Massively Open Online Medicine

The new darling of the online educational community is Massively Open Online Courses (MOOCs). The example which figures most prominently in the popular imagination is the Khan Academy, though its founder says otherwise, noting that MOOCs are merely online transplantations of traditional courses, while Khan Academy offers something different.

Others would take issue with his conclusion, or characterization. A “connectivist” MOOCis based on four principles:

  • Aggregation. The whole point of a connectivist MOOC is to provide a starting point for a massive amount of content to be produced in different places online, which is later aggregated as a newsletter or a web page accessible to participants on a regular basis. This is in contrast to traditional courses, where the content is prepared ahead of time.
  • Remixing, that is, associating materials created within the course with each other and with materials elsewhere.
  • Re-purposing of aggregated and remixed materials to suit the goals of each participant.
  • Feeding forward, sharing of re-purposed ideas and content with other participants and the rest of the world.

Sounds great, but is it working? Can it work? A piece in the current issue of The Washington Monthly took a look and concluded:

Given the current 90 percent dropout rate in most MOOCs, an 8-point gap in completion rates between traditional and online courses offered by community colleges, the 6.5 percent graduation rate even at the respected Western Governors University, and the ambiguity of many other higher education reform ideas, there’s good reason to think that an unbound future might not be so great.

The best American innovations in education were the Land-Grant College Act of 1862, which helped create a system of public universities, and the GI Bill of 1944, which ensured that an entire generation had the money to attend college. This widespread access to the college experience enabled people from working-class backgrounds to advance en masse into professional jobs that required reasoning and logic and extensive knowledge of the world. The question is whether or not we will continue this trend or simply give up and say that a few online classes and specialized training are good enough for the majority of Americans.

In other words: Democratization of higher education – good; MOOCs – not so much.

Why is this relevant to you, gentle reader?

The question is whether the promise of MOOCs, or their inability to deliver, will characterize MOOM — Eric Topol’s neologism, “Massively Open Online Medicine,” used in his HIMSS 2013 keynote.

In health care, a perfect implementation of big data and data analytics, combined with open access for clinicians and patients, would yield a success in MOOM along the lines of a connectivist MOOC.

We are not there yet, but Topol (who, by the way, has joined me and a growing number of others as a member of The Walking Gallery, dedicated to the very relevant themes of patient empowerment and data liberation … see his jacket,Bursting from Within and mine, Friendship Pins) continues to call for a move to population health practiced based on individualized information, which would tend to rely on a population of quantified self adherents and e-patients. Unfortunately, at present these are vanguard groups, the minority blazing the way for the majority. There are numerous initiatives afoot seeking to leverage big data, analytics and the health care system to provide population health (a more traditional example: theAccountable Care Organization). Indeed, the future probably holds an even more radical shift away from the health care delivery system as we know it today (Topol spreads the meme of 80% of physicians not being needed in the future) with home-based and wearable sensors replacing much of the current way of practicing diagnostic medicine.

Given the FDA’s recent smoke signals about mHealth guidance being issued in the near future, perhaps that future is in fact inching closer, but it seems to me that it will take some time before the democratization of medicine, or health care, or health can truly take hold. The current health care data privacy and security rules — like so many regulatory constructs — are designed to fight the last war, not for the current field of maneuver. Technology, delivery systems and rules all need to change before real improvement can bloom. Just as in the case of education there remains a high value in traditional higher education that has not yet been replicated in the MOOCs, MOOM has not yet delivered on its promise.

Here’s hoping we don’t have to wait as long as the time between the land grant college act and the GI Bill.

David Harlow writes at HealthBlawg, a nationally-recognized health care law and policy blog, where this post first appeared. He is an attorney and lectures extensively on health law topics to attorneys and to health care providers. Prior toentering private practice, he served as Deputy General Counsel of the Massachusetts Department of Public Health.

6 replies »

  1. With MOOCs (and maybe some MOOMs), I think the participation level is based on two things:

    1. How much students/patients are required to invest. When have to pay 1000’s for a course, you’re much less likely to a) sign up and b) drop out. And you already have been sold on the value.

    How would that apply to health care? High-deductible means you’ll do what it takes to stay out of the system? or to get better “grades”

    2. External rewards. Until the outside world sees MOOCs as a viable alternative to traditional education, they’ll have limited value and we’ll see a lot more experimentation trying/dropping among mostly working people. This will take time. I suspect most people taking them for intrinsic value for now, to challenge themselves. MOOCs (and eventually MOOM–whatever forms it takes) will have to move down Maslow’s hierarchy, as it were, to improve the motivation to stick with them. I wrote about this recently: http://www.hl7standards.com/blog/2013/04/04/engagement-is-a-strategy-2/

    Logically, the approach is irresistible. But for most not as irresistible as the next beer/doughnut/cigarette/slice of pizza and the ads that sell them.

    In education, as in health care, the feedback loops are often very long (decades), the doughnuts are here now. Systemically we need to provide near term rewards if we hope to shift near-term decisions toward the healthy and slay the 20% GDP beast. And, like an addict, we have to want to change. There’ll be plenty of pain along the way and plenty of $$ pushing unhealthy decisions.

  2. Leonard, MOOM is of course already happening (as it was before it was so named), just not as massively as we boosters might like to see. The point of comparing it to MOOC is to highlight the fact that a majority of folks out there seem to retain a preference for the traditional mode of delivery (courses or medicine) despite the advantages inherent in the MOO approach.

    Over the long term, population health management based on personalized planning derived from individualized monitoring and communications will be the way we go … unless we somehow manage to blithely blow through the 20% of GDP marker in health care spending and keep on going as recklessly as we have to date.

    The improved outcomes and reduced costs that are likely to result from this approach ought to be irresistible … but hey, maybe that’s just me.

  3. MOOM became a term 2 months ago and it already hasn’t delivered on it’s promise? That’s like saying a baby was born two months ago and the parents are disappointed the infant can’t play the piano.

    The question is return on investment. There’s certainly some debate that with increasing tuitions many traditional universities still provide a return, and same is true for traditional medical delivery. With MOOCs it’s still way to early to measure, but with 0 cost, I suspect it easier to show a return. For now, the calculation MOOC students mostly make is return on time invested, not on the money.

    I suspect, based on your definition, MOOM is already happening in the multitude of online patient communities. That’s the place to look for measurable improvement, for a return… and patients like me is already starting to see it….http://healthaffairs.org/blog/2013/02/07/the-patient-engagement-pill-lessons-from-epilepsy/

  4. Oh well this seems to benefits many people all over the world, however I still am not sure if the curriculum is in order to acquire competency for people.

  5. People should be able to demonstrate competency. If they need to traverse whatever kind of content curriculum is available in order to acquire competency, fine, but if a person can demonstrate domain competence summarily, all the better — except for the curriculum hustlers.

    I view a lot of these educational fads as just that, fads.