IT advances that are changing the rules

The exciting thing about information technology is that as it gets more sophisticated, it grows in ways that were hard to imagine at the outset. Collaborative technologies that exploit the connectivity of the internet are completely remaking the way that people work with their peers, interact with their customers and, ultimately, how they derive meaning from their craft. I have three computer-savvy kids who teach me this everyday. A few stories I've come across provide better documented evidence.

An article in last week's New York Times magazine (please see "Sex, Drugs and Updating your Blog") describes a musician who decided to write and publish a song a week, which led to a devoted fan following and a connectedness between him and his audience that is redrawing the lines of how he creates, markets and sells his music. Being directly connected to his fans allows him to target live performances to places where he knows he'll have a sell-out, and it also allows him to get immediate feedback on his music. On the downside, it's created an enormous responsibility to maintain direct connections with an ever-growing fan base who have come to expect a direct relationship with the artist.

Second, yesterday's Boston Globe had an article on "crowdsourcing" (please see "Crowdsourcing: Mining the masses for the next big thing"), defined as "throwing your arms open to the Internet community and inviting them to help create content or software." Music, software, video -- you name it, all sorts of products and services that are based on intellectual capital are being collaboratively developed by groups of otherwise unaffiliated contributors.

A specific example of this was described on National Public Radio a little while ago (please see "Musicians Collaborate from Afar on the Web" ). This was a story about websites that allow completely collaborative creation of music. Someone starts with a seed, like a bass line or a melody, and anyone else can upload overlays of instruments and vocals or anything else they can think of. "Songs" arise organically from the combinations of these layers, and indeed, one can imagine many "songs" being "created" from a single seed by mixing and matching these overlay tracks. Perhaps most fascinating, a listener can mix and match these tracks to generate a song that suits his or her tastes.

The web has expanded our current notions of "product" and "creator" and "consumer" to the point that these definitions start to merge into each other. I wonder how long it will be before these types of technologies start reshaping health care delivery -- longer than in the music industry, to be sure, but faster than most people appreciate at present. Collaborative input to diagnosis and treatment of individual complex cases, for example, which of course happens today, but is mostly limited to circles of colleagues who know each other. Or building rich libraries of treatment pathways, developed by mixing and matching layers of sub-pathways (pathlets?) from a wide variety of contributors. And this is all "b2b" or "physician2physician" collaboration -- what about "b2c" or "physician2patient"? The ability to have rich, 2-way, ongoing conversations with many patients presents many opportunities and, of course, many burdens and responsibilities as well. There are obviously many, many other examples, but I'm limited by my imagination (and the time-pressure to post this blog!).

One wonders whether the widespread use of such technologies will first require fundamental changes in the way medicine is organized today, or whether such technologies in the hands of younger physicians will fundamentally alter the structure of medicine. We have a tendency in the field of medicine and informatics to focus on how different health care is than everything else. As information technology becomes more useable and more sophisticated, it starts to look more similar.