John Sharp added to my Word of the Day Calendar by asking what my thoughts were on apomediation in health care. Apomediation is a new scholarly and social technology term that characterizes the process of disintermediation.


Disintemediation is the removal of the intermediary from the process. In other words "cutting out the middleman." A common example is consumers using the Internet to purchase goods or services directly. Before the Internet, many people relied upon travel agents to get the best deals on airline tickets and vacations. Now days people often book directly online, bypassing the travel agents. Of course the Internet also has acted as intermediary or enabled a different type of intermediary to develop.


An intermediary is a third party who stands in between a consumer and a service, often acting as sort of middle man for the consumer to obtain goods or services by a supplier. For example Autozone serves as the middle man should I want to buy new window wipers. I can't exactly go to the factory and plunk down my credit card and purchase a set so I rely upon Autozone to purchase some from the factory and have them availble for sale.


Apo is latin for spearate or off. An Apomediary would be somebody who is seperate from the process but available should the consumer need help. Gunther Eysenbach goes into great detail about apomediation and Medicine/Health2.0 in his post, Medicine 2.0 Congress Website Launched (and: Definition of Medicine 2.0 / Health 2.0).

In the health context, disintermediation (cutting out the middleman) means
a more direct access of consumer to their personal data (e.g. in web accessible
EHRs – left circle of the diagram) and general medical information (on the web –
right circle of the diagram) with all its advantages and hazards. The main
problem of cutting out the gatekeeper is that the traditional role of the
middleman is to guide consumers to relevant and credible information (the
intersection of both circles in the center of the diagram) and that by bypassing
the middleman consumers/users may “get lost” in the vast amount of information.
Apomediation theory conceptualizes that “apomediaries” (which includes Web 2.0
approaches) can partly take over the role of the intermediary and “push” or
“guide” users to relevant and accurate information.

As you can see from the diagram librarians and health professionals are labled as intermediaries. While Eysenbach lists friends and online users as apomediaries (the blue green dots sprinkled around the dotted funnel) he primarily focuses on online programs and tools which act as the middleman. Some of the examples he gives are Digg, CiteULike, and the Amazon.com ratings. Eysenbach further states, "health professionals now partly bypass traditional intermediaries such as information brokers or librarians. I remember that when I was in medical school I had a summer job as information broker, where health professionals or scientists would call or see me and I would do an online Medline search for them. "

He acted specifically as an intermediary funneling informaiton to people. He believes things have changed since then. "Today, people obviously use PubMed and other Internet tools directly, and search the web and/or the library for relevant information. But what is "relevant", and how can we deal with the onslaught of information? The "apomediaries" here are shared bookmarking tools such as CiteULike or Connotea, where people receive pointers to recently published relevant literature based on what others with a similar citation/bookmarking behavior have cited/bookmarked." Of course can use CiteULike to your heart's content but if your library didn't purchase the online access to the journal you aren't going to be able to read it to cite it. So merely pointing to the relevant literature may not always fulfill your informational needs.

While I agree that these type of online tools have helped guide people to information and have served as a sort of apomediation function, I disagree that librarians are all intermediaries. I have always thought of my self as an apomediator (even though I had never heard of the word until now). Health professionals do not have to come to me get information, but when they do I guide them (or provide them) to the needed resources and information. Those health professionals that do not specifically come to me for my services are using resources that we create or provide that help them find the information. We are not directly consulted but the tools we have created, paid for, licensed, displayed, are in fact still used to find information. One example is Ebling's Library Tool Bar which is a tool bar plug in to help find information using tools that other Ebling users have found useful. Other librarians have created del.icio.us accounts for users to peruse and help patrons get RSS feeds to searches and journal table of contents. So does that mean librarians are still intermediaries because the tools we create are guiding the users, or are we apomediaries who stand by and create products and guides to push people in the direction when needed?

Are librarians truely intermediaries or are we a combination of an apomediary and intermediary?

Labels: Social Software, Technology