What's Next After Health 2.0: Content+Community Online?

Bloggers' Note:

This is just a primer to get the cerebral juices flowing on this subject.

Hands down the best discussions about where things are moving will happen at Health 2.0 (in case any Health Management Rx readers don't use Twitter, full disclosure: I'm helping Matthew and Indu manage speakers and volunteers for this event). Matthew Holt will give far more interesting and complex thoughts on the subject, along with an all-star lineup of firms figuring this out during DBAs.

This post is the result of some incendiary conversations that occurred yesterday as I was hanging out with the HealthCentral crowd in Arlington, Va, learning how they manage 35 online communities covering areas of consumer interest ranging from sexual health to ADHD (full disclosure: I write about health, policy, and politics for HealthCentral).

Managing the flow of health-related information, both subjective (user posts) and objective (news links, etc). is an amazingly complex job. The backend content management system that runs this thing is a behemoth.

I don't know why I found discovering the sheer computational muscle that runs the HC works surprising - lets chalk it up to lack of sleep after some crazy Nexthealth design days and nights.

I'm not usually so slow in making these connections, but I also don't usually do this type of synthesis-storming alone - the Nexthealth hive is an excellent supportive group where many of us work together to connect the dots...I don't like going solo.

If the Nexthealth crew was hashing this out over wine, cookies, and whiteboard scribblings, we might describe it this way: If Health 1.0 was content online, and Health 2.0 is content+community online, then what we're looking at with long-tail firms like HealthCentral is an organization similar to libraries with a bunch of book groups...some information, or value, is composed by expert authors and the rest is user or community generated.

But online, the proportions of who generates the majority of content, and thus who defines the 'value' of information, is flip-flopping. And therein arises the credibility of sources issue that has Health 2.0 execs beating their heads against the wall trying to solve.

It's a simpler issue than most of us think - more of the tools, companies, and content we design must allow users to bring subjective values to bear. The tools themselves MUST be objective. Neutral. Search terms shouldn't be the only way to judge 'value' or 'credibility' of information.

Why? Because the subjectivity of healthcare decisions is infinite, variable, and thus indefinable.

Or, I should say, it has been. It's like we're trying to make the evolutionary leap from single-celled to mammalian life without interim stages.

We need to be gathering more data about NOT what healthcare consumers are searching for, or who they're talking to, but what they're trying to USE our tools to DO...what decisions are being driven by online health content? online health communities?

Content is great. Community is fantastic. Commerce, which happens online in Health 2.0 and offline via care in the 'real world', is even better. But we need coherence between all of these for consumers' actual choices and decisions to be impacted. Why?

Because the health content and communities we're pasting up all over the cloud don't actually exist in a vacuum.

How do consumers USE this content? What do/buy decisions do we make as a result of participating in online health communities? A prime example - I might be a DiabetesMine user and buy a new pump after reading about it on Amy's site.

Ok, so, if Amy's site has the coherence factor down, then I don't have to leave that online interaction to buy the thing, unless I CHOOSE to do so...I should have access to that healthcare good online or offline, and the choice to buy at either point according to my preferences and values.

And as a healthcare consumer, it's impossible for anyone else to define how my preferences and values impact my do/buy decisions.

But it is NOT impossible for them to provide tools that help me clarify how I make do/buy decisions in health using Health 2.0 content+community companies. Nexthealth is working on one that we'll release as a public good very soon (we'll even give you the code so you can modify it to be more relevant to your healthcare planning at the 'point of service'). And it's this type of data gathering that should have Health 2.0 companies lifting up the couch cushions digging for coins.

Without knowing how consumers value our services based on THEIR end game, what they want out of wellness, what's next for THEIR individual health, we can't build companies that provide anything of value.

It's no coincidence that the majority of Health 2.0 firms are living on VC vapor, or ad revenues. Freemium models come the closest to helping health consumers reach the end game; they're providing an application, a decision support tool like those SugarStats offers to people living with diabetes.

Again, the system isn't providing people with these tools; it's users, recognizing what's next for them and building an offering that lets them articulate and discuss value to make decisions for health, who are changing the system.

An i for an i model is changing healthcare ("i" need/want this, so "i" will build it and then "you" and "we" can use it) now, but we'll start to see more "i" to "you" built for "us" models. We are most definitely still building out the long tail, which has to happen before we can get to semantic interoperability (dipping in and out of healthcare buying online and offline).

Again, complete semantic interoperability for health means consumers should be able to access healthcare goods and services, online and offline, at will.

We need companies built around data-gathering and ear to door functions that let us hear what consumers want, and what decisions they're trying to make with all our wonderful "Expedias of Health 2.0."

It's no coincidence that you can still build a B2B and B2C software applications company that solves a niche need for people and make millions of dollars. Applications help people DO stuff with what they learn and what they're talking about, based on what they want to accomplish.

What does your Health 2.0 site/service help users accomplish? Where is the "do/buy" intersection? How many clicks does it take me to get there? You damn well better be able to answer a question this simple, in less than 15 seconds. Otherwise, what value IS it you're providing?

But let's go back to where Health 2.0 is right now for a hot second....how can we possibly define a singular health content and community site or service has value for every user at any given point in time?

The answer is simple: We can't.

We have to let THEM tell US what they find valuable in making healthcare decisions - what kind of information? What kinds of people? How do they want to pay? WHAT moves them to the make/do/buy decision point for health?

This means massive amounts of data, and also increased data transparency and transference.

But here's another problem with Health 2.0 companies; we're still feeling verrry proprietary about our users' data and our customer bases, as well we should.

But it is possible to anonymize data, and then explain to consumers in a passionate, engaged manner, why they should consider allowing your firm to release some randomized information for public health research purposes. 23andme is doing this sort of thing already; in essence consumer-direct genetics companies are the first giving us the option to make our genome 'open source.'

But they're still giving us bits and pieces, right?

They're not literally copying and pasting our entire individual genome into a Google doc and letting us share it, compose Wordles from our chromosomes, or lock it up in a vault and throw away the key. It's like getting a hard film copy of our X-rays and having to tote that around - it's literally a disconnected snapshot of one part of our body where something is wrong. We don't have any way to connect that back to our larger wellness picture.

The trick here is for companies to build machines, tools, interfaces, services, and goods that let us just use the hell out of them, however we want, when we want. This means we should be able to access them on our phones. In our homes. In our cars. At stores. At banks. On our laptops. Go mobile. Go web-based. Then build an interesting brick and mortar access point.

Think of the banking industry, which is a tired metaphor for where healthcare is going but will be even more applicable in the next 2-3 years.

Via online banking, physical banking locations, and ATMs, we can access our bank accounts any which way we choose. It's completely up to us, the consumers.

And here's the beauty - I don't have to look at my bank balance the same way every time. If I'm on the road, I make a phone call. If I'm online, I chat and check via the bank's web interface. If I'm traveling and need cash, which I hate to carry, I sniff out an ATM.

Again, the CHOICE is up to me, the consumer, and the really interesting part is that I make that DECISION based not on my 'knowledge' of the financial industry, or my level of education or banking literacy.

I just know I need money, and I need to know how much money I have. Why do we assume it will be any different for consumers of health goods/services once we make data and tools to access it available to them in brain dead simple interfaces, both online and offline?

Look. We trust people to elect a President. To pay taxes. To go to school. To buy a car. To buy or rent a house. To take care of kids. To enlist in the military. To pick a college, or a job, which impacts your earning power, lifestyle, and all manner of complex interconnected factors.

In Africa, despite disease, poverty, and war, cell phones are a booming industry. I may not have indoor plumbing, but I can text someone. We're making all the wrong assumptions about consumers and healthcare, health information, just like we used to do regarding technology.

Can you imagine what would have happened in the consumer electronics industry if Steve Jobs had seen a prototype of the iPod and said, "um, nope, that's not how users listen to music now. We'll pass." The end goal there: consumers will be able to access music and movies, online and offline, at will. We'll build the online piece.

So why don't we trust consumers to make choices in healthcare? They don't all have to be super-consumers; most will not be...go back to the 10-80-10 rule. Most, the Middle 80, will use these services on a limited basis. Some people check their bank balance every day; some check it when they pay bills, some never check it and get into trouble.

If we can't check our healthcare data out when and where we want, and get as little or as much complex info about it as we want, we're all going to be bouncing checks with our health.

To Health 2.0 companies - build the tools. Make em sweet. Make em simple. At Nexthealth we're all about figuring out ways to do that; connecting people online and offline. The decision-support model we'll release is just a handshake- our way of introducing ourselves and getting involved in an ongoing conversation.

Health 3.0 and 4.0 companies will let us do this with our healthcare information. Check out the backend EHR built by Myca for Jay Parkinson's Hello Health...that baby is absolute beauty in pure software form.

So the tools we design from here on out have to be objective, neutral, and allow each user to access them, harness them to make decisions for health and wellness that have PERSONAL relevance, in real time. So, when and where they need to make a decision.

How do we drive population-based healthcare change? Start at the grassroots level, with each individual. Teach each consumer that they have healthcare choices to make. It's that simple, and that blindingly complex. For instance, people my age, and those with open minds (thanks Jacqueline!) are more likely to search for health information online, and much more likely to use online social networking sites. So who's building health decision-support apps that call to the Guitar Hero Healthcare generation? So far, only sites like I'm Too Young for This, etc.


Here's the problem, still, with online health content: In libraries, newspapers, etc. the vast majority of the content was 'expert' generated - authors who go through an academic or 'traditional' publishing process, etc. - they've passed the barriers to entry. Sure, a bit of library and academic content was generated by rank amateurs, but it was much more difficult to gain entry into that rarified atmosphere.

Online health content sites remove many of those barriers to entry. Health 2.0 sites (content+community) break down the walls even more - community members act as peer experts. The rise of the amateur, or here comes everybody according to Clay Shirky.

Libraries needed their Dewey Decimal system for years, and online repositories of content are still struggling over 'logical' organization and creating ever-evolving ways for users to get our hands on the information we need.

Bill Allman and I talked about my helping out with some content management or filling more of a community manager role...after touring the software, and then spending some time in the community pages, guess which one I picked?

In essence, I find it very difficult to remain interested in/invested in business models in the Health 2.0 world that continue to populate the evolving landscape with older barriers to entry.

Everything I'm investing in now breaks those barriers down. I don't want to be an 'expert' writer, or journalist. I don't want to spend time uploading expert content. I want to be exactly what I am; an e-patient. A blogger. A speaker liaison for Health 2.0. A policy op-ed writer for HealthCentral. A Nexthealth initiator, co-founder, and firestarter.

This is the reason we're building the Nexthealth model open-source. Why we'll release the API as a public good. Blow barriers to entry right to bits.

I'm not going to say anything foolish or arrogant like this thing will raise the bar for Health 2.0 firms. It's not even about raising the bar. Instead it's about creating tools that lower the bar, get closer to the ground, where the people are...we don't need more pie in the sky killer apps no one actually uses...we need to build things that get closer to what people want and need, when they want and need to make a decision.

The problem is the gulf that exists between where we are now: Health 2.0, content+community, and where people and companies like Virgin Health are trying to go - incentivizing behaviors so consumers make healthier choices, which saves us money and the system time and resources.

But here's the kicker: You can't incentivize how consumers make healthier decisions if you don't have a consumer-centric system that gathers a hell of a lot of data about how consumers are using your content and community to make decisions. To buy things. To do things. What great hubris to believe we can convince people to do things differently and take responsibility for their own health when we repeatedly lock them out of making choices in the system.

To get from here to there, people have to be able to take that wonderful health content and those wonderful friends they met in health 2.0 social networks and USE THEM TO MAKE DECISIONS.

How will consumers ACT based on the health information they're finding online? WHO will they go see in the real world based on recommendations they gained online?

And once you can figure this out, how to motivate consumers to move to the do/buy stage, THEN we'll start seeing viable, revenue-producing business models for Health 2.0 firms.

Note to the larger Health 2.0 community - banner ads suck. I don't want to look at them. If you alienate me with your ads, I leave your wonderful site. Those things don't tell me what I want. They don't offer things I want to buy. I'm more likely to click on a link for a product from someone I follow on Twitter. If you slam me with ads, I think you lack credibility. Take a harder look at where you're putting your ads and how often you're putting them in my face. Ok. Rant over.

In addition to "how do I make money" we need to be asking ourselves the following about our user bases....

How do they figure out how to navigate in a system that does its best to dictate care?

How do we build and support a consumer-centric system, where the patient realizes "hey, I'm smack dab in the middle of this tangled web, and I've got a hell of a lot of choices to make that 1. I don't understand yet and 2. didn't even know I had the ability to choose."

But oh. Once we can choose to buy health goods and services, online and offline, lookout.

I'll wrap up this break from Nexthealth work with a final question every Health 2.0 firm should be able to answer: How are you helping healthcare consumers (and who are your consumers? patients? docs?) figure out what's next?

And by the way, if you're a poor broke student, analyst, or startup entrepreneur, leave a comment or get in touch - we're looking for 20 more Health 2.0 volunteers (free admission to panels, demos, and events).