Web 2.0 Technologies, Tools and Applications in the Realm of Medicine: A Survey and Review
Faiza N. AlOtaibi ¹ and Nervana M. Bayoumy ²
Abstract— Since the internet field has been recently developing very rapidly and since the participation and collaboration have been remarkably established with the evolution of Web 2.0, this study is aimed at delving into Web 2.0 in the medical field as well as identifying the familiarity and the use of Web 2.0 technologies, applications and tools among medical professionals and students in King Saud University, Riyadh, Saudi Arabia, and to view their potential benefits as well as the barriers to using such technologies and services in the medical education. An online questionnaire was distributed among all medical staff and students in king Saud University, College of Medicine and University Hospitals. The data were analyzed using Microsoft excel. One hundred seventy respondents participated in this study. Considering the familiarity with Web 2.0 technologies and services, most responses showed almost high familiarity with major types of Web 2.0 tools and applications but less actual use. As for the frequency of use, Wikis, search engines, instant messaging and media sharing were highly used in regard to learning purposes. Regarding usefulness and confidence in professional learning, Wikis, search engines and media sharing were viewed by the majority as being extremely to very useful in helping learning process. Easy and fast accessibility to information and sharing experiences and resources were amongst the advantages indicated. Insufficient definition of the concepts and technologies behind Web 2.0 was among the main disadvantages indicated along with the lack of credibility in professional purposes. Internet requirement was also pointed out as a major disadvantage of such technologies. Web 2.0 represents a highly beneficial and well-developing field in terms of medical use. Therefore, awareness and education about these Web 2.0 tools, technologies and applications should be emphasized among medical students and professionals. Despite the relatively high familiarity with Web 2.0 technologies and tools, there is a lack of knowledge and effective use in the medical application and educational purposes. Key Words— Web 2.0, Medicine, Health care professionals, Medical education

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ecently, there has been a great deal of revolutions in the web-based collaboration ware. With the emergence of what is known as "Web 2.0", a raising number of tools, technologies and applications have been widely used in all walks of life including Medicine. The term "Web 2.0" that was coined by O’Reilly Media in 2004 refers to a blizzard of almost free web services and technologies including web-based communities, blogs, wikis, social-networking sites, folksonomies (tagging), social bookmarking and photograph annotation, podcasts and multimedia-sharing sites, and Really Simple Syndication (RSS). 1-3 Wikis: Ward Cunningham, who firstly invented the notion of wiki, used the word “wiki” to describe this user-editable software (Wiki means “quick” in Hawaiian) . A wiki is a collection of web pages that can be easily edited by users. Wikis can be described as “shared repository of knowledge with the knowledge base growing over time” (Godwin-Jones, 2003).4,5 Examples include Wikipedia: the


collaborative editable free encyclopedia, PBWiki, Wikispaces, WikiAnswers or Google Docs and Spreadsheets. Medical Wikis include: AskDrWiki, Medpedia, Ganfyd , WikiDoc, or Wikisurgery. Blogs: Blog is a contraction of "web log" which are an online collection of user-generated commentaries and links on different subjects with a reverse-chronological order. They are communications tools that don't only function as personal diaries but became highly regarded medium for editorials on specific subjects. Entries can be Photographs, videos and audios besides the texts and hyperlinks.6Examples include Blogger, Live Journal and microblogging such as twitter. Blog search engines include Technorati. Examples of medical blogs include Science Roll. Podcasts: A podcast is a collection of digital media files (either audio or video) distributed over the Internet that can be played on some mobile devices, personal computers or any other digital portable players e.g. MP3, MP4, or IPod.7,8 The seamless integration of data, text, images and sound is clearly delineated with this newly emerging technology. Certain popular sites offer podcast search engine such as Yahoo. Podcasters are programs that release downloadable media. Examples of them include: Doppler, iTunes, Juice and MediaGo.

 ¹ Medical Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia.  ² Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.



RSS: RSS (most commonly translated as "Really Simple Syndication" but sometimes "Rich Site Summary") is a format for delivering regularly changing web content. Many news-related sites, weblogs and other online publishers syndicate their content as an RSS Feed to users through subscription so that RSS feeds can be read using software called an "RSS reader", "feed reader", or "aggregator", which can be web-based, desktop-based, or mobile-device-based.9 My Yahoo, Bloglines, and Google Reader are popular webbased feed readers. PhysEmp allows subscribers to RSS feeds to track jobs form the user's desktop or phone. Examples of RSS medical search sites include: MedWorm, RSS4medics. Most of Web 2.0 sites, technologies and applications as blogs and podcasts can be syndicated to internet users through RSS feeds. Social bookmarking , folksonomies and Social networking sites: Folksonomy is a means by which internet users can tag, share, save and organize their favorite resources on the web. Social Bookmarking is a tool to get hundreds of sources of interest being tagged; this in turn would create a community of the same interest and expertise.10 The most leading social bookmarking sites examples include delicious and Digg. CiteULike and Connotea promote sharing of academic publications by many users of common interest7. Diigo for example is a collaborative research tool and knowledge sharing community that allows users to bookmark and annotate contents. Now many web sites offer bookmarking options for a favorite page to be tagged using their toolbars as Google and yahoo. Social networking sites in essence are online communities that provide users means for interaction and sharing.10Facebook, MySpace, LinkedIn and NING are the most popular social networking sites that are used world widely. Social and medical search engines: In contrast to the traditional notion of search engines, present search engines with the web development have become more relevant to the field of interest and delineate the search with various features, tools and services. Examples of medical search engines include: Healthline, OmniMedical Search, Google health and Google scholar. More options have been developed for searchers to share, tag and invite others. Media sharing, and peer to peer file sharing: One of the greatest benifits of Web 2.0 is the extreme capability of almost all kind of multimedia to be shared including texts, audios, videos, photo, graphics or animations. Flicker, slideshar, scribed and YouTube are wellknown media sharing sites. File sharing has played an enormous role in the development of peer-to-peer communities. Examples of these include: KaZaa, Bit Torrent, and LimeWire.

Instant messaging, videoconference and voice calls: A much faster and easy way to get updated in a real time and be synchronized (connected in a real time) with another individual or to your community is instant messaging with its developing features that enable voice or video calls. Web links, photos and files can be shared through most instant messaging programs.11 Voice calls (VoIP) or telephony describes the technology of voice transmission through IP networks.12 Videoconferencing and videocalling are advanced techniques that deploy greater capabilities allowing people in different locations to get involved in many bossiness or educational fields.13 The most common examples in this regard are: MSN live messenger, Yahoo, Google talk and Skype. Medical users now can create a web page or blog, use peer to peer file sharing and post messages to chat rooms, newsgroups or forums. They can distribute a wide variety of podcasts or educational multimedia with the folksonomic evolution; medical users can bookmark favorite medical contents or tag search bookmarking sites. Syndication feeds have made it much easier to get updated with medical contents or any form of Web 2.0 tools. Search engines such as Google facilitate the easiness and promptness of getting medical or health resources. Medical users can really contact individuals or groups via instant messaging or Voicecalls (VoIP), videophones or through videoconferences. A great example of Web 2.0 smashup is which is an automated freely accessible electronic web site that integrates and aggregates data and resources on global infectious disease and their impact on health acting as an alert system. With search engine optimization, medical users can get a comprehensive and wide variety of Web 2.0 sites, tools and applications. Numerous research in the recent literature have highlighted the evolution and the rapid usage of these web services as well as how much they facilitate interactive information sharing, participation and collaboration, and enhancing user-centered design, accessibility and interoperability on the World Wide Web.3,7,14-19 Several studies have also tackled the issue of Web 2.0 adoption in the educational systems and how Web 2.0 significantly is developed in the learning and teaching processes, in libraries and in many educational aspects.20-29 A number of publications have forged ahead with this emerging web in terms of user-generated content and social collaboration, supporting tools or toward advancements.30-32 Since medicine is one of the most influential and evergrowing filed, it has become involved in the technologies, applications and tools of Web 2.0.7,33-36Starting at 2008, Medicine 2.0 has become an annual international conference on Web 2.0 applications in health and medicine that is also known as the World Congress on Social Networking and Web 2.0 Applications in Medicine, Health, Health Care, and Biomedical Research. It is organized and cosponsored by The Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for



Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations. Medical community, healthcare professionals and consumers are eager to get updated with the recent knowledge easily and instantly. Consistent with this goal, many studies with regard to medicine 2.0 or health 2.0 have been conducted to explore the implication of Web 2.0 services in the health centers and hospitals and the effect of this on physician's improvement, patient-physician relationship and public education. The objective of this study was to examine the familiarity and the use of Web 2.0 technologies, applications and tools among medical professionals and students in King Saud University, Riyadh, Saudi Arabia and to look into its potential benefits as well as the barriers to using such technologies and services in the medical education. This study was also meant to be enriched with Web 2.0 review and its role in the medical field.

know what RSS feeds are while 24.47 % never used them. 25.53% used them for both personal use and professional learning while 11.70% used them for personal use only. The minority (5.32%) used them for professional learning only. As for Wikis, most of the respondents were familiar with wikis. 50.54 % used wikis for both professional learning and personal use, while 24.37% used them for professional learning only. 8.60% used them for personal purposes only. When asking about the contribution to wikis, the majority (62.77%) had never contributed to a wiki, while 19.15% had for professional learning purposes only, 5.32% for personal use only and 12.77% for both. Concerning blogs, 28.41% of the respondents used them for personal purposes only. 13.64% used them for both professional learning and personal use. The least majority was with 3.41% using them for professional learning only. How respondents used blogs in professional learning is indicated in (table 1). Table 1 - How do you use Blogs?* % of respondents Answers 39.53% I only read blogs 2.33% I only write my own blogs 12.79% I read blogs and write my own blogs 
*Not familiar with and never used answers were excluded.

An online questionnaire was prepared for this study and was distributed via an email introductory invitation between December 2009 and January 2010. The sample included all male and female medical staff and students in king Saud University, College of Medicine and University Hospitals. The questionnaire was based on the reviewed literature.37, 38 Questions considered of information on the social and educational use of Web 2.0 technologies, tools and applications. It was provided with the purpose of the study and was explicit with examples and explanations. It contained six major questions; the first one was on the four main distinctive features of Web 2.0 including: RSS, Wikis, Blogs and Podcasts, the rest were about the frequency of use in professional learning, the usefulness in professional learning, general confidence in use, and the advantages and disadvantages of Web 2.0 use in medicine. A question lastly asked for comments on the use or potential use of these technologies to aid medical education. Data were collected by, and responses were downloaded both as summaries and detailed spreadsheets. The data were analyzed using Microsoft Excel 2007. As the demographic data responses were incomplete, no comparative analysis was considered in this study. However, an analysis aimed to provide an overview of the respondents' insight and their behavioral patterns was conducted.

As for podcasts, the vast majority of respondents were familiar with podcasts with 34.09 % using them for both personal use and professional learning. %21.59 used them for personal use only while 6.82% for professional purposes only. When asking about the creation of podcasts for professional learning, the vast majority (89.66%) had never created podcasts for professional learning. Their use in professional learning is indicated in (table 2):

Table 2 - How do you use podcasts?*
% of respondents 18.39% 9.20% 31.03% Answers
I only listen to or watch podcasts online I only download podcasts I listen to or watch podcasts online AND  download podcasts 

*Not familiar with and never used answers were excluded. About the frequency of use Web 2.0 technologies and services, respondents were asked to rate their frequency of use on a one-five scale. Those who were always and usually using Web 2.0 services are shown in (figure 1). Most of the respondents were always using search engines, instant messaging and wikis (probably Wikipedia among all Wiki-based sites), Podcasts, social bookmarking sites, videoconference calls, voice calls and RSS feed had the lowest frequency of use. Regarding how beneficial are the services offered by Web 2.0 in aiding learning, respondents were asked to rate the usefulness in regard to professional learning on a one-five scale. Respondents who regarded these as being

Of all medical professionals and students in King Saud University, College of Medicine and University Hospitals, One hundred seventy respondents participated in this study. Regarding the characteristic types of Web 2.0 with consideration to RSS, respondents varied between familiarity and non familiarity. 32.98 % of the respondents didn’t



extremely and very useful are shown in (figure 2). The majority regarded search engines and wikis as being extremely useful.       As  for  the  confidence  in  using  Web  2.0  technologies  and services, respondents were again asked to rate this on  a one‐five scale. most respondents considered themselves  extremely  confident  in  using  search  engines,  wikis  and 

media  sharing,  in  contrast  to  social  networking  sites,  vi‐ deoconference  calls  and  instant  messaging  of  which    the  majority  of  respondents  considered  themselves  as  being  slightly confident in using them. Respondents who consi‐ dered  themselves  extremely  and  very  confident  in  Web  2.0 use are shown in (figure 3).   

Fig. 1. Frequency of Web 2.0 use in professional purposes among respondents .

Fig. 2. Usefulness of Web 2.0 tools and applications in professional development among respondents.



Fig. 3. Confidence in Web 2.0 use as indicated by respondents.

Fig. 4. Familiarity with Web 2.0 tools and applications as indicated in this study.



Concerning the advantages and disadvantages of Web 2.0 in medical education, a number of explored advantages and disadvantages were proposed in the question as reported by Gabriela Grosseck (2009) . Free text box was made to allow further suggested ones. The most important advantages as emphasized by respondents were; the reduction of costs, the flexibility in choosing a technology,

the easier and faster accessibility to information and sharing experiences and resources. Few also suggested that the new generation of portable players and new mobile devices has made Web 2.0 tools and application easily maintained, and this new wave of innovations helped in distant and e-learning (Table 3).

Table 3- Web 2.0 Advantages % of responThe most applicable advantages dents in this study 10.29% Easier and faster access to information, when and where it is needed 9.78% Flexibility, as far as the possibility of choosing technologies is concerned 9.78% Reduction of costs 7.89% Sharing accumulated experiences (blogs, microblogs, wikis, flickr, youtube) and resources 7.20% The low level of complexity needed for use (minimum skills in using the Internet) 6.69% Creating digital content (especially media, podcasting, videocasting) 6.00% Independence from the platform (a computer, with browser and Internet connection is enough) 5.49% Redistribution of effort, so that less and less time and energy are spent during search and information management (, RSS) 4.97% The integration of a variety of Web 2.0 technologies in the teaching-learning activities 4.80% The increase in number of modalities of use and the heterogeneity of didactic practices and of types of formation, due to the diversity of the new technologies 4.80% Reliability in continuous usage, over an extended period of time 4.46% Compatibility with the elements of the educational field and the existing contextual dynamics 3.60% The major focus on didactic innovation, and not on the technology per se 3.60% The major focus on didactic innovation, and not on the technology per se 3.43% Compatibility with the elements of the educational field and the existing contextual dynamics 0.34% (other)  Web  2.0  applications  are  easily  maintained  with  the  generation  of  digital  platforms  such  as  windows  mobile,  iPod,  iPhone,  blackberry  and  many  media  players  that  facilitate  learning  and  communication  whenever  and  wherever needed.    A new wave of innovations in distant and e‐learning.  

As for disadvantages; the most majority agreed on the internet connection as being a must- requirement. They emphasized that a sum of technologies and concepts are hidden behind Web 2.0 and are still insufficiently defined.

They also indicated that it leads to low quality of the actual content and gives anyone the opportunity to complain thus creating a community without rules (Table 4).



Table 4 - Web 2.0 Disadvantages % of respondents in The important applicable disadvantages: this study 16.25% An Internet connection is required (especially a broadband connection) 13.36% It leads to a low quality of the actual content, with sites which struggle in deep informational mediocrity 10.83% It gives everyone the opportunity to complain, thus creating a community without rules 10.47% It hides behind it a sum of technologies and concepts which are still insufficiently defined 10.11% It has limited security 7.94% It promotes amateurishness by invaluable contents generated by users 6.50% It is a kind of second-hand Web, a medium for persons with low digital abilities 6.14% It has monetary quantification (the Internet as a business - Google) 5.42% It offers free things, in open-source structures, with a rather vague significance 5.05% The speed of programs is incomparably lower than the one of desktop programs 5.05% The extremely diversified offer of technologies which can be used and which exist on the market at the moment, make the actual selection process difficult 2.53% It doesn’t mean anything per se, it is just electronic junk 0.36% (other)  Its software must be compatible with that operating system to work on  your device.     

Regarding respondents' thoughts about the use or potential use of Web 2.0 in the medical education, 10 comments were received, one pointed out that: "since healthcare professionals and medical students are often on the move, I find that these emerging tools and technologies are of ultimate benefit for their busy work and personal lives. With just one device in their pocket, they can manage their daily tasks, access vital information, and stay connected to colleagues, family, and patients." Another referred to the simplicity of taking advantages of communications and data updates and that blackberry for instance had made it easy for instant messaging. Two of the respondents suggested for adopting new subjects or courses on Web 2.0 in the medical curricula and workshops about the utilization of these technologies and tools in the medical field. Half of the respondents expressed their concerns about the internet or WIFI connectivity that should be enabled throughout all medical facilities in the college. The remaining suggested for promoting KSU (King Saud University) educational Web 2.0-based tools e.g. a new channel on YouTube for KSU to encourage medical education and for improving many KSU network sites in terms of accessibility and content enrichment.

shows insights into the applicability of these tools to underpin medical applications in the college of medicine. On the basis of familiarity with Web 2.0 technologies and services among KSU medical staff and students (Figure 4), most responses showed relatively high familiarity with most of Web 2.0 tools and applications. Albeit less real and effective use, as shown by J Sandars & S Schroter (2009). 37On the frequency of use basis, Wikis, search engines, instant messaging and media sharing were the highest being always to usually used in regard to learning purposes. The finding of wikis and search engines as being most frequently used for professional purposes corresponds with the percentages of physicians using Web 2.0 tools as reported by B Hughes,  I  Joshi et al. (2009).39 On the basis of usefulness and confidence in professional learning, Wikis, search engines and media sharing were viewed by the majority as being extremely to very useful in helping learning process. Extreme to very high confidence was also shown by the majority in using these. This is to be anticipated since these three Web 2.0-related sites are convenient and quickly accessed. As with every single innovation, Web 2.0 has its own advantages and disadvantages, however, Web 2.0 has excelled beyond the expectations in terms of collaboration, openness and user-generated content. Most of the advantages related to learning purposes selected by the respondents evolve around the fast and easy accessibility, reduction of costs -since almost all Web 2.0 technologies and tools are free- and flexibility in choosing technologies. Many respondents also pointed out to the great deal of experiences that can be shared through community spaces and interaction within groups as one of the advantages. This in turn would be part of young user's motiva-

The concept of creating and sharing content has made tremendous progress with the new web known as Web 2.0. A myriad of significant social software are shaping our life in terms of communication and education. The use of Web 2.0 technologies, tools and applications is greatly overwhelming globally,3 and the impact of these technologies on medicine is becoming more acknowledged. This study tests the acquaintance and experience with the newly developing services offered by Web 2.0. It



tion and learning. Requirement of minimum skills for use, creating digital content and independence of platform are mostly selected among other advantages as these facilitate a quick and easy handling . Disadvantages selected by respondents in reference to learning development are represented by the internet connection requirement as a major concern in this study, the rest revolves around the low quality of the actual content, generating community without rules and thus promoting amateurishness, less knowledge about the use, insufficient definitions of these technologies and limited security. Information credibility and user confidence with regard to authenticity and reliability is a major worldwide issue in this era of internet openness. However, the effect of this might not be daunted with a highly and widely growing informative web. The undeveloped knowledge and skills acquisition to a verity of Web 2.0 technologies, and the Lack of clarity about Web 2.0 integration in medicine in order to leverage its use are the main interpretations of this study findings. Interest in the influence of e-learning in medical education has been highlighted recently and it has been also increased within the realm of Web 2.0.40,41 consistent with this and based on respondents' comments in reference to educational aspects of Web 2.0, respondents showed a great renaissance of interest in significant applications of Web 2.0 in the medical sphere. They emphasized on advancing the knowledge of Web 2.0, developing Web 2.0 in the education system and overcoming deterrents against Web 2.0 use. Limitation to this study is the low responsiveness to the invitation of the questionnaire. Demographic characteristics couldn’t be overall judged due to a lack of complete data obtained. However, overview estimation is given. This study would've become more interesting and enriched if it had been provided with the whole study population and with a full and comprehensive demographic attributes so that further extensive analysis would be made. Further investigations regarding Web 2.0 applications in KSU medical school need to be done and the education about the technology impact on medical practice and learning needs to be raised among medical practitioners and students to support medical education and professional development. This might be established through courses and workshops for instances. KSU data base to enhance and facilitate Web 2.0-based medical educational system would be of ultimate improvement to be issued. Web 2.0 is the future of education as stated by Stever Hargadon (2008) .The future of Web 2.0 particularly in medicine is promising with the burgeoning digital environment and virtual reality. The challenges of Web 2.0 in medicine are to get handled as the web develops.

With medicine being now in the era of Web 2.0, medical personnel and health care professionals should gain competence in the information technology updates. Frequency of use and familiarity with Web 2.0 technologies, tools and applications vary considerably according to each of Web 2.0 types with research engines, wikis, media sharing and instant messaging having the highest familiarity and frequent use. Corresponding to the effective use of Web 2.0, search engines, wikis and media sharing were also considered highly aiding in learning purposes. And also being confidently used. In this study, most respondents referred to many advantages when considering professional learning development. Nevertheless, the internet requirement and information credibility were the major considered disadvantages. Web 2.0 awareness and knowledge need to be promoted and its potential use in medical practice and health field should be further emphasized.

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