Health 2.0 and the Big Bang

GlennIt’s hard to believe that last week’s Health 2.0 conference was just the third annual installment of the event. The phrase, “Health 2.0” entered our lexicon at light speed and seems to have been there longer than those few, short years. The conference has become a must-attend for hundreds of people, dozens of companies and a hodge-podge of innovators, consumer activists, and buzz trackers.The Twitter feed from last spring’s Boston event rivaled that produced by the Octomom (well, not quite), and had the wireless carriers supporting last week’s event not sustained a massive H1N1 attack, that feat would have been surpassed easily. Heck, even Aneesh Chopra, our nation’s first-ever CTO, was there to kick it off. Congratulations are in order for the conference organizers, Indu Subaiya and Matthew Holt, but going forward they will have their hands full attempting to manage the wild growth of their event.

In their opening remarks last week, Subaiya and Holt reminisced that their initial conference focused on search, communities and tools. They chose to broaden that focus for the next one, to include bringing together content and transactions in a user-friendly way, and they tipped their hats to a broader concept still: the fabled concept of data liquidity as an enabler for their constituency. This year, they broadened things further by introducing “unplatforms” that could mix data, applications and channels, and in so doing, brought mobile devices, social networks, widgets and more under their tent. Health 2.0, it seems, is exploding like a supernova, and the conference organizers have so far made no visible effort to reign-in the expansion

.Subaiya and Holt are going to have to decide whether they want Health 2.0 to be perceived as All Things to All People, or draw a line around whatever foundational principles they choose to adopt and keep the focus narrow.The easier and more lucrative option, at least in the short term, is to enjoy the ride. Despite the whinging about lousy wireless hook-ups and a spectacularly impersonal venue, most people loved the conference and came away with several good ideas.Few would blame the organizers for taking this path, but before they do, they would be wise to consider similar decisions made by leaders of the Health Care TQM movement, which 20 years ago was every bit as trendy as Health 2.0 is today, but whose influence faded badly after that.

The concept that Total Quality Management principles–originally developed by W. Edwards Deming, Joseph Juran and others to improve performance in manufacturing organizations—could be adopted for use by health care organizations gained widespread acceptance after a pair of articles (here and here), introduced the possibility in 1989.Conferences were formed and grew rapidly, and journals were started to promote the concept. Consultancies claiming to help implement TQM grew like desert flowers after a downpour. Awards were created to honor early adopters and entire careers were built around expertise in the area.But now, most of that is gone. TQM is yesterday’s trend. And sadly, despite a continual stream of success at local levels, quality-related issues that TQM seemed ideally positioned to help solve—things like medication errors, readmission rates and unnecessary test ordering by physicians—remain endemic to our health system.What happened?It had nothing to do with the TQM principles themselves. There is way too much evidence from hundreds if not thousands of successful projects that proves TQM can be implemented by health care organizations, and that in such cases it improves the quality of care and reduces associated costs.The problem was that leaders of the TQM movement chose to be inclusive (an admirable trait in most instances).

Facing the same challenge that the Health 2.0 conference organizers confront today, they chose to open their doors to dozens of new trends and ideas that were at best distant cousins of the foundational principles of TQM. First, there was Systems Thinking. Then came re-engineering. Eventually, self-efficacy theory, organizational change theory, and even techniques to foster individual creativity found their way under the tent.All these movements are based on solid science and have their place in the lexicon of health care improvement strategies. And to be sure, TQM leaders’ decisions to include them under their tent contributed to rapid growth of the movement. But the price those leaders paid was a fatal dilutive impact at a national level regarding adoption of the foundational principles of TQM itself.People began to wonder what TQM actually meant and what it didn’t. There weren’t enough experts around to support and train folks interested in implementing TQM. Supposed TQM advocates espoused different messages about what TQM was. And as is the American way, many of the best and brightest minds chose to pursue tangential interests in search of their
own fame and fortune.

It was inevitable that health care organizations and policy makers would shift to the next best thing.

TQM had become the Old Soldier in Douglas MacArthur’s farewell speech. It never died, it just faded away.

As I watch Subaiya and Holt continue their well-intentioned efforts to expand the Health 2.0 tent, I can’t help but wonder whether the same fate awaits the exciting movement they helped create.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.

8 replies »

  1. Can you email something back to me about why you can’t print my post? Does it need to go on another blog spot?
    Please reply to pammie416@gmail.com
    Thank you,
    pam walter

  2. Michael – Thanks for your interest in our Cybercitizen Health™ study and the kind words about its methodology. I just wanted to follow up about your thoughts on our Health 2.0 definition and explain why we include individuals who both create AND consume health-related social media. While it’s true that the Health 2.0 population would be smaller if we only included consumers who actually contributed health-related content online, we’d be missing a big piece of the puzzle. Even if a group of consumers have never written a blog or uploaded a video to YouTube, the fact that they reading, and therefore are at least on some level affected by, user-generated content makes them a part of the social media phenomenon. These “readers” are looking beyond the more traditional, edited online content like news and articles to the opinions and experiences of others. And at the end of the day, we serve companies and brands that are using digital channels to connect with health consumers, so if they are contemplating the potential of a social media campaign, they are interested in both the people who post as well as the audience that would actually be reading and potentially influenced by the content.
    To answer your question at the end of your comment, clients of the Cybercitizen Health™ study are able to look at the data on a more granular level – by type of participation, type of online media, condition group, influence level, etc. So they do have access to the market size/characteristics of those posting health-related content and can see relative share of contributors and creators. It’s a research advisory service so we work with clients to help them use the data in ways most relevant to their individual objectives. We use press releases to give people a preview of the wide range of eHealth behaviors we track, but in the end it is in fact just a small taste of what’s available to subscribing clients. Just as a final point of clarification, we don’t include people who viewed DTC television commercials featuring patient testimonials in our Health 2.0 population – we limit the definition to online social media.
    Maureen Malloy
    Manhattan Research

  3. Very interesting discussion Glenn. What makes H2.0 most relevant is if providers are willing to acknowledge that they are one of the few industries operating at a 0.2 business model. Too many see themselves, probably due to their clinical expertise, as operating at H1.9.
    I think the distinction will come by separating the healthcare business (process and functions) from the business of healthcare (clinical). It’s the healthcare business that needs the focus to get to H2.0, otherwise H20 is only water.

  4. Glenn is right. As Exhibit No. 1, take a look at the just-released Manhattan Research study that claims “About 35% of the U.S. adult population uses social media for health and medical purposes in 2009.” Their methodology, in terms of how many adults they survey and the way in which they do it, is impeccable.
    But now look at the definition: these Health 2.0 cybercitizens are people who”create or CONSUME content on health blogs, message boards, chat rooms, health social networks and health communities, and patient testimonials.”
    I’ve highlighted the word, “consume.” That’s right: if you’ve ever read a patient testimonial on a hospital Web site, glanced at a blog or — perhaps? — seen a TV commercial for a prescription drug that features a patient’s testimonial, you are a Social Media cybercitizen.
    Even if this definition of Social Media could include a big helping of brochureware.
    Of course, Manhattan Research may have more meaningful numbers available for those who, tempted by the press release, pony up the full price of the report. Perhaps someone who has done so can enlighten us on whether the statistics get more reliable at a more granular level.

  5. Excellent post and I agree with the sentiment!
    But I wonder, Glenn, what you think should be excluded from the concept? And, conversely, what is the core?