Is there a Piazza in medicine's future?

One of the holy grails of clinical information systems is to build decision support programs that would provide doctors with real time advice during the care of patients. The industry is moving along in this realm. The idea is to mine the clinical data in a hospital's records to look for patterns that would make the practice of medicine more evidence-based.

That is all to the good and will likely bear fruit. But let's think differently and explore the potential value of social networking in helping out clinicians.

I'm drawn to this idea by an article in yesterday's New York Times, entitled "Homework help site has a social networking twist." The story is about a start-up company called Piazza, created by a young woman who found herself alone while other students collaborated on engineering problem sets.

When Pooja Nath was an undergraduate at the Indian Institute of Technology Kanpur, an elite engineering school in India, she felt isolated. She was one of the few women on campus. While her male classmates collaborated on problem sets, Ms. Nath toiled in the computer lab alone.

The experience as a young woman in that culture formed the foundation of her start-up....

Students post questions to their course page, which peers and educators can then respond to. Instructors moderate the discussion, endorse the best responses and track the popularity of questions in real time. Responses are also color-coded, so students can easily identify the instructor’s comments.

Although there are rival services, like Blackboard, an education software company, Piazza’s platform is specifically designed to speed response times. The site is supported by a system of notification alerts, and the average question on Piazza will receive an answer in 14 minutes.

OK, I know clinical decision-making is different from getting the right answer on a homework assignment. Wait, is it all that different?

Students post questions to their course page, which peers and educators can then respond to. Instructors moderate the discussion, endorse the best responses and track the popularity of questions in real time. Responses are also color-coded, so students can easily identify the instructor’s comments.

What if a clinician had access to a cadre of like-minded clinicians and posed questions and got answers in real time? We can imagine this at different levels. Think of medical students on rotation, performing patient histories. They are not allowed to actually treat the patients, but what if they wanted to test their diagnostic and prescriptive skills, by quickly tossing questions to the medical world version of Piazza and seeing how well they have analyzed the situation? Participants could include other medical students and the course instructors.

Ditto for residents, except they actually deliver care as well as analyzing patients. And, of course, ditto for attending physicians as well.

In short, decision support systems do not need to be based on mining computerized databases. They could, in addition, be based on mining the experiential database of thousands of clinicians.