By
Everyday Health and Revolution Health have announced their merger, creating a consumer health Web site designed to challenge WebMD. The new company will operate under the name Waterfront Media.
There’s no doubt that they will get a lot of consumer traffic to their network of sites. One of the things that remains unclear for both Waterfront and WebMD is to what extent they will serve primarily as reference sources versus playing a greater role in consumers’ own health management. The answer may very well lie in the degree to which they provide information therapy (Ix), not just health information.
As 1.0 as it is, there’s certainly no shame in being a valuable reference tool. I’m a big fan of information democratization. But it’s impact on care management has limitations.
From the Ix perspective, accurate and comprehensive health information is only one third of the equation: the right information to the right person at the right time. Proactively delivering (or prescribing) that information “just in time” or at the particular moment in care that someone needs it to make an informed decision or support a healthy behavior requires another level of functionality. Similarly, tailoring that information to the particular needs of a diverse population in a way that is actually understandable, meaningful, engaging and actionable requires considerably more sophistication than the science and technology that supported a 1.0 world.
Just as I’ve said many times before that technology is only a tool, good information is only one (necessary but not sufficient) ingredient in Ix. Figuring out how to get timely, tailored information not only consumed but also internalized by lay people is critically important to effective and efficient health care. This is what Ix is all about.
That’s why the intersection of Ix and Health 2.0 is so important for the future of health care — for effective self-management, for participatory medicine, for real patient-centered medical homes, and for a more effective care delivery system that truly supports consumers’ needs. The IxCenter will be focusing increasingly on this intersection in the coming months, and there is a lot more exciting news on that front coming to you in the very near future.
Categories: Uncategorized
Yes, and this is exactly what millions of people have been doing for well over 20+ years online. I’m not sure exactly what a physician adds to this behavior, especially in terms of justifying a new terminology to describe this everyday, ordinary behavior (recommending online resources).
In olden days, we’d call this bibliotherapy. Writing is writing, whether it appears online or elsewhere.
I agree, physicians may be a great resource for recommending online health information. But without hard data showing otherwise, they may be no better nor worse than anyone else doing the same. And as a health consumer, while I may check out my doctor’s recommendations, I’m just as likely to do the research on my own to see what else is out there that goes well beyond what he or she recommends.
I don’t think Josh’s view is incompatible with those of the other comments above. I am a primary care doc who has spent the last several years building and working in innovative delivery models, in all of which we prescribe information to our patients as a critical part of our care interactions. The most important thing is that consumers/patients/people get the information they need to best manage their health and be engaged in their medical care. My experience is that people use information from a variety of sources- friends, the web, and their doctor- depending on the patient (not everyone is able to or wants to troll the web themselves) and the situation (eg how serious, private, complex, etc). I don’t at all think the notion of doctors prescribing information means this is the only place people can and should get knowledge, but I do think in many situations it is an important part of the picture.
Also, I don’t think this sort of information prescribing should or even is only being done at large integrated groups like Kaiser, the VA, etc. While they have the capital, IT support, and structure to purchase or build fancy platforms with branded content libraries, we and many others are finding ways to prescribe content in different ways. For instance, when I am with a patient I will go to one of a number of bookmarked sites I trust or do a google search, and then simply copy the URLs into an email to the patient I send him or her as a starting point when they go home to learn more about what we have discussed. This costs me nothing (but a bit of time, but I feel this sort of education is a key part of my job as a physician- indeed the word doctor means “teacher”), and does not require a fancy IT system or support.
John,
I appreciate where you’re coming from, and I agree that there are many ways for people to find and ingest health information. But it also depends a lot on the individual.
Susannah Fox from the Pew Internet Project has told me that health care is much different from other industries Pew has studied in that consumers are much more likely to seek out a professional in a time of crisis. In fact, according to Pew data, 80% of Internet health information seekers (and I presume a greater percentage of the general public) seek guidance from a clinician. Several other consumer surveys have reported similar findings.
I’m not at all saying that most consumers will stop there. My own e-patient experience last week with my 4-year-old’s new diagnosis of asthma is a good example. I wanted the pediatric allergist to answer a slew of questions. As I recounted the two-hour appointment to my wife, I remembered some of his answers with more fuzziness than others (much to my wife’s chagrin). Some tailored Ix (including an after-visit summary to detail next steps) could go a long way toward helping me and my family on the right path.
No doubt with our information-seeking tendencies, we would supplement that with many other health information searches. But my efforts thus far with both searches and posts to pediatric social networking sites have not yielded information specific enough to answer my particular questions.
The reason why I want the “information prescription” (in this case from my doctor, though as I said before, it could come from other trusted sources as well) is that I want my doctor to treat his dissemination of information to me as carefully as his selection of medication prescriptions for my son.
Respectfully, Josh, it’s not surprising you didn’t find many answers to whether this new combined entity will have much value for “information therapy,” because as Brad pointed out, that’s not their mission. Not everything fits into one’s world view, even if you try and hammer that square peg into a round hole.
Even your definition of “information therapy” is hopelessly 1.0-based. People being “prescribed” information? Since when has information ever needed to be prescribed in order for someone to ingest it? That’s a very top-down, doctor-based model.
A person who recommends someone else read a particular article or such isn’t seen in any field as a “prescription,” but as a recommendation or idea. Prescription has a very specific definition and if you seek to change the meaning of a word, be prepared to have people completely misunderstand your intent (and then having you to re-define the word to the point of 2.0 meaninglessness, like “friend” has become).
People take a far more organic and chaos-driven (dare I say “human”?) approach to information, including when and how they “ingest” it. People no more need a “prescription” for information than they do a large corporate website telling them how to run a support or patient advocacy group. Information-seeking (aka “learning”) is a normal part of the human experience. BTW, I’ve been “prescribed” information every time I click on a link on any health website for the past decade, by providing a piece of information that tells the server more refined information to provide me.
Health (to the nth power) is an evolving medium. It is interesting that the classical medical library may become extinct very soon. The survivor and next evolutionary step will be on the internet, imbedded in the providers EMR. This is the most efficient delivery of information at the point of care…instantaneously available for the provider and allied health providers.
Another possible business model might be similar to Google’s adclick model. It also might be useful for generating revenue as it is used for specific patient encounters.
My medical group has chosen the model of licensing content from one of the top providers not mentioned, and integrating it into our existing website. Over time, we intend to utilize that content more and more in the treatment of our patients, thereby allowing them to take a more active role in their healthcare. It’s all about education, and currently the physician community is not doing enough of that. I can’t blame them, because our healthcare system needs a lot of work in order to create an environment where education is promoted over simply treating problems. Patients must also step up to the plate and take responsiblity for their healthcare. We have a long way to go in that regard.
Thanks for your thoughtful description of information therapy in reference to my former employer (Rev Health/Waterfront) and WebMD. I don’t believe information therapy fits in the core business objectives of the large CONSUMER health websites currently in the marketplace at this time. Josh, to your point, Ix requires that ‘we’ know something about YOU, so that we can provide timely and personalized information/tools. In the current on-line community environments, the products and content are not designed to ‘receive’ clinically-relevant information from the visitor because the vast majority of visitors to these ‘communities’ are the casual consumer who takes a quick read of comments/information and moves on. While there may be a group of committed citizens, they are small relative to the total volume. Consequently, these products will fall short of providing Ix as you have appropriately defined it.
It remains to be seen whether these players will invest deeply into products such as PHR in a fashion that permits easy data capture of the visitor to enable a personalized and timely (‘just in time’) exchange of information/transaction.
From the perspective of consumer health websites:
I think we can all agree that there are (at least) 2 categories of consumer health website users-
1.) the casual viewer who likely landed on the page after performing google search and is unlikely to return and
2.) the committed user who engages in deep research on a specific topic or collection of topics/issues and returns time and time again to that website/community. Committing resources to build PHR or other tools that will fulfill Ix prerequisites requires these health websites to value the ‘committed user’ as a target popn that fulfills their core business objectives and meets their financial needs in order to survive. In the absence of fulfilling these requirements, we are not likely to see such products built by these entities.
Even if a consumer websites decide to commit resources to build products that can provide evidence-based and personalized information in a timely manner, these products meet criteria for Health 2.0 technology but still fall short of satisfying the 3-pillar model of Ix— where is the clinician?? Getting a return on the significant investment required to build these products is challenging. None of the larger consumer health websites that I am aware of, has figured out how to engage (pay for) a cadre of clinicians to provide comprehensive and continuous ‘education’ or ‘clinical oversight’ to their users in an affordable manner within one of these products. While people have tried a ‘pay as you go’ model, I am still looking for examples of success stories, defined as 1-2% of the 12-17M unique visitors/month going to the likes of WebMD paying to participate in Ix model described herein. (please chime in if you have such examples)
So where should we be looking??
Instead, we should be looking at companies serving employees of self-insured employers. These companies have access to the data (via automated claims information, provider, and employee provided HRA, trackers, etc) necessary to provide timely and personalized information, and have the right business model (paid per member per month with outcome-based incentives rather than the pharma/cpg advertising model of consumer health websites) to develop these resource-intensive products. These companies can also hire their own pool of experts or engage the employer/insurance company’s provider network.
Finally, you may ask why would a provider be interested in participating in this model?
1. Convenience – work from home, communicate on multiple platforms (text, webcam, email etc.) (AND convenience for consumer as well)
2. Efficient – per above and ready access to pre-populated responses to frequently asked questions, and treatment protocols
3. High Quality and Safety – automated access to evidence-based guidelines, interaction tools, and protocols at point of care.
4. Affordable– permits full range of patients to access care regardless of preferences, geography etc.
5. Additional revenue and reduction of burnout– more and more primary care doctors (i am not talking about specialists or surgeons) are leaving medicine or moonlighting in order make a decent living and this opportunity provides an additional revenue source and/or makes their practice more efficient and as such allows them to reduce their workload.
Where else should we look?
As you know all too well, many of the organizations you work with including Kaiser, Group Health, and the VA provide the BEST opportunity for building a prototype. They have all the ingredients needed (patients, information, clinicians, and data) AND there interests are aligned with the consumer (including limited conflicts of interest). That is, it is in these organizations’ self-interest to improve the quality of care delivered, to improve the health status of their (long-term) population, and to reduce inefficiencies and health expenditures.
In short, we should look to self-insured employers and self-contained healthcare delivery organizations to provide the robust models of Ix of the future. While you may see the top 5 health consumer websites engage in Health 2.0 as describe above, I doubt they can afford to commit the resources required to build robust Ix products as we envision.
Cordially,
Brad
Brad Jacobs MD MPH
Gilles,
You’re absolutely right. If my post suggested otherwise, it certainly wasn’t intended.
That’s certainly part of the intersection of Health 2.0 and Ix as well. When we talk about Ix, we have always discussed three “prescribers” of information: 1) Clinician-prescribed; 2) System-triggered (based on data sources that serve as “information triggers” like a new lab value, medication, diagnosis, etc. that suggests a new need for a particular piece of information); and 3) Consumer-prescribed. Even within that last category, there are multiple possibilities: Self-prescribed; prescribing to a friend/family member; and prescribed by someone in a peer group (this could be from an online social network, from fellow “patients” in a group visit, or from many other sources).
Thanks for helping me to clarify.
Josh
Josh,
this is all true but I believe there is still another aspect of the online communities that has not been fully understood and may be of big significance for all those in the long tail of medicine.
You wrote “Figuring out how to get timely, tailored information not only consumed but also internalized by lay people is critically important to effective and efficient health care. This is what Ix is all about.” In a growing number of cases the members of these communities have a much more fundamental role that just be consumers of information. They are becoming first rate researchers and are able to find connections between seemingly unrelated bits of scientific information long before any “expert” does. And because this activity, for multiple reasons, takes place in the deep web, the only way to learn about it is through social search.