We Built This Twitter.

“We all invented the telephone…” wrote Karel Čapek. Turns out ‘we’ invented twitter as well. Good job everybody!

Well, that’s according to this article at least, which describes how some of the core functions of twitter, in particular the ability to reply “@” someone, and to use “RT” to indicate something was retweeted, were evolved into existence by the users themselves. The author talks quite lovingly of watching a living system adapt and watching ‘native’ users begin to own and control it. It’s quite a wonderful image – and an excellent example of why effective technology can mean learning from and adapting with the users, rather than by directing use in advance. (Before you avoid the article for being too doe-eyed though, there’s no fear that the author is unaware of twitter’s less charming qualities. In the first paragraph he describes it quite aptly as “a rage machine.”)

For me, it’s a really neat example of something called ‘bricolage’ in action. Trish Greenhalgh and team used this term to describe how people play around with technology to adjust it to meet their needs – they experiment and they invent, to create the functions they want (and drop the bits they don’t want). The lesson of this for health research, I think, is that we may need to be less focused on controlling how people use technology, and instead consider how we can learn by watching them explore and adapt the technology themselves.

I talked about this a while ago (one trick pony, me) as being the health research equivalent of “desire paths”, of working out what we can learn from watching the users of technology, rather than trying to predefine exactly how something works in advance. This isn’t our natural state in health research by any means – we’re used to setting up and controlling the system (for very good reasons). But if setting the system in advance just means it’s doomed to failure, maybe we would do better to see the users of the system as the experimenters and the designers, and our role becomes about supporting this process. This attitude would certainly complement the increasing practice of of professionals learning from patients, rather than the other way round.

This applies, I would argue, to many (if not all) areas of health research, but I think technology is going to be a particular domain to watch in terms of seeing examples of it in action – and in terms of being a testing ground for whether health researchers and professionals can learn to work in this way. We’re all breaking new ground when it comes to using technology, and I’m personally excited by the idea that the architecture of services, and potentially research itself, could be constructed over time by the users – the patients – themselves. Sites like Patients Like Me are great examples of patients using technology to provide useful and meaningful services, and showing us – the ‘professionals’ – how it can be done. I really do think that the architecture of future services, at the very least where technology is concerned, will be something that we design together. For that to happen, we professionals need to learn how to support patients themselves to drive that evolution, and also need to remember that we may need to evolve as well.

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