Eyeworld

September 2016 • Ophthalmology Business 21 from abnormal ones, and for quick manual segmentation of optical coherence tomography. In all cases, the information was collected fairly rapidly with relatively good accuracy (81% to 88%). However, the use of crowdsourcing to distinguish normal optic discs had low specificity. One study published this year in the Journal of Medical Internet Research focused specifically on the crowd- sourcing results from CrowdMed and reported that the site provides helpful guidance for some patients. 3 However, "further development and use of crowdsourcing methods to facilitate diagnosis requires long-term evaluation as well as validation to account for patients' ultimate correct diagnoses," concluded the authors. This study found that half of patients who used the CrowdMed site were likely to recommend it to a friend, 60% thought the CrowdMed process led them closer to a correct di- agnosis, and 57% reported estimated decreases in medical expenses. 3 OB References 1. Ranard BL, et al. Crowdsourcing—har- nessing the masses to advance health and medicine, a systematic review. J Gen Intern Med. 2014;29:187–203. 2. Wang X, et al. Crowdsourcing: An overview and applications to ophthalmology. Curr Opin Ophthalmol. 2016;27:256–261. 3. Meyer AN, et al. Crowdsourcing diagnosis for patients with undiagnosed illness: An evaluation of CrowdMed. J Med Internet Res. 2016;18:e12. Contact information Greenwalt: pixelkeet@gmail.com One typical case is a patient who had inexplicable extreme swelling in her legs for 20 years. She went once a year to get fluid removed from her legs and was told that was the only solution. Within 2 weeks of posting her case on CrowdMed, a physician who was very familiar with this type of condition weighed in and offered a more definitive diagnosis and possi- ble treatment. Increasing role for crowdsourcing in medicine Many companies use crowdsourcing to collect ideas both internally and externally. The bigger question for doctors is obviously whether crowd- sourcing is effective to help make treatment decisions about patients. A study that focused on crowdsourc- ing in medicine found the approach was used for problem solving, data processing, surveillance, and surveys. The study analyzed 21 studies that used crowdsourcing and found that it can boost quality, speed, and research of a project. 1 However, the authors also think that standardized guide- lines are needed for crowdsourcing metrics so it is easier to compare methods and clarify the work that is done. There are even some researchers pondering crowdsourcing specifi- cally in ophthalmology. Wang and co-authors, of Wilmer Eye Institute, Johns Hopkins University, Baltimore, published a report earlier this year on the potential applications of crowd- sourcing in ophthalmology. 2 They reported that crowdsourcing has been used to help pinpoint images from patients with diabetic retinopa- thy, distinguish normal optical discs A moderator monitors informa- tion given on the site to make sure it is relevant and medically sound. The moderators can also make sure medical detectives are not trying to solicit for new patients on the site, which is prohibited. Additionally, the site makes it clear that the informa- tion given on the site is not medical advice and that patients should still rely on their own physician. So, there is no liability involved. The cost to use CrowdMed ranges from zero to $749 a month. The free membership, available by invitation only, can be used by a patient looking to share case details with all of his or her physicians, but there is no moderator and no cash rewards. For $149 a month, at least five medical detectives weigh in on a case, and there is a case monitor as well as cash rewards for medical detectives. The charges and partici- pation level of medical detectives, as well as the chance for compensation, increase from there. Common users of CrowdMed within the medical field include medical students (so they can learn from the experience), retired physi- cians (so they can continue to apply their expertise), and nurses (who may have medical insights but often don't get to lead the charge when working with doctors), Ms. Greenwalt said. Al- though actively practicing physicians use the site, they are frequently too busy to participate fully, she said. Through CrowdMed, more than 1,400 medical cases have been solved, Ms. Greenwalt said. The average patient on CrowdMed has been sick for 7 years, has seen eight doctors, and has spent $70,000 in medical expenses, according to the website.

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