Health 2.0 is a trend accompanied by both buzz and buzzwords. That worries some advocates for the poor, under-served and just plain old and sick. Will those groups be left behind in the latest information revolution?
The potential positives of the Web-as-health-care platform for interactive health care services could be seen in two full days of presentations and discussions at a recent meeting in San Francisco, called the Health 2.0 Conference. Still, a certain Silicon Valley sensibility remained: widgets for weight control were much more likely to target the calorie count of cappuccinos than corn dogs.
Yet the real question is not whether Health 2.0 arrives clothed in hype; of course it does. The capitalistic ritual of “new and improved” is similar for software and soapsuds. The important issue is whether the substance of Health 2.0 can help deliver health care services significantly more efficiently and effectively while reducing disparities. Look beneath the hype and you can see it’s already starting to do so.
First, full disclosure. I moderated a conference panel that addressed health care costs, quality and, in part, the poor. My expenses were paid, and I’ve been working with conference organizer Matthew Holt and colleagues on a report that explains Health 2.0 in a way that makes sense to those who work in the trenches.
The most important thing to understand is that Health 2.0 is genuine change happening right now, not just another idea of how health care might be different tomorrow. The Web-as-platform (dubbed “Web 2.0”) and its technical architecture of user participation and customization are already ushering in Government 2.0, Journalism 2.0, etc.
Web 2.0 represents the difference between the phone book and Facebook, between static information (I live on this street) and dynamic information (I live in a community of these Friends, doing what’s on this Wall). More broadly, when compared with “Web 1.0” — the Web as information retrieval system — it is the difference between data collected and controlled by an authoritative source and data collected, regenerated and continuously changed by its users. This “leveraging of collective intelligence” lies behind the conference shorthand of Health 2.0 as “user-generated health care.”‘
Give the Lady What She Wants!’
The 19th-century retail pioneer Marshall Field famously proclaimed that his department store’s mission was, “Give the lady what she wants!” Web 2.0 enables the 21st-century fulfillment of that adage with a speed and precision Field could never dream of. Just as the department store gave those with modest incomes unprecedented access to goods they could never previously find or afford, Health 2.0 can do the same thing with goods and services related to health care.
As an example, let’s take Keas, a personalized health management site founded by former Google exec Adam Bosworth and unveiled at the conference the day after being heralded in an article in the New York Times.
Bosworth’s presentation of Keas’ diabetes module, delivered in blue jeans, epitomized the tech-mogul ethos that casually proclaims, “I am cool and successful.” The thing is, what Keas has actually done is cool and, if it works, deserves to make those who did it even more successful. Keas has partnered with some of the leaders in patient empowerment and evidence-based medicine in diabetes and other conditions to produce a highly personalized, data-driven and constantly updated disease management tool.
It is a tool available free, everywhere, all the time, whether your computer is at a library in rural Montana or a penthouse in downtown Manhattan. Except that having access to doctors with anything close to the level of knowledge and available time represented by the Keas program is likely to be a far bigger problem in Montana than Manhattan.
Then there’s the behavior change aspect. In a 2007 article in the New England Journal of Medicine, Steven Schroeder wrote: “The single greatest opportunity to improve health and reduce premature deaths lies in personal behavior.”
Interactive, personalized Web sites with supportive social networks can save some of those lives, whether it’s QuitNet for smokers or a long list of sites for weight loss.
What sites can’t do is change the personalities of those using them. Let’s face it, dieting, even with cool interactive tools, is a lot less fun than indulging. When it comes to that crucial motivational requirement, sites’ programs such as NutritionQuest are using scientific research about behavior in order to take users by the hand and lead them to change. Other programs provide a constant stream of financial incentives. And still others help you to face the french fries head-on, with mobile phone-accessible calorie counts at Burger King, Wendy’s and similar emporiums of temptation.
To be sure, many of the user interfaces in this first generation of Health 2.0 products are still designed for the tech-savvy, the highly educated and those who believe they will never in their life need reading glasses. That is changing, however.
More than a decade ago, groundbreaking research by the University of Wisconsin’s Comprehensive Health Enhancement Support System program showed that the poor, the elderly and rural populations facing diseases such as breast cancer benefited from an educational and support community run online. Today, the communities on sites such as HealthCentral, Organized Wisdom or the extraordinary PatientsLikeMe are beginning to reflect the full diversity of America.
Internet’s Wide Reach, Growing
One factor in that diverse reflection is that even in rural America, Internet use runs only 10% below that of urban areas (63.3% vs. 72.6%). A Department of Agriculture report noted that, for farmers, “online purchases now replace the once common Sears and Roebuck catalog.” A Pew Internet survey, meanwhile, found that eight of 10 Internet users have looked for health care information online. Pew adds that many of those who are not online are that way because they choose not to be.
Web 2.0 is an extraordinarily powerful force for the democratization and personalization of information. Health 2.0 brings that power to the provision and organization of health care services.Health 2.0 can’t teach you to read, get you a job or lift you above the poverty level, but it can shatter barriers of geography and expertise. And it doesn’t require an insurance card. Which was why the Health 2.0 Conference has regularly included sessions on how efforts, such as the Millennium Village Project, are aiding health care in remote parts of Africa, South America and Asia.
Meanwhile, Health 2.0 is becoming part of the U.S. health care environment, whether it’s swine flu tracking for public health purposes, remote access to specialist care or a growing list of other applications of Web-as-platform.Sometimes “new and improved” is genuinely new and improved. That doesn’t make Health 2.0 a panacea, but it does make it progress.
Michael Millenson is president of Health Quality Advisors LLC, a principal in Health 2.0 Advisors and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age.” This piece first appeared on iHealthBeat.
Categories: Health 2.0