Some more reflections on Health 2.0

It’s late at night and I’m red-eye-ing it to Boston to the Partners Center for Connected Health Symposium. Just like at Health 2.0 last week there’s going to be about 1,000 people there. And while originally the session I’m leading on Social Networks was going to be about it for Health 2.0, the agenda has morphed quite a bit and several of the people and players who were on at Health 2.0 are also going to be in Boston. (Although my understanding is that the polite Harvard guys won’t torture them into demoing the way we make them do it!)

That tells you a couple of things. First, smart people think alike. While Connected Health started out as being mainly about remote monitoring and its place in disease management, the core group of consumer-facing tools that make up an increasing share of Health 2.0 are entering into the DM and Connected Health realm. Second, the semi-automated DM systems that are primarily call-center driven are suffering some more realistic expectations compared to the famous $34bn plus forecast from Forrester a while back. And that of course is highly highly related to the perceived failure of Medicare Health Support.

All of this leads to the underlying tension that Health 2.0 puts squarely on the table. Is the future of health care going to be led by self-organizing groups of patients and their representatives, or will it be dominated by technologically-extended versions of the major health care organizations who are now responsible for care delivery?

My suspicion is that the answer is both.

A few quick other points about the Health 2.0 Conference.

Indu & I received effusive praise from just about everyone we
spoke with, but also a few criticisms. So let me try to answer some of
them here.

There’s been a little too much tittering about some of the problems
faced by some of the online demo-ers. First off with over 100 live
demonstrations—many of which included brand new never-seen before
software, you can expect some problems. It’s extremely unfortunate that
there was a problem with the Internet that slowed down the first
plenary session demos, and as the conference organizer, we must hold up
our hands for not being quite thorough enough with the hotel’s Internet
service to ensure that it was perfect.

But nonetheless WebMD, Aetna, PDX, & Kaiser were able to show
new and cutting edge technology (even if some of the response time
lagged a little) and Microsoft’s problems were due to a password
miscommunication. We managed to solve the Internet problems at lunch
the first day, and after that—with one exception where the individual
concerned went off the reservation—every main stage Internet demo went
fine and although I wasn’t at every break-out, my understanding is that
those Internet demos went fine too. And while Yahoo may have “chosen
wisely” by showing a screen shot, the only reason they showed a screen
shot is because that application has not yet been built, and they were
only allowed to show that as an example to help the audience understand
the context of their announcement with Healthgrades.

Nonetheless, those people chortling at the problems Peter Neupert
had are missing the point. With Healthvault, Microsoft has made an
extraordinary effort to move the entire online health field along—and
even people who’ve been very critical of Microsoft’s technology and
behavior in other areas admit that the stance they’ve taken towards
giving users control over their data and controlling their own data’s
privacy seems absolutely genuine. I’ll be doing a detailed test-drive
of the newly upgraded HealthVault in the coming weeks (to match the one
I did earlier this year of Google Health), and while I’ll not be
pulling any punches, I will start with the bias that more online health
information and tools are progress on the road to a better health care
experience and a better health care system. Meanwhile here’s Sean
Nolan’s take on the day…and what you should have seen.

Similarly, I’ve noticed one or two complaints that the technologies
shown in the consumer tools panel were either not real or viable in the
current market. I’m absolutely open to criticism about my fashion
sense, the panel’s timing (we ran over—our fault, not our demoers), and
whether the skit about Matilda’s life made sense. We clearly tried
something very ambitious. But it was never our intention in putting
together that panel to show that these were all either perfect tools or
that the companies which built them were all necessarily going to

What we (I hope successfully) showed was a series of extremely
complex tools ranging from iPhone-based content delivery systems
(ADAM’s new iPhone application), to genomics results, communities &
counseling (23andme, Navigenics), to online multi-modal live visits
(American Well), to complex programs for managing wellness (Keas), lab
tests (MyMedLab), treatments (DoubleCheckMD), drug-pricing, choice and
regimens (DestinationRx & Pharmasurveyor), and money (Quicken).

These tools are all real. They’re either in production, or very
advanced development, and they all represent a huge advance on tools
available for consumers today. In fact the only “canned” presentations
were the two calls from Silverlink and Eliza—for technical reasons you
cannot precisely “time” a inbound call from their systems which meant
that a real inbound call would not have fitted in the rigors of the
skit. But both those companies deliver millions of those calls each
week, so they’re clearly not vaporwear.

The question of market viability is of course one all those
companies need to face. But in a health care system in which crazy bad
behaviors and useless technologies are heavily rewarded every day, is
it a bad thing to suggest that we need to change incentives so that
tools which have the potential to so greatly improve patient experience
are put on a level playing field?  I think not.

But the point of the panel was to show the potential for improving
the patient experience, not to question 12 companies’ business models.
We did that, very successfully I might add, the day before in the Scott
Shreeve “lets get real” panel. And getting big businesses—especially
pharma companies—on a panel to discuss how they are spending their
money is not easy.

And for sure everyone brings their own bias to the conference. Hope
Leman got all pissy about PatientsLikeMe’s policies and business model,
and was bitter that librarians weren’t well represented.  Fair enough. We should do better to include more of those perspectives next time.

Others complained to me that there were no patients. A fair
criticism, although our spring fling in March included 4 actual
patients sharing their experiences throughout the day, and most of the
speakers and demoers relayed great stories or information about their
users. And of course Edelman was able to show its new data about patients an their engagement. Still others wanted more about physicians or more about policy….

The upshot is that Health 2.0 is a conference focused on showing how
technology allows people to find health information, to organize with
others, and to manage their health. Everything we add in another
dimension—while very valuable—takes time away from the many many
organizations that want to show their technology. And we want them to
show it.

There’s only so much time in a two day conference, and I’d rather
err on the side of showing more technology that may make a difference,
than having more people talk about how great it’s going to be, or
telling the crowd what’s wrong with this approach.

For sure we’re going to be changing the format the structure and the
content to reflect requests from our audience and to reflect the
changes we see. So this is not static.

But yeah, I admit it. I’m biased. But in case you weren’t watching,
the current health care system is not exactly in good shape. Health 2.0
tools and services have the potential to change at least some of it.

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7 replies »

  1. I am not sure why Peg wants to do away with the terms patient and provider… Because everything in healthcare, as in most of life, depends upon context. Gary. As a physician, you may think of “healthcare” in the relatively narrow context of professional diagnoses and treatments, but the ideas of both “health” and “care” inhabit a much larger space.
    The Web enables multi-party conversations and challenges the notion of information gatekeeping. It empowers the folks we call patients and consumers to challenge ideas/practices, and to demonstrate/share their unique forms of expertise.
    For starters, remaining open and listening to these nonmarket caregiver voices might go a long way towards reducing both the high costs and the high rates of iatrogenesis present in the current biomedical enterprise.

  2. I follow Matthews Health Care Blog regularly. As a physician I began becoming interested in Health IT,EMR and other software solutions to empower physicians and hospitals to make a leap to transform their ‘model’ for practice. I was involved from the inception of RHIOs with David Brailer and ONCHIT from just about day one.
    I was a coordinator for an embryonic RHIO in Southern California for several years. The potential stakeholders were less than enthusiastic in supporting the enterprise. I developed several models for ‘sustainability’, ranging from shareholder status with equity share, non equity subscriber, and joint partnership with vendors. All efforts failed. No one wants to pay for it….and hopefully government will not.
    The EMR and interoperability of disparate systems has matured. Evolution of these systems will be accelerated in integrated health systems .
    Demos are fallible, as is IT. I am not sure why Peg wants to do away with the terms patient and provider?
    Some seem to prefer consumer and seller? I think the issue is transparency….The terms consumer and provider is anathema to professionals…Despite all they are not on equal footing, even if consumers would like it to be so.
    One of the issues physicians have had is that the old cottage industry operated much under it’s own set of rule, avoiding what we have now seen with burgeoning bureaucracy of government, consumer watchdogs, etc. How did we exist for decades without all the important pundits….?? I also noted that the driving forces did not include providers, just vendors, and administrators. Providers, physicians must be involved. How many physicians were at Health 2.0 and were the ones present all entrepeneurs?

  3. Matthew,
    A terrific conference and a huge success, as the audience numbers attest. A few quibbles that I heard over the two days – too much emphasis on demos, not enough on the issues Health2.0 companies faced bringing their tools/technologies to the market. In light of this, perhaps dividing the conference into separate demo sessions and discussion sessions might be best. One of the best talks, according to my informal poll, was Jonathan Bush’s caffeine-inspired articulation of AthenaHealth’s business model on the morning of the second day. Clean, clear and aggressively to the point. Perhaps guiding the other presenters to the same standard would elevate the discourse.
    (PS I liked the Mathilda routine. I thought you looked good in a skirt! And, as a Stranglers fan, I do remember ‘gobbing’.)

  4. Just found your blog via a Twitter post and will be subscribing to learn more. I work in communications at Washington State University Spokane, which focuses primarily on health sciences, and am on a health foundation board that is just launching.
    Spokane is home to Inland Northwest Health Services, http://www.inhs.org, an electronic medical records provider that serves the two competing hospital systems here. It was originally formed as a joint venture between the two systems and involves docs, services such as imaging and pathology, and other providers as well. WSU Spokane is partnering with them to build it out as a robust research resource as well, with a clinical data repository.
    Spokane has a unique collaborative culture that we’re embedding in our teaching and research as well, preparing health care professionals to work as members of a team and to use knowledge drawn from health IT for evidence-based practice.
    I’m wondering if there are any other communities where competitors partner this way on EMR, or where the health IT providers are partnering with higher ed. Contact me on Twitter @BarbChamberlain or via email chamberlain-at-wsu.edu if you have examples of this type of collaboration.
    (For a video that highlights our “team care” approach as submitted to Google’s Project 10tothe100 idea contest, see http://twurl.cc/6iq)

  5. California state legislation requires all hospitals to be rebuilt or retrofitted for earthquakes by 2013. Therefore new technologies will be a key part of the new hospitals being built to replace really older ones in CA. This might make an interesting future post?
    One hospital I’m working with that will be built by Sutter Health is in the East Bay (Castro Valley, CA). It will have kiosks for self-check-ins for patients (think e-tickets at airport terminals); HIPAA-compliant kiosks for visitors to find patients; WIFI access in waiting rooms; proprietary wireless headsets for nurses and physicians. Plus a brand new capability — universal care unit, a multi-purpose room for patients for anesthesia care, surgical pre-op, recovery, short-term observation, ER care and more.
    The architects or Sutter project manager for the new CV hospital could weigh in on these new technologies.

  6. Time to stop using the terms “patients” and “providers.”
    After all, ordinary people deliver (provide) most of their own healthcare, investing their time and money educating themselves (or not)about staying healthy, choosing nutritious food, avoiding food-borne illness, getting enough sleep, nurturing relationships, finding an exercise partner, preventing accidents around the house, keeping doctors’ appointments, learning about their diseases, complying with doctors’ orders, seeking peer support, seeking alternative forms of healing.
    Self- and family-based caregivers (nonmarket providers) need a much more visible role in the emerging Health Web 2.0 paradigm. As the folks with health questions, concerns and problems, each of us also has a wealth of experience and expertise to share–at the very least, the knowledge of how we organize the affairs of daily life while keeping ourselves healthy or coping with specific diseases and/or disabilities.
    There’s a lot of good research on the relative size and value of nonmarket economic activity. Its imputed value equals or surpasses that of the market economy, but it goes unnoticed because our dominant way of thinking about economics encompasses only those activities that involve money exchanges.

  7. As a patient and organizer of an unofficial disease-specific social networking community, I would love to participate in future gatherings. I had considered attending this Health 2.0 conference, however, I was busy speaking at the J&J Global Communications Conference about blogging, social networks, and patient support.
    The overwhelming response was positive as attendees wanted to know more about the type of interactions which patients/consumers want to have with corporations. How can they join the dialog already taking place? What does interactive really mean? What don’t consumers want from corporations?
    One attendee sent a question to the panel (but which wasn’t asked due to time limitations) about corporate sponsorship. Hmmmm….. maybe that’s something I need to look further into. My internal response was along the lines of – you mean corporations would sponsor people to do what I’m already doing? Nice thought.
    So if you ever need a patient to give perspective from the other side of the computer screen, I’d be glad to discuss opportunities. 🙂

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