Defining Health 2.0 - Debate Rages On

Call it Health 2.0, definition v2.0: A fresh round of chatter last week surrounding the semantic debate.

  • Dr. Ted Eytan kicked off an additional thread here.
  • Lodewijk Bos of ICMCC in Holland has an excellent response here.
  • Dr. Reece at MedInnovationBlog weighs in with his customary panache here.

While I've posted at length about portions of the topic before, formulating a response to Dave and Ted puts the broader puzzle pieces together - I'm reposting my response below.

Why the continued harping on Health 2.0?

My greatest fear is that continuing noise about cementing a single concrete definition will prevent early innovators from moving forward.

This is why much of my recent research, with co-collaborator Maarten den Braber and the neXthealth team here in Holland, is focused on the evolution of Health 2.0 towards the penultimate end-goal - completely realized consumer centric care that adds transactional value for companies, caregivers, and consumers.

Are we too enchanted with defining Health 2.0 to look ahead and refocus on what's most important, namely:

  • What Health 2.0 allows us to do?
  • Why it's necessary?
  • Whom it allows us to involve?
  • How it allows us to connect?
  • When and where it provides new access points to a traditionally hierarchical, closed delivery system?

Do you agree that Health 2.0 is a transitional phase, a stop on the roadmap towards consumer-centric care, or do you think it's an endpoint where we've realized the full benefit of tossing patients, HIT, PHAs, and providers in the proverbial blender and hitting 'pulse'?

I'm worried we're holding our fingers on the button a bit too long.

Let's pour out the blended mix and see who likes the taste, then worry about refining the recipe.

As a result of our concern about roadblocks to implementation, Maarten and I begun work on a concrete model current providers will be able to use to plot the route to consumer-centric care.

After hashing out the concept in a paper last week, Maarten remarked: "If you can see it you can hit it, if you can hit it you can kill it."

We won't be able to 'see it' ladies and gents, much less 'kill it,' if we can't move from discussing to doing.

Below are my thoughts on how to get it done.


Hi Dave -

Crossposted a portion of the response below over at Ted Eytan's blog...seems like the debate surrounding a universal Health 2.0 definition, like the EHR/PHR debacle, will hang around for awhile while early innovators and interrogators hash out the lexicon.

Then once we've dotted our i's and crossed our t's we'll need to reach out at a more systemic level and get implementors involved (then we'll see hospital execs attending Health 2.0 conferences) - one patient's voice can be powerful but the wisdom of crowds multiplies the effect and amplifies the volume.

So the vital question becomes not JUST how to define Health 2.0, but how to get innovators, interrogators, and implementors to all have a seat at the table and connect concepts, current service lines, and create future partnerships that offer maximum value on both the personal and population levels.

A group of us here in Holland are wrestling with the same conceptual questions.

After participating in the first Health 2.0 Unconference here in Holland in April, we've come up with the following tentative stab at defining not only the 2.0 portion, but the evolution towards complete consumer-centric care, which Maarten and I inelegantly define as a consumer being able to 'dip' in and out of the healthcare system (virtual AND brick and mortar) "at will."

"At will" means consumers who want to be active partners in care have the tools (provided by innovative entrepreneurial startups and offerings that connect virtual services and real-world systems) to help them do so...but we must also remember not all are capable/willing to become proactive partners in care.

Before we get into the definitions of Health 2.0, etc. and how the movement will help us arrive at consumer-centric care, we need to have realistic expectations of end-consumer engagement numbers - let's add a dose of pragmatism to our idealism.

Consumer engagement in healthcare will follow a sort of 10-80-10 rule (gross oversimplification but helps illustrate the point)...10 percent will be hyperengaged 'superpatients' and 'superproviders' who are early adopters. These people, including e-patients, medical bloggers, etc. (i.e. us) are already pushing the system towards the next phase by defining Health 2.0.

But another 10 percent of consumers are incapable (physically incapacitated)/unwilling (selectively incapacitated) to become primary, proactive, participatory partners in care.

That leaves the gulf in the middle for Health 2.0 to ignite - 80 percent or so of consumers who are waiting to see what value will be offered.

To get those middle 80 percent involved though, there are a few more progressive evolutionary stages we'll have to define and nurture.

At it’s simplest, Health 2.0 = content (what many have mentioned, Scott et. al.) and community (Amy Tenderich at DiabetesMine, etc).

The end goal, of course, is better, safer, consumer-centric care.

This can only be realized by combining currently disparate groups of initiatives, which can be loosely clustered according to 2 motivating factors: efficiency (quality, safety, transparency), and empathy (Jacqueline Fackeldey’s theory of “human-to-human” hotealthcare @ Fackeldey Finds, Dr. Reece’s “Human 2.0″ @ Med Innovation Blog).

If we use web-evolutionary terms to define the current position, then we can predict where Health 2.0, consumer-centric care - enabled by HIT but also ‘brick and mortar’ integration of wellness tech- will go…

*Health 1.0 (1C) = content

*Health 2.0 (2Cs) = content + community

*Health 3.0 (3Cs) = content + community + commerce (transactions that create value for both company and consumer)

*Health 4.0 (4Cs) = content + community + commerce + what we’re currently missing - coherence

Then we arrive, eventually (hopefully) at fully realized consumer centric care - something we're calling "neXthealth" (more info on this definition available).

At this phase, consumers (patients, providers, payors) can dip in and out of the system at will (online, offline, virtual and brick and mortar services).

In an ideal world, we’ll all come the realization, sooner or later, that consumers in the healthcare system are not just patients, not only providers, but ANYONE who generates, purchases, provides, recommends, or reviews healthcare and wellness goods, sites, and services.

We’re starting to see firms that realize Health 3.0 goals now - Organized Wisdom, Carol.com, SugarStats.com, American Well…but what they’re missing is the 4th C - coherence - a connection platform that bridges their services to other online and offline organizations in an 'open source' fashion.

Services and sites will begin to offer ways for consumers, probably patients and providers first, to connect current care delivery platforms (hospitals, retail clinics) and web-based services (physician chat, PHAs, online scheduling, etc).

More here…http://healthmgmtrx.blogspot.com/2008/04/defining-health-30-and-40.html

Also, for those interested, many of us are tweeting about Health 2.0, 3.0, etc. on Twitter.com - for interesting developments, blog posts, and links search and follow:

jenmccabegorman (Jen McCabe Gorman - Health Management Rx, neXthealth)
mdbraber (Maarten den Braber - neXthealth)
martijnhulst (Martijn Hulst - neXthealth)
shakingtree (Niels Schuddeboom - neXthealth)
fackeldeyfinds (Jacqueline Fackeldey - Fackeldey Finds, neXthealth)
Jeroen Kuipers (Building Better Care, neXthealth)
icmcc (Lodewijk Bos)
NCurse (Berci Mesko - ScienceRoll)
Marston (Marston - SugarStats.com)

And Dave, I'm hoping you'll be attending Health 2.0 in San Francisco in the fall?

Best -

1 comment:

Lodewijk said...


"My greatest fear is that continuing noise about cementing a single concrete definition will prevent early innovators from moving forward."
"Are we too enchanted with defining Health 2.0 to look ahead and refocus on what's most important."

As I did come up today with the formulation of a definition, I think I should answer these questions.
Call me old-fashioned, but I think defining things is absolutely essential to be able to move on. Only that way we are sure we are talking the same subject and using the same foundation to move on.
An example, for at least five years we are in the process of cementing a concrete definition of what an EHR is, however you can not say that it caused us to stop looking ahead.