Over 100 years ago, when doctors still made house calls and people still died at home, it would have been difficult to predict the events that led much of the Western world to a trillion dollar healthcare systems technology industry in the US alone, doctors who work in healthcare conglomerates and people who die in the hallways of hospitals.

In the mid 1970’s, computer pioneer, Ray Ozzie was working on the PLATO project, an experiment to harness the power of networked computing for rich communication and group collaboration.

PLATO’s many features included email and an instant messaging feature dubbed “Talk-O-Matic.”

While working on the project, Ozzie, communicated online with a collaborator who worked remotely from off-campus. Ozzie was impressed by the eloquence and intelligence of his offsite workmate and the two quickly bonded. Ozzie’s only complaint was that when they sent instant messages to each other, his offsite colleague was a frustratingly slow typist.

After their joint project was completed, Ozzie met his remote partner in person for the first time during a party at the partner’s house in 1975. Only then did Ozzie discover that his colleague was a quadriplegic, bound to a wheelchair, whose slow typing was a result of having to interact with the keyboard using a stick held in his mouth.

The incident had a profound effect on Ozzie. He was struck by how the technology allowed them to connect so closely, despite physical constraints and without preconceived judgments. The two had met in a shared mental space that was uniquely enabled by networked technology. (Courtesy of Wharton School online)

In the late 1980s, Ozzie went on to invent Lotus Notes. Notes had the vision of easy to use collaboration. It was ahead of its time, requiring bandwidth and computing power that was not available. It was difficult to deploy and implement and slow and cumbersome to use.

Today, Ozzie’s dream of a shared online mental space can come true

Thanks to low-cost tablets, computers and broadband Internet and cheap cloud server computing; for just a few dollars a month, and without being dependent on a large slow-moving IT organization, any physician or healthcare worker can sign up for a service like Pathcare to create a private, personalized network of care in just a few minutes by themselves.

The private personalized network of patients and doctor makes doctor clinical guidance and patient personal experience supremely accessible using a simple social software interface. Over 10 years ago, 20 years after the launch of Lotus Notes, the IT industry realized that email was not a good tool for collaboration and sharing content.  Napster was a great way to share music, Dropbox is a great way to share files. Email is a great way to send messages to people and interfere with their work day.

Using a paradigm of shared content (guidance, patient status updates, groups) instead of a paradigm of messaging has a number of advantages:

Save time by not using email.

Email message is intrusive – you have to login, you can easily be distracted with offers, friends, clients, spam. For a busy physician – email does not connect with the patients’ personal/clinical context and it forces the doctor to rely on memory and notes.

Be on the same page.

In a model of a shared mental space for doctor and patients – visualize a table top where a doctor can put down a page with clinical guidance – for example dosage and physiotherapy schedules. At any time, and at his convenience, a patient can leave a Post-It on the page with his personal experience, or status update regarding the clinical guidance – this is what I took, this is when I had a bad dream and this is when I did my PT exercises.

Having the data in the shared mental space makes it easier for the doctor to understand and analyze what is happening in his mind and faster to make a decision. Easier and faster is good for the physician is good. Good for the physician is good for the patient – good for his health outcome and increasing trust that the system really really works.

Do it anywhere.

Imagine that you can do this anywhere, from vacation, from home from a friend. Save visits to the office. Less time in traffic. Less time waiting in an office or hospital ER with a bunch of sick people – which is depressing and dangerous for your health.

Our project for doctor-patient networking, Pathcare, is an excellent example of a private social network that parallels a real life network.

In real life, a doctor has anywhere from 100-300 patients depending on load, specialty and location. The doctor has 1:N interactions – telling all his over 50 male patients to get a colonoscopy, or all his patients to get more exercise. The doctor has 1:1 interactions as well sharing his guidance with a patient and getting the patient personal experience back.

The second facet that makes this social networking (as opposed to a chat room or email thread) is the use of social software – private messaging, groups of members and contents, personal profiles, file sharing and commenting on content. The key to understanding the value of private social networking for healthcare (and I agree that social media is a poor label) is to understand how data that is instantly accessible to both patient and doctor with a minimum of fuss can help a doctor make an easier and faster decision and help the patient get better.

Use patients: healthcare’s biggest underutilized resource

A shared mental space online can help chronic patients and their caregivers, help themselves and free  doctors to focus more of their attention on the problem and less energy in the data collection process.




Danny Lieberman is the authority in applying threat analysis to Governance, Risk, and Compliance (GRC) in healthcare. He is a sought-after speaker, prolific blogger on healthcare technology, and advisor on software security and privacy compliance issues to healthcare and medical device vendors. He is passionate about Pathcare: the private social network for a doctor and her patients. Danny is a solid-state physicist by training, professional programmer by vocation and avid amateur saxophonist and biker.

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