Two overlapping and powerful trend clusters make this necessary. The first centers on information, reflecting the combined impact of the explosion of medical information and its increasing transparency as we transition to an open access format. The second trend centers on time, reflecting the combined impact of the decreased time providers have in fewer moments of direct patient-provider interaction (partly due to the commodification of medicine[3
]), and the rapidly growing time spent online in social platforms by our patients and more recently by providers.
The information overload is striking and profound. PubMed http://www.ncbi.nlm.nih.gov/pubmed/
currently classifies nearly 22 million citations [4
], with a new publication being added every minute on average--a rate that has more than doubled over the past 20 years [5
]. In my field of practice alone, advanced heart failure and transplant cardiology, 482 guidelines that reference heart failure management are available for review and incorporation in clinical practice in the National Guideline Clearinghouse [6
Concomitant with this accelerating information overload, our medical information has become more broadly and transparently available, leveling the patient-provider playing field as data increasingly moves to an open access model. Moreover, early access is no longer weighted towards healthcare providers, as late-breaking clinical trials are now often highlighted in publicly available press releases before they appear in peer-reviewed journals, placing additional temporal tension on patient-provider interactions.
Given these two simultaneous information trends, namely vast data overload and increasing information access, the idea that accurate and meaningful information can only flow in one direction, from a provider to a patient, can no longer pass the straight-face test.
The second trend cluster centers on our most precious commodity-time. Face-to-face patient-provider interaction has become scarcer across the spectrum of health care, affecting all providers. Paperwork, particularly documentation, consumes up to one-third of a physician's workday [7
]. Physicians-in-training are affected to an even greater degree, with residents spending up to six hours a day in documentation [8
], nearly twice as much as twenty years ago[9
]. With duty hour restrictions, it would appear that they are at risk of devoting more of their schedule in the future to documentation than to direct patient care.
Moreover, this problem is not unique to physicians; it is frankly pandemic. A recent time-motion analysis of floor nurses demonstrated that less than 20 percent of their shift was spent in direct patient care, with the largest block, 35 percent, spent in documentation [10
]. Fundamentally, evolving and competitive demands placed upon health care providers continue to limit opportunities for direct patient-provider communication.
Simultaneously, time spent in social media has grown explosively. As of 2010, the world spends over 110 billion minutes per day on social networks and blogging sites, translating into 22 percent of all time spent online. Time on-line continues to increase exponentially, with the average user spending nearly 6 hours a day on social media sites as of 2010 [11
]. Concurrently with more time spent in social platforms, when online, patients and their caregivers are more commonly online searching for medical information, as well as seeking peer-to-peer support. This online health care presence is increasing at a rapid rate; 61 percent of patients are now seeking both support and medical information online [12
], and looking for health care information is now the third most popular online activity, after internet search and e-mail [13
Fundamentally, this represents the opportunity. Much like Alice in Wonderland who shrank when she drank the "DRINK ME" bottle and then bumped her head as she grew after eating the "EAT ME" cake, we face dual challenges as moments of direct patient care that continue to shrink and information for clinical care continues to grow at an astonishing rate. Fortunately, our information is more and more transparent and open sourced, and we know where our patients are. They are online, and they are awaiting our participation.