In healthcare, where buzzwords tend to have the lifespan of fruit flies, Health 2.0 is maybe a year old and already is growing cyber-whiskers, on a given day generating more than 130,000 hits on Google, outstripping consumer-directed healthcare at about 44,400 hits, but lagging personal health record at 294,000.
It has attracted a pair of entrepreneurial conference organizers, consultants Matthew Holt and Indu Subaiya, who put on their first show, the Health 2.0 User Generated Healthcare Conference, Sept. 20 in San Francisco, drawing about 480 attendees with a waiting list of another 100, according to Holt. The pair is planning a two-day, follow-up spring fling in March in sunny San Diego and a second, larger show next fall.
So what is Health 2.0? The term is the healthcare derivative of the far more ubiquitous Web 2.0 (15.9 million Google hits) coined by Web pioneer Dale Dougherty, a vice president of OReilly Media, a publisher of computer technology books and magazines and the host of IT conferences. It was during a brainstorming session for a planned conference that the muse struck Dougherty, but it was company founder Tim OReilly who chronicled the genesis of Web 2.0, and popularized its use in a seminal, 16-page essay, What is Web 2.0: Design Patterns and Business Models for the Next Generation of Software, published in September 2005. The idea, according to OReilly, was to analyze the common traits of companies that survived the bursting of the dot-com bubble in 2001 for possible incorporation into the next generation of companies.
In his essay, OReilly shies away from giving a concise definition of Web 2.0, opting instead to provide seven basic principles. The first three of these principles are probably the most important and, arguably, the most applicable to healthcare, at least according to examples of companies cited by Web 2.0 mavens contacted for this story.
The first principle, OReilly says, is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured so that the more people use it, the better it becomes. He described it as an architecture of participation. An exemplar is eBay; as more and more buyers and sellers participate, the broader the eBay market becomes, which creates more value to the customer.
OReilly calls the second key principle harnessing collective intelligence, which also is referred to by others as the wisdom of crowds. To avail themselves of this wisdom, Web 2.0 developers must create applications that are dynamic, with user participation designed into the systems, so that participation itself becomes an integral part of making the underlying database more valuable. Amazon.com adds value by enabling readers to write and post reviews of software and books and to be engaged in other ways, such as preparing wish lists.
OReillys third principle, Data is the next Intel inside, notes that specialized data, enhanced through analysis performed by the service provider as well as by the contributions of service users, becomes the core asset of a Web 2.0 company. The Amazon wish lists, for example, are aggregated by Amazon and used as buyers guides.
Holt says his definition of Health 2.0 tracks closely to OReillys formula for Web 2.0.
I think the term Health 2.0 helps crystallize a number of things going on, Holt says. What he (OReilly) is doing, really, is putting a series of definitions around something to help him think about it. And what I and Indu have been doing is pretty similar.
Individually generated content in healthcare is not new, Holt says. There were chat rooms in the 1990s, but what has happened quantitatively is the amount of content and the ease of availability of that content has changed enough and the tools have changed enough, that we have something that is so substantially different in healthcare that you can call it something different.
The other thing thats going on thats contemporaneous is a societal shift in which there is an understanding that medical care is an ongoing process rather than a series of episodic events, Holt says. The relationship between physicians and patients is becoming more of a team rather than a priest/supplicant relationship.
And while, more and more, physicians are communicating online with other physicians, theyre also communicating more with patients, and patients are leading other patients in support groups and in other online activities, with or without physicians, Holt says. You could almost argue that healthcare is being produced by patients to some extent.
Scott Shreeve is a physician entrepreneur who co-founded the healthcare IT company Medsphere Systems Corp. in 2002 and left last year in an acrimonious dispute over the companys approach to open-source software. Shreeve is starting over with Crossover Health, which he is pitching as a technology-enabled health plan.
Shreeve, an attendee and a member of the advisory board for the recent Health 2.0 conference, has a much broader definition than Holt of what Health 2.0 is and where it is headed.
I think Health 2.0 has everything to do with outcomes, quality and healthcare reform, Shreeve wrote in a recent blog posting on the subject. Health 2.0 is absolutely descriptive of a culture of transparency, a focus on healthcare value, and is the underlying philosophy powering the current reform movement.
Everybody knows that healthcare is broken, Shreeve said in an interview. Health 2.0, he says, is a broad, big vision. And there are hundreds of companies that have broken their backs trying to solve this problem. Its a conundrum, but just because it is hard, that means were going to stop trying? Clearly, Shreeve answers, no.
An example of a potential Web 2.0 winner cited by Holt and Shreeve is PatientsLikeMe.com based in Cambridge, Mass. The company was founded in 2004 by three engineers from the Massachusetts Institute of Technology: two brothers, Benjamin and James Heywood, and a college buddy, Jeff Cole, after another Heywood brother, Stephen, was diagnosed in 1988 with amyotrophic lateral sclerosis, or Lou Gehrigs disease. The site encourages the development of communities among patients with ALS (1,461 current members), Parkinsons disease (850 members) and multiple sclerosis (2,132 members), according to recent postings, and is looking to expand to other diseases such as HIV/AIDS.
An official with PatientsLikeMe declined to be interviewed for this story, but according to information on its Web page, the site gathers from its community members basic demographic information as well as date of diagnosis, treatment options and duration, and self-reported outcomes. Some data, such as symptoms and specific drugs in use, are aggregated and tracked. Patients include tales of difficulties in obtaining accurate diagnoses, narratives of their treatment plans and the beneficial or detrimental effects of their drugs and other activities, such as exercise regimes, yoga, etc.
According to the site, our operating costs will be covered by partnerships with healthcare providers that use anonymized data from and permission-based access to the PatientsLikeMe community to drive treatment research and improve medical care. We only share anonymized data with trusted partners and all our patient information is kept safe and secure.
Another Web 2.0 example that Shreeve particularly likes is Athenahealth, which started life in 1997 as a physician practice-management company long before the dot-com bubble burst, according to co-founder Todd Park, executive vice president and chief development officer of what is now a publicly traded company based in Watertown, Mass.
We morphed our business model from an obstetrics PPM to an online billing company with the valuable core experience of getting our butts kicked in billing.
Park says their timing fortuitously coincided with the growth of the Internet, making it possible not only to provide the new billing service online, but also to leverage the wisdom of crowds.
We started to solve doctors biggest problem, Park says, dealing with tens of millions of insurance rules. We said the only possible way to figure them out, because these rules (were) not published anywhere, is to harness the power of the network of doctors to do that. Using the experiences of multiple physicians, Park says the company used the collective experience of their denied claims to reverse engineer a database of insurance rules and build a computer software system, or rules engine that could read and apply them to new claims.
David Brailer, the first chief of HHS Office of the National Coordinator for Health Information Technology, and who now heads Health Evolution Partners, a San Francisco venture capital fund, says he spoke at the Health 2.0 conference and introduced some skepticism to the event. Despite what he described as his long-term optimism about social networks in healthcare, Brailer says he is skeptical that there is going to be a short-term, broad application, for Web 2.0 technologies in the healthcare industry, citing two huge barriers Health 2.0 companies must overcome.
One is the age gap. The Web generation is applying it to things the Web generation is interested in, whether its choosing college dorms or sharing opinions over the latest fashion trends, but the people who consume healthcare are not the Web 2.0 generation, Brailer says. There are some diseases that affect younger people and some older people are gravitating to Web 2.0, but it has to overcome a huge (age) barrier.
The other issue is privacy. People are willing to post some personal information on social networking sites such as Facebook and MySpace, but when it comes to medical information, thats another matter, Brailer says.
Were not going to be making a lot of investments in Health 2.0 unless we see a real business there, filling a real business need, he says. This is a great concept, but it is following the contours of what happened in the dot-com boom. Many of the companies are obsessed with capturing users but not focusing as much on the business model, he adds. Thats why Im just skeptical about this.