Health Search's Big Fail: Context, Meaning, Consumer vs. Customer

Designing and developing the Nexthealth app is a trip. Literally.

We're nowhere near done; the more we examine where this is going the more I realize we need 1. a big chunk of change, 2. a brilliant programmer/developer or 20, and 3. to clone me, or at least enlarge the team substantially in a smart way.

More amazing firsts happen every day, and since we're packing 6 months or so of development into 3 weeks in order to do a brief demo at Medicine 2.0 on Friday, crazy stuff is happening minute by minute.

Last night for instance, I spent almost 2 hours on Twitter embroiled in a rolicking debate with @symtym, @bobcoffield, @dporter, @caparks, etc. Other health/medical tweets like @ruraldoctoring, @medpiano joined with thoughts on 'consumer-centric' care later, as did 'new' followers whom I'd never 'met' before - welcome @sjdmd!

If I've left anyone out I apologize - brain's a bit fried after traversing every problem in the healthcare universe, from consumer-centrism to the definition of payors to coding and whether or not universal care will work and back.

@symtym's observations and critiques of our Nexthealth research represent some of the most amazing peer-to-peer interaction I've ever experienced.

@symtym - even though there's no 'advisor' category or coordinate on the Nexthealth graph (yet) I hope you'll consider last night's tweet a serious invitation.

Interrogators and those who critique ideas and theorems in such a detailed, forthright manner are invaluable. Again, I thank you for your time and insights.

Here's why our conversation was so amazing:

1. It began, endured, and ended (without injury or insult, although it was a close call at times :) on Twitter

2. I couldn't type as fast as I could answer, so I used my 12seconds page to record short, 12 second video burst responses to questions/comments; toggling between these two new niche social networking technologies came more naturally to somone as tech averse as I am than I could ever have imagined

3. The back-and-forth drew in multiple other healthcare minds whom I respect and admire; in short, it was one of the most intense focused factories for healthcare debate (including policy discussion) I've ever experienced

4. IT WAS FREE. Free to use Twitter, free to use 12seconds and respond via video, free to get some of the best intense brainstorm time in with some of the brightest minds in healthcare...I've remarked before that the knowledge transfer on Twitter is amazing -it's like a mini-MBA

Lots more thoughts today, but I want to close with a focus on coding, health search, and 'meaning/relevance' for customers, consumers, and the holy trinity (payors, providers, patients).

First, a disclaimer - everything I've learned about coding, programming, and development has been packed into 20 intense days with our awesome (and very patient) initial developer Brad Sugar. So I'm bound to be wrong. Often. You heard it here first.

Also, this thing we're building? Decision-support search/portal/mashup for healthcare choices? Yeah, it didn't exist. Anywhere. We've had to invent new graphing, coding, and database logic for the app, based on entirely new research we're presenting at Medicine 2.0. So finding other sources to back this up is gonna be tough. If you're interested, comment, and I'll send you some material.

I'm not going to venture into some of the detailed and complex coding portions of the Great Twitter debate; if you're interested look at my Twitter page and updates, or use Summize to check out last night's conversation.

Basic thoughts (for now, I'll present these from a patient perspective):

Current health search is a big fail.

Here's why.

We can't code for meaning. Coding, programming, is by nature quantiative, 'objective.' Meaning is subjective, personal, and qualitative.

The best we can do is code in a way that allows users to bring their baggage, and try to ensure this baggage enhances rather than occludes search results.

Whenever a user performs a search, and interacts with a search engine, we have an end goal in mind, right? Even if the end goal is just kicking the tires to learn something new.

Examples: Find lowest price on discontinued DKNY city perfume. Find microfiber sports bras specially manufactured for breast cancer survivors with prostheses. Learn more about social networking. 'Background' check a job candidate. Get directions from home to a campground. Buy wedding invitations. Design new skateboard deck. Find a doctor in New York city who has an appointment next Tuesday at 10am to check out a rash. Etc.

With health search, it's not about the keywords. It's not even about the diagnosis.

It's about the decision. The do/act step. Choosing what to do next.

A diagnosis does not exist in a vacuum. But this is how we currently perform health search.

Look at how people are using current search (even semantic search engines like Hakia and human powered search engines like Organized Wisdom) for health....

Try doing a search on every search engine you know for "breast cancer." Now try "i found a lump in my breast what do i do." Interesting results, no? Do they have meaning to me if I just found a lump and am trying to decide what to do next?

Currently, we Google symptoms. Then we have to find a care provider to check out the symptoms, provide us with a diagnosis and a treatment plan.

Here's an example of one decision-tree based on the above example. There are tons of choices inherent in that sentence, and anyone who doesn't think there are choices or decisions to be made in healthcare might be fooling themselves, just a teensy bit.

First, we have to choose to learn about our symtoms. Second, access the web. Third, select a doc. Fourth, schedule an appointment. Fifth, decide to keep it or not. Sixth, decide to comply with treatment plan.

EVEN PHRs by themselves are useless.

The real kicker is that even if someone came up with a kick a#$ PHR/EHR, in isolation it has no value. That's one of many reasons we don't have a working system yet...it doesn't have incentivized value for the Holy Trinity (payors, providers, patients) that connects all these functions for the end goal of better health.

But even 'better health' is a systemic overview...by itself, without a connection to personal decision-making for the patient, a bunch of health information and clinical findings have no real-world relevence.

But individual PHRs then have to tie back into the system - it's a classic FUBAR catch 22.

The trick then is that no individual exists in a vacuum; you have to connect that individual application back to a systemic or population based tool, with widespread availabilty, and the potential to scale.

And yeah. We've got a business plan in development to do that (sep. from Nexthealth decision-support app).

But I digress into complicated stuff :). Much more to come....