and new applications are only limited by an entrepreneur's ideas and drive. The same forces that allow creative college dropouts to start their own online businesses are the same forces that will generate their competitors for years to come.
Just as important, the context in which one interacts with an online community also is rapidly changing. Someone might be using a desktop computer one day, then start using a Web-enabled phone the next. Someone could be defined by their friends in one year, then by their health support group in another. Context switching generates a whole different set of needs, by which some sites might become preferred over others.
The growth and proliferation of a seemingly endless supply of substitutes suggests that the landscape will remain dynamic for some time to come. The ultimate result is a patchwork of physical and online communities that is in constant flux -- highly dependent on personal context and technology options, as well as online creativity and network effects.
Eroding the Health Infrastructure?
What does the explosive potential for online communities mean for health care? If you were to ask participants at September's inaugural Health 2.0 conference in San Francisco, there is a general belief that someone will crack the calcified health infrastructure using a novel online health community of patients, providers and other participants. What does that site look like, and who does it serve? Most are still not sure, but there are many nascent companies trying to do just that.
Online health communities have the potential to provide an unbelievable wealth of anecdotal and factual information for individuals unable to access our outdated health infrastructure. But just like other online communities, they are at risk for dissipating through other substitutes, poor business models or aggregation by larger players. Whether companies will develop the appropriate context and critical mass for success remains to be seen. Outside of health care, the formula for online community success has been fairly unpredictable -- and it's likely to remain that way within health care as well.