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).

Healthcare for the "Middle 80"

“Head for where the puck is headed, not where it is...” - Hugh McLeod

“I think the internet could revolutionize health care just like it has revolutionized the music industry, the travel industry, and the newspaper industry. And with all due respect to this beautiful shrine of a Newseum, those industries got run over by the clue train instead of jumping onto it.”
- e-patient Dave (Center for Information Therapy's 7th Annual
Wired Conference, June 12-13, 2008 @ the Newseum, Washington, DC)

“You say you want a revolution, well.....you ask me for a contribution, well, we all do what we can...” - The Beatles

Ain't this America...

It's 10:22 am on a sunny Saturday morning.

My baby sister and her husband stand outside greeting a new neighbor. My sister is 38 weeks pregnant with their first child, my niece. The new neighbor just got out of nursing school, recently finished her OB/GYN rotation. She wants to be an L&D nurse.

My sister's house in Blacksburg, VA, is part of a unique green development for working-class families. My sister, her husband, the new neighbors – they are the “Middle 80.”

And our current healthcare delivery system is failing to seize new opportunities to communicate with them.

They are the part of the pie American economy presidential candidates salivate over, the part of the American economy aware of outsourcing to the Pacific Rim, engaged in green behaviors if they want to be, banking online, trying to make a living in an economy taking a head dive.

The Middle 80; our new lower, hard-working, sometimes college-educated, lifestyle oriented middle class. And more than half of them think our next Commander In Chief should make HIT a top priority.

They read and write poetry, watch DVDs on friend's laptops, choose not to have a microwave, attend wine tastings at local shops on Fridays, and last night hosted a campfire-party for 50 to bon voyage church friends moving to Richmond, complete with bay-blue and white pennants and coordinated wrapped plasticware.

The Middle 80 is, far more than we give them credit for, resourceful.

My sister created “We'll Miss You” penants from green, blue and cream calico fabric after she didn't find any to her liking. When likeable solutions are not presented in the marketplace, the Middle 80 craft them from bits of knowledge gained via experience and the references of friends, family, and yes, neighbors.

I've written before about the 10-80-10 rule in healthcare, where 10 percent of consumers will be unwilling/unable to be engaged, participatory partners in care, 10 percent of consumers will be 'hyperhealth' hyperengaged, tech savvy, and all over Health 2.0 services like white on rice.

And then there's the Middle 80.

When I translated the 10-80-10 rule from sales to healthcare, there wasn't much hard supporting evidence that the same percentages would hold true for consumer behavior in healthcare. Turns out, consumers are consumers.

Lately though, there's been some pretty substantial research to support it; Susannah Fox of the Pew Internet and American Life Research project reported more than 80% of the American public uses the web for healthcare related search (and Google uses that study to sell health advertising here).

And the Kaiser Permanente study hyperlinked here and above tells us 65% have gone online to get information about a medical condition. 73% think the benefits of being able to access healthcare records online outweigh privacy risks.

And that study is a year old. Think of how the world has changed in a year. Think of how the healthcare delivery system has not.

Let's look for a moment at how American healthcare is missing the boat for the Middle 80, like my sister, and what she chose to do about it.

Memorial day weekend. My sister and cousin were traveling back to Virginia from Southern Maryland.

A curve, a wobble, and the van carrying my baby sister, her baby, and my baby cousin flipped to the right side. After admittance and constant monitoring, all were released from the hospital with clean bills of health, except for one little thing; my future niece was now in breech presentation.

Her doc suggested a c-section and put it on the OR schedule for June 18^{th -} 39 weeks.

We're bustling around the house getting ready for the day, headed to Wal-Mart to pick up groceries and cook up a freezer-full of food for the first weeks after the baby is born. My sister's alto voice is strong as she tells me the latest chapter in her personal health narrative. She is determined to convey how and why she chose to become a proactive participant in her care.

My sister: “I had never asked them why they scheduled it for 39 weeks rather than 40 weeks.”

Many more patients than we believe, even those who trust their physicians, literally, with their lives, are scared.

Scared of what may happen, yes, but also scared to ask questions of care-providers.

When she learned she was pregnant, my sister read quite a bit about natural childbirth, explored homebirthing options, accounts by midwives, doulas, etc. when she learned she was pregnant. However, she'd read almost nothing about cesarean sections.

My sister does not own a television. She does not own a microwave. She does not have a computer or internet access at home, which is why I'm sitting in Bollo's coffee shop in downtown Blacksburg, sipping a skinny mocha, typing this story.

But my baby sister – she wasn't satisfied with not knowing why her doc had scheduled the c-section for 39 weeks. She wasn't satisfied with not knowing the risks. She wasn't satisfied with feeling scared.

So what did she do about it? What just about anyone in their 20s does now. She went online.

She used the computer at work to search for information on Google using the search terms: “c-section,” “when should I have a c-section,” “external version” “how should I flip my baby.”

Based on what she read online, after asking her doc if this particular potential solution was appropriate, she went to the gym and laid upside down on the incline bench with her butt higher than her head for 10 minutes. She stopped when she got dizzy, and felt “embarrassed and discouraged.”

I asked my sister why she looked online for this information. Her response? “Fear.”

My sister: “My perception of what happens if you're not willing to educate yourself is that the doctors will make decisions for you and it'll happen. They'll just tell you that this is the way it's gonna be and that'll happen. I felt safe, don't get me wrong. I felt like I would have been taken care of and that they would have made healthy decisions for me, but maybe not my optimal decision.”

My sister's OB does 5-10 versions a year. 3-4% of babies have some kind of breech presentation. 65% of external versions are successful at around 37 weeks (Blogger's note: Revised after original posting; if I've still got this wrong please let me know in the comments). About 4% of originally successful external versions fail -the baby flips back around. Sometimes this is natural – the stubborn babies don't want to turn, some can't due to neuro-muscular defects.

Question to my sister: “Why didn't you ask your doc or schedule an appointment to talk about your fear first?”

Even though she trusts her physician absolutely to do what's best for herself and her baby, my sister said she went online due to a variety of complicated, interrelated factors including time and a desire to learn for herself what options were available, and hear what other moms thought. “I can tell he's rushed. I feel like he's always been frank with me, has not sugarcoated anything.”

For instance, early in her pregnancy, she prepared a list of questions. One of the first she asked her doc: “What do you see as the risks and benefits of natural childbirth?”

His response: "First let me tell you about my experience with pain. People experience pain differently. Some women can come in at 2cm and are writhing on the table, and some women come in at 8cms and think they're having indigestion.

I think it's really sad when I see a woman dead-set on natural childbirth and she's in pain, or the labor doesn't progress, or the baby goes into distress and she requires an epidural or a C-section (or other intervention) and “it ruins the birthing experience.” They lose the focus of the miracle that their baby is being born."

"On the other hand, women come in planning to have an epidural and it's the middle of the night and they're waiting on the anesthesiologist, or you get it and it's not effective, again, the focus is taken away from the miracle that's happening."

Me: “This was a great answer."

My sister: "More than the risk and benefits of natural childbirth, I think he was speaking more to the mindset of either, the experience.”

She's the part of the consumer healthcare experience no one thinks is happening, but it's out there happening, 80 percent of the time. At least.

I'm wondering how she and her doc have managed to fit so much conversation and cooperation in determining her optimal care plan into 2-4 minute windows. Me: “How long are these visits with your doc?”

My sister: “There have been visits that have been half an hour long, there have been 5 minute visits. It depends on whether or not I have questions. I have to be prepared to make the visit that long. They're not gonna stay in there. Why would they? They have a whole waiting room full of people.”

“When I was at the hospital and he was flipping the baby, he also had 3 ladies in labor, two dilated at 9cms and 1 pushing, and he was still responsible for taking calls at the hospital.”

Literally and figuratively, docs have their hands full. And they're not getting paid to juggle the optimization of care for every patient who wishes to participate.

Our payment and incentivization system is turning docs into mechanics, but we're not giving them the tools they need to keep us running at the levels we want. It's like an experienced, certified, knowledgeable mechanic being confronted with a next-generation hybrid car, and trying to fix the thing's engine with the only tool she's got - a sledgehammer.

The Middle 80 percent of today's medical consumers are the hybrids, and the bulky, imprecise tools we're giving our docs to operate with are the sledgehammers.

This is the other part of the 'consumer' experience in medicine we're all forgetting. Patients aren't the only consumers in the coming “consumer-centric” system. Physicians are consumers of goods and services that increase their ability to treat patients efficiently and empathically, or they would be if better options were out there.

But that's a blog post for another time; let's go back to the 'patients as consumers' thing for a bit.

Part of the problem with the current state of consumer-centric care is that we have problems accepting that simplifying offerings for patients doesn't necessarily mean creating products for the “lowest common denominator” as one Center for Information Therapy's Wired attendee put it yesterday morning during a roundtable discussion.

In one sense, it doesn't matter that the average health literacy level is the equivalent of a 5^th grade reading level. Though the average reading level in the US as whole hovers around a shameful 8^th grade level, this hasn't stopped our economy from moving past the industrial age, to the service age, and finally to a knowledge and innovation economy, driven by supply and demand market forces. US healthcare, however, is still stuck in the 'industrial age' model of care delivery.

The “industrial age” approach to healthcare assumes that the same model will work for everyone in the Middle 80. And you know what they say about assuming.

This completely misses microsegmentation which has swept the global consumer economy. If we aimed for the “lowest common denominator,” we'd aim all offerings at the lower 10 percent, and miss the Middle 80 entirely, both here and abroad.

But in many ways, we already are missing them.

EMR and PHR platforms marketed today are consumer-centric, proprietary, closed-end systems that are bulky, clumsy, and slow-moving. Several tech and web players have semi-decent models, but their organizations lack the coherence needed to make confluent applications palatable to the Middle 80.

When this coherence factor arrives, it will herald the arrival of 'nexthealth' (remember from this post that nexthealth = content + community + commerce + coherence, when healthcare consumers, all of them, can 'dip' online and offline for access to healthcare/wellness goods and services).

An application (or 20) that meet the Middle 80 where we live, play, work, love has yet to arrive, but it's on its way. It'll be here sooner than you think.

Someday soon this post will seem unusually prescient. It's not.

All it predicts is that some few healthcare and HIT entrepreneurs are aiming where the puck is going, and this approach will bear fruit. They will succeed in changing how patients and physicians, two underrated, underrepresented healthcare consumer segments, view healthcare planning and delivery, as both an art and a business.

The Middle 80 is out there, actively searching for 'what's next.' The question is, are you building some part of it for them, or will you watch, bewildered, as the evolution of consumer-centric care passes you by?

Hospitals WANT Guitar Hero Healthcare

"Hospitals want involved patients" - from the Chicago Tribune.

Good piece, but a bit outdated.

The Joint Commission's Speak Up! Program has been around for a few years (at least since I used it as a Patient Advocate 'rounding' in 2003-2004), but you rarely see a specific staff person within the acute care setting responsible for implementing the program.

Our hospital, however, had a team of 5 Patient Advocates rounding on inpatient floors discussing the Speak Up! Program with patients and families.

What, we found, however, upon administering the program is indicative of the healthcare system's larger 'chronic' issues....

The process looked a bit like this:

1. PA enters the room, cheerily confirms identity with double checks (name, armband) - after asking if we can chat about the program and if the patient would like privacy while we do so.

2. Hands patient or family member/friend/caregiver/partner Speak Up! brochure while we give the pitch, usually multitasking and wiping staff board, refilling water pitcher at bedside, etc. Some people don't want the paper or the pitch, so PA asks if any other questions or any assistance we can provide.

3. Asks if patient has any questions or if we can be of assistance. 9 times out of 10 answer is resounding "yes" and issue is NOT related to Speak Up! program but medical care continuity (ie are my labs in yet? When will I be discharged? Who is my new nurse? What's for lunch?)

4. Chase down medical staff (nurse, tech, or in VERY rare cases doc) if it's a medical issue. Otherwise repeat we are 'only' PAs and not qualified to give medical information, but we have feet, and lungs, and can thus chase down and corner medical staff who can give correct info. (This would be why I wore sneakers, Nike Prestos, to work).

5. Bug caregiving staff incessantly if big issue, deliver message and confirm 'report' handoff verbally (and usually in my notebook with time and staff name cited in case I later had to do a variance).

6. Return to patient room and report progress on issue/contact resolution. Deliver sunshine and a smile (or 50).

Final findings from a year spent as a Patient Advocate:

1. Patients want to be involved. (10-80-10 rule: 10 percent unwilling/inable to self-advocate and be participatory, 10 percent hyperengaged, Guitar hero healthcare types, and middle 80 percent may be involved at varying levels).

2. Family members want to be involved.

3. Many doctors don't know how to treat patients who are verbally self-advocating...but if someone whips out a notebook and starts taking notes during the conversation they're on best behavior.

4. Communication between docs and nurses is often FUBAR. The blame baton is passed back and forth like care delivery communication is a contact sport. The rest of us, including patients, are relegated to acting as befuddled spectators.

5. Top issues of concern to patients are related to the 3 Cs: cure, care, communication.

Every initiative that purports to encourage increasing 'guitar hero healthcare' or 'patient involvement' must take systemic deficiencies in addressing the 3Cs into account. To ignore any of them is to court systemic failure.

Right now Ted Eytan is continuing to push on the most complete, viable definition of Health 2.0 for consumer-centric, patient-directed care advocates. Take a look. It's important work.

Until we can define 'involved' patients at a basic level, hospitals will have a hard time connecting idealistic goals to real strategic planning.

Patient involvement, CONSUMER involvement, is a vital component to figuring out 'what's next' for Health 2.0, and beyond.

Yesterday I sat in a nearly empty room at HIMSS DC Summit 2008 watching Jay Parkinson present the first truly consumer-centric GP practice model (here's some WSJ coverage).

Jay's new practice, Hello Health, is opening it's first storefront July 1st in NYC. Pay attention policymakers, hospital execs - the future of healthcare is closer than you think.

Startup in a Hospital - the Transcript

Jen: Ok so Maarten den Braber and I are on the train, after a Nexthealth meeting on Wednesday, the fourth of June - it's 11:33, we're just about to arrive in Utrecht.

Jen: Um, we decided that when we present our paper on the semantic web sparking health 2.0 in Vegas - ah - since we're bootstrapping Nexthealth NL, we need to find a way to get into town and get involved in the healthcare scene there...so - we wanna do "Startup in a Hospital."

Jen: The idea is to stay in a hospital in Vegas for 3 or 4 days, before the conference, to find a hospital contact who'd be willing to let us videoblog from the room - and present possibly some portions of our talk, since what we're talking about is 'nexthealth.'

Jen: Kind of action items to get that going is to contact...Dorrit at InterimIC, see if she knows anybody in Vegas, email Paul Levy, to see if he knows any hospital executives out there, to put out an all post bulletin to our networks via LinkedIn and Twitter, to also talk to some of the docs and med students that we know in the blogosphere to try to find somebody in Vegas...

Jen: Again, we're thinking "Next Hospital," (nexthospital.com), "Startup in a Hospital" (startupinahospital.com), live videoblogging...if we had any kind of video capability on the train we would be doing this, but instead we're just hitting you with the really really low-tech option of an actual tape recorder. Thank you GE for our - circa 1985 recording of the birth of this startup. One of many to come.

Maarten: Startuphospital.com? So...
Jen: Startupinahospital.com?
Maarten: Startupinahospital?
Jen: Yeah...

Maarten: So we should ask - maybe for The Netherlands we should find a sponsor....we need to get our tech gear sponsored - so we'll need videophones, we'll need webcams, we'll need to be able to stream live from the hospital...for the conference...
Jen: Nokia, Apple...(laughs)

Maarten: We'll have to get the, uhm, oh! We'll, we'll try to pitch it to Vodafone. We'll ask Vodafone. They sponsored something at MoMo - we'll get them to sponsor videophone - so Startup in Hospitals...
Jen: Nokia, Vodafone, we're the bloggers you really wanted to meet but didn't have time to at MOMO 6 in Amsterdam, so we'll be in touch.
Maarten: Oh...
Jen: By the way, we need all this equipment in, umm, 4 weeks time because the International Conference on the Semantic Web is happening in Vegas from the 14th to the 17th of July, so, yeah, get back to us quick on this.

Maarten: Ahhh, what else do we need? What else do we need?
Jen: Branded scrubs!
Maarten: ?
Jen: Anybody want to sponsor us while we are videoblogging from our Startupinahospital.com? What are we calling it? Hospitalstartup.com? We should be wearing branded scrubs! With nexthealth.nl and our sponsors, so Vodafone, if you want to sponsor us, that would be really great and we'll wear scrubs...

Maarten: We'll call Scoble and get on Fastcompany.tv...
Jen: laughs.
Maarten: laughs!
Jen: Also, um Jason Calacanis (nice middle name) at Maholo, ah, yeah, we'll be calling you too, Andrew Hyde, Brad Feld at Foundry Group and TechStars, we'll be calling you guys. We're the people who keep annoying you with healthcare and entrepreneur startup slogans for VCwear.com...


Maarten: Hospitalwear.com, Hospitalstartupwear.com - we'll have to launch here, we'll have to launch our own version online!
Jen: Right so if you guys don't help us we'll compete with you.
Maarten: (laughing) - So...

****Train noise - conductor (in Dutch) - Maarten needs to transfer at this station - great flurry of activity ensues as we pack stuff away****.

Maarten: Yeah see you in Vegas. Next time I think in scrubs. Inside a hospital. Doing a startup. Maarten: Oh! We can get Madonna to sponsor also.
Jen: Celine Dion, the Luxor hotel, this list goes on and on.
Maarten: And, and, and we get a free room at the MGM Grand. If we're not comfortable enough.
Jen: Yeah and some high stakes chips, that, that would be really nice too...PS- we are crazy!



As if you needed our help in figuring that last part out...

Importance of Communities in Healthcare: Nexthealth.NL

"The changing of customers habits and behaviours wrought by technology means the old ways just do not work anymore."

- Tomi Ahonen + Alan Moore, Communities Dominate Brands


This Washington Post article has extremely interesting implications about how 'personal' portability influences grounded interactions with geo-local delivery of medical services.

Let's look at the concept of communities and 'personal' portability first.

More than 70% of the 100,000 people tracked (secretly) via this study of cell phone usage never ventured more than 20 miles from their home turf.

That is an astonishing figure.

If almost 2/3rds of us stay within 20 minutes of home, local hospitals still have the opportunity to be concrete care monopolies, acting as 'medical homes' for a vast majority of grounded community members.

The portability of personal health records (PHRs) and electronic health records (EHRs) may have a much more community-based focus than previously supported by research from within the healthcare community (although RHIO organization would seem to implicitly rely upon an assumption that most medical care will be 'locally' delivered within a tight geographic base).

If this is the case, then why aren't RHIOs working?

Becaause siloed 'brick and mortar' communities of care no longer hold exclusive sway - where we live in 'real life' is no longer our only definition of 'home.'

And where we seek medical services in real life is no longer our sole definition of 'healthcare.'

The idea of 'local' community has expanded exponentially with web-based Health 2.0 technologies combining content + community.

Health 2.0 communities like Diabetes Mine and Patients Like Me have delinked healthcare and geographic limitations: intimate, everyday community interactions (which hold vital healthcare implications) no longer happen solely offline.

Even those of us who are homebound or live with 'limited' mobility now have expanded geographic communities in which to live with and learn about our health, enabled via web access.

While brick and mortar healthcare organizations address what's physically wrong with us, I'd argue that online healthcare sites and services allow us to rally additional support, which is accessible at will (when and where we need it most) and address the psychic issues related to illness and healing.

Online healthcare and wellness communities help patients and other consumer segments address a 'crisis of meaning' and reconcile challenges inherent in straddling two worlds.

If you have a chronic condition, in one world, you are a powerless 'patient,' defined by your diagnosis within the medical ecosystem. In another world, the real world, you are a person doing your best to live well, minimizing constraints caused by a lack of coherence between your 'patient' identity and your 'personal' identity.

It is largely the web-based communities which are generating debate about how to reframe healthcare as a conversation and reclaim our personal health narratives.

The good news is that these conversations are jumping offline, but not fast enough.

Those of us debating healthcare evolution in the blogosphere need to be doing more to cooperate with offline policy makers and implementers who can drive innovation from within the current hospital-based system. We need to push past our safe-haven comfort zones online.

Online, the e-patient experience is not automatically devalued. Instead, e-patients involvement with patient-centric, web-based 'medical homes' encourages constructive, community-based reconciliation of patient and personal identities.

E-patients are 'owning' health, recovery, and wellness goals rather than silently suffering the dehumanizing experience of being labeled a patient 'other.'

We are reclaiming what it means to be healing (or dying) in a system that devalues the "human-to-human" empathic approach, subverting recuperative effects of communication below clinical approaches to 'cure.'

Sharing our personal illness and recovery narratives, in sickness and in health, is a vital component to sparking healthcare change, at both an individual and a systemic level. Connections and online health/wellness communities are viral and exponential -people connecting people.

Nexthealth was started to address advantages of connecting innovators who want to spark healthcare change and are willing to drive "what's next," integrating healthcare design, planning, and delivery both online and offline.

Only through person-to-person interactions, 'connecting the dots' on the web, and in the real world, and creating a road-map to consumer-centric, patient-directed care can we support a healthcare delivery ecosystem that values conversation and cure equally - that supports both empathy and efficiency initiatives. That reconciles the patient and the personal experience.

Please join us. Nexthealth.nl does not aim to subvert or exclude any group - it will take a global hive community of firestarters to spark change and build roadmaps leading to "what's next" in healthcare.

Gauntlet is Thrown - Why I Believe in Consumer-Centric Care II

Blogger's Note: This lengthy post attempts to make up for time lost during last week's vacation, so if you're looking for a quick, easy read, come back tomorrow. If you've been waiting for a follow up to earlier posts dealing with consumer-centric healthcare, take a deep breath and read on. Better yet, join the conversation. When I say "healthcare consumer," I mean YOU.

“The pessimist complains about the wind; the optimist expects the wind; the realist adjusts the sails” — Anonymous

Recently I wrote this 'dear diary' style confessional post, which is quite a departure from my normal approach to writing for Health Management Rx. I took a big risk in revealing my patient backstory, but I believe it's paid off.

The post details (at a personal level) why I believe (at a professional level) a consumer-centric orientation is the only thing that can improve both efficiency and empathy within our healthcare system.

I paused before hitting the “publish” button on this post numerous times, but a wise blogger (thanks Drew!) told me that at some point revealing a personal anecdote contributes sufficient value to the ongoing discussion -especially when it’s coming from an e-patient.

Today’s post, then, is concerned with:

1. Continuing the conversation;

2. Formatting a response that drives readers toward further discussion; and

3. How to follow through and develop new business ideas that expand the current limited scope of the traditional 'healthcare consumer' (with actual scenarios detailing new business approaches).

Since I’ve committed a cardinal blogger's error by waiting so long to publish a follow-up post, I suggest you read the original post first, as well as the comments.

Now on to Part II of Why I Believe in Consumer Centric Care.

First, we must stop treating patients and other healthcare consumers as the "cheap gas that fuels our sector."

If you don't believe this, stop reading now.

The quote above is from the blog "Perspectives from the Pipeline," detailing the career of rising nonprofit czarina Rosetta Thurman - Rosetta, couldn't have said it better. (Congrats again on your new professorship you amazing nonprofit leader you!)

Although Rosetta was discussing the 'disposable' nature of young, idealistic nonprof employees who are used/abused until they burn out and leave 503c waters for greener corporate pastures, the quote also applies aptly to how we currently bill and treat patient encounters in the US healthcare system.

Healthcare consumers are currently (pick one):

A. The "cheap gas that fuels our sector;"

B. Passive receivers of care 'products' and service bundles;

C. Brief, disposable interludes of episodic care delivery; or

D. An illustration of how our interactions with providers are ruled by payment, pricing, and promotion of our current hierarchical structure.

E. All of the above.

If you answered all of the above, there's only one system big enough and powerful enough to connect disparate consumer segments and generate a small series of 'microquake' developments that aggregate into big change - the web.

Future web-based, consumer-directed applications, a subsector of HIT that has yet to live up to its potential, present an opportunity to do just this.

Here's my position: The entrepreneurial creation of semantic web applications is the only movement chugging along fast enough to join patients and providers before the healthcare spend bankrupts our economy.

We can't rely totally on government, advocacy groups like IHI, certification bodies like JCAHO, etc. A commerce-based, consumer-centric approach, driven by companies that pave the way using web-based tech, is the only thing that will move us quickly towards improvement. If a significant portion of the American population starts using 'killer apps' for healthcare, the rest of these organizations will jump onboard.

(Blogger's Note: If you want to hear more about how to harness the power of the semantic web to advance consumer-centric care modalities, come watch as co-author and neXthealth partner in crime Maarten den Braber and I present the concept at SWWS 08 in July - we'll be talking about how the "Semantic Web Sparks Evolution of Health 2.0" and providing "A Road Map to Consumer-Centric Healthcare").

Taking a completely understandable, traditional healthcare perspective, some readers respectfully disagree.

After reading my post and some earlier commentary on PHRs, Dr. Ian Furst, one of the most prolific medblog commentors I know, and whom I'll have the great fortune to meet at Medicine 2.0 Congress, threw down this gauntlet.

After rereading Ian's post, I find one of the only points where our opinions truly differ is that I do believe the internet concretely allows physicians (and patients) to reach out to each other with “greater richness.”

I am, however, sorry to see Ian takes exception to my assertion (and certainly not mine alone) that the web will help save healthcare – the Health 2.0, consumer-centric partyline "goes that the internet will allow you’re [sic] doctor to reach more people with greater richness than ever before. Don’t believe them – it’s bullshit."

And yet the internet is allowing us to do just this. All of our blogs allow us to do this. Ian's blog, written and richly informed by his commitment to his profession as a doctor, allows him to do just that, doesn't it?

To Ian: Do your patients read your blog? Do you tell them about it during visits? Do you invite them to comment and participate in the online conversation?

I won't argue with most of the rest of Ian's entry, as it's spot on - including the point that we're still stuck in Web 1.0 and Health 1.0. I agree wholeheartedly.

As an industry (the business of healthcare) and as an 'art', we're still largely focused on what content, sometimes on what content + community (Health 2.0) can do for primary care, when we need to be moving beyond and focusing on developing a realistic roadmap that will guide us towards efficient, empathic consumer-centric care in a wide spectrum of sectors.

And yes, this means breaking wide the 'traditional' definition of consumers in healthcare mentioned in the comments section by Dr. Wes.

First, my confessional style was not a play for anyone's pity - I don't need or want it - but rather a plea for professionalism and respect as we continue to advance the conversations between patient and provider on how to improve the system for both.

If one more person who reads it begins to think of herself as as 'healthcare consumer' then we're one step closer to improving care, one person, one patient, one provider, one caregiver at a time.

After reading responses and comments from Ian, Dr. Wes, and Drew from Our Own System, I am extremely proud to know professional physicians (and health admin students - there IS hope for the future Drew!) who are equally passionate about improving doctor-physician relationships.

So here's point 2 for the day: We obviously 'get it' here in the blogosphere, and although we differ on smaller issues (Just how much DOES a good consumer website cost, Georgia? IBM?) we're still talking to those with similar views and then patting ourselves on the proverbial backs.

We've ALL got to get out there and pay it forward.

I'm walking the walk here in Holland with a bunch of amazing folks founding neXthealth NL.

What are you doing, dear readers, to talk about consumer-centric care outside our comfort zones? Become cheerleaders for the cause? Seek out voices of dissent?

What we need in the medical and healthcare blogosphere is a classic case of "less me, more we"…How do we connect patient-centric medicine bloggers with policy wonks?

If we get that debate going we might see some real fireworks, instead of just pushing at each other with sticks to drive site traffic.

My question for today is this, dear readers:

Why would we NOT try ANY and ALL measures available to improve patient care, even if it is a PHR designed by a consumer-company or a consumer portal that costs 5.2M?

Let's answer the question above using actual business case scenarios, and detailing how future web-based developments may help expand the current healthcare consumer spectrum.

Dr. Wes detailed a dose of healthy skepticism about 'consumer centric care' in the comments section of my original post.

He implied that if I was in an ambulance on my way to an ER I wouldn't stop and check the ER's ratings on my mobile phone. Let's start with this example and examine how the semantic web might help drive us towards consumer-centric care.

First, Dr. Wes's assertion is not entirely correct. My main point with pushing the consumer-centric discussion is that if companies build these types of services, SMARTLY consumers will use them.

If a mobile, web-based app was available on my Blackberry for me to quickly and easily access ER ratings info (within the 'holy trinity'- 3 clicks to information access), I would use it - yes, even from the back of an ambulance if I was capable of doing so.

Of course, that's the big "IF"...and there's simply no way to predict if I'll be conscious and cognizant enough to use such a service. But I'm not the only consumer who would find such data valuable in this scenario. Let's flesh out the example a bit.

Scenario I using Dr. Wes's example: PATIENT AS CONSUMER (during care).
If I was in an ambulance on the way to an ER and physically/mentally able to use my mobile phone and access a web-based app that lets me check quality and safety ratings (i.e. not coding and conscious), I might indeed check to see if an ER was listed in the top 10 in my area.

If I have a rare, chronic condition for which I'm currently under treatment, I might also use this service to send an email to my treating specialist using my cell's address book, letting the office know I'm on my way to that ER. This would provide continuity of care, especially if my condition were to worsen en route or after arrival.

Scenario II using Dr. Wes's example: PATIENT AS CONSUMER (prior to care).
But most likely I wouldn’t NEED to go that far, because if I was conscious I’d be able to recall looking at a website to see top EDs BEFORE I’d need them, when I read a blog post or press release or saw a news article about this new 'killer' app (no pun intended).

And now I'll push the point even further.

Follow along carefully because here's where things really get going.

When we succeed in creating a truly consumer-centric American healthcare system, quick-thinking, fast-moving startups will create services and products for consumers outside the 'traditional' categories, like patient and provider.

Scenario III using Dr. Wes's example: AMBULANCE CREW AS CONSUMER.
In this instance, if I was on my way to an ED, my ambulance crew might use a web-based application to check wait times/availability at several area hospitals simultaneously without radioing to all separately.

This would allow them to choose a route more quickly, accept it on the mobile device, and instantaneously upload driving directions to the in-ambulance GPS unit. Meanwhile this killer 'Paramedic 911' app might also transmit arrival time and patient stats to the hospital ER prior to arrival.

In this case the paramedic crew is the 'consumer.'

Scenario IV using Dr. Wes's example: FAMILY/FRIENDS AS CONSUMER.
Also, even if I’m unconscious, if I’m in an accident or injury and a family member, friend or spouse is following the ambulance, there’s a good chance THEY would be checking on a mobile, web-based application to see if the hospital where we were headed was highly rated.

In this case the family member following my ambulance is the 'consumer.'

The scenarios above are a bit out there, but not too far out in the future - the web-based infrastructure to build these services is in place.

Now all it takes are startup teams with vision, drive, a really good developer or 20, and dollars. Health 2.0, neXthealth NL crews - who wants to take these concepts and make them a reality?

One of my main points in the original post was that current ‘consumer-centric care’ includes both the patient and physician in the care process, which may (or may not) be facilitated by technology and ‘corporations.’

One of my main points today is that a fully-realized ‘consumer-centric’ system involves many more parties than just the patient and physician. So anyone using a mobile phone to check hospital rankings then becomes a consumer (including the hospital Board member or exec who is checking to see how they rate).

And a further point of clarification. I don't seek to raise the perspective of the patient over that of the physician. To the contrary - I in no way want to unilaterally make “all” of my healthcare decisions, and I don't want the web to replace the relationship I have with my docs. I want it to augment and support that relationship.

It is this example of mobile, highly personal interaction with tech that demonstrates perfectly my deep, individual support of your main theses, Drs. Ian and Wes - that relationships between physicians and patients are intensely personal, and that ANY tool we test, including the web, MUST improve communications and care rather than clutter up the airwaves.

Tools not used are tools wasted waiting for an applied purpose.

Tools used incorrectly are a drain on systemic productivity.

But who currently defines whether or not the tools that enable us to possibly enhance care are used "incorrectly?"

In a more 'democratic' system, BOTH patients and providers, as partners in care, must co-determine which tools allow us to move towards more efficient, empathic, consumer-centric delivery.

In a more democratic healthcare system then, many segments of consumers will use tools such as the web to move towards consumer-centric care.

But first, give e-patients - empowered patients - the tools we need to communicate better with our physicians, to harness the power of personal goal setting (and attainment), and that, my physician friends, will change "our" system.

The web is just one of many tools in our arsenal to save healthcare, but it is a big honking John Deere rather than a wimpy garden spade.

My point is that nothing short of massive collaboration, continuously evolving entrepreneurial activity, and a new way to view the communications between all stakeholders in the healthcare system will save the private-public hybrid that is the current American healthcare system.

The web is ready and waiting for companies to develop applications that do just that.

The government is also getting ready though…

But Dr. Wes's point in the comments section is excellent - it's absolutely going to take a he&% of a lot more than a government/industry partnership, as illustrate by this example of Philly's failed 'universal wireless' project.

Do we want to see federally funded universal care programs administered by HMOs enacted in 2010 and failing by 2015?

And us consumers?

We're tired to death of having traditional choke-hold messages forced down our captive throats in other industries - but we haven't yet risen up to protest spoon-feeding (or more aptly syringe-feeding) in healthcare.

We haven't yet seen the rise of consumer-oriented, web-based service companies that show us the light, show us how things could be. That show us we can look and want and need and buy and participate more in BOTH the art and the business of getting better.

But these firms are out there, and the scenarios I describe above are on the way - make no mistake.

The telephone, the internet, Google, neXthealth - some entrepreneur will step up and show us what being at the center of the healthcare web, literally and in tech lexicon, can look like.

And once we realize all the choices out there, we'll need help navigating the system.

Lucky for you, Dr. Wes, we're still at the point where we'll largely come to our docs for this type of assistance.

We still trust you MDs...we don’t want to replace you with tech - let's all keep it that way by being open beta testers of innovations that could improve care -web-based or otherwise.

The mainstream media, in addition to the blogosphere, are already on the case, one prophet at a time, convincing consumers to move towards proactive wellness goalsetting.

It's happening in other industries. Let's take telecom again for example...30 percent of us now receive most or even ALL of our calls on cell phones.

As a physician, you appropriately emphasize the importance of communication. So, Dr., how are you adapting your communication style to keep up with new conversational pathways?

It's only a matter of time before consumers realize our healthcare is entrenched in methodologies as antiquated as the gramophone.

Yes, medical technologies wide and wonderful have been introduced. But the care process, the actual design of hospital and healthcare delivery, has changed little since the Roaring 20s.

We also thought we would be fine without penicillin, the x-ray, respirators, ex-fixators, chemotherapy. Of course we would - we didn't know any better until a game-changing innovation, often, gasp, a technology, modified the care process.

And, my friend, I warn you - once we know this, and our money talks, where we can't interact at will - we will walk. And you will too.

Your best hope, if you want to avoid this big-bang evolution, is to pray for federally-funded healthcare and a completely socialized system.

Plus, only 14% of 940,000 docs in the US have minimally functioning EMRs in place, so you've got 84% of market capitalization to rest your laurels upon before you have to actually implement change.

I say the semantic web will save healthcare because it will help unleash increasingly powerful market forces of supply and demand.

But it is certainly not the ONLY factor to do so - current disruptive innovations like retail clinics and "focused factory" specialty hospitals, as well as concierge care, all turn consumers minds (consumers = patients, providers, payors, physicians, pundits, etc.) to a more robust discussion of value in healthcare...

And this circles us right back around to the control issue.

What IS value in the current healthcare system? Who defines it? And why the he@% didn't anybody invite patients to the prom sooner?

Vanderbilt sets the bar higher than ever before with a “no tolerance for unprofessional behavior.” The goal? To ensure a quality patient experience. Get it? Professional behavior in the medical sector = QUALITY EXPERIENCE.

Until we start thinking, developing, and implementing tools to ensure a quality experience for ALL consumers who interact with the healthcare system, we're still sitting dead in the water. Get going. Stop waiting for someone else to throw you the oars.

Health 2.0 Unconference NL - The Nitty Gritty Review

On April 12, 1955, Dr. Thomas Francis announced the success of Dr. Jonas Salk's polio vaccine trials.

Salk was a workhorse completely committed to his cause - he spent 5 years developing the vaccine and then a year testing it in the field.

It took more than 7 years of his life, but Salk's preventative R&D helped eradicate the polio virus' devastating effects. 2 years after widespread use, polio cases had fallen 85-90 percent.

53 years later, a movement in preventative wellness management is tackling the largest, 'unspeakable' problems in healthcare.

Health 2.0 promotes proactive, preventative measures to optimize individual health (and thereby improves collective health), putting the patient at the center of the care model.

With 2 years of HealthCamps, conferences, and most recently the Health 2.0 Unconference NL, the movement started by Salk-style workhorses Matthew Holt and Indu Subaiya has gone viral worldwide.

When Maarten Den Braber, Martijn Hulst and I started emailing about our interest in Matthew and Indu's concept and planned the first Health 2.0 event in Europe, we had no idea we selected such a portentous date - you can't beat the success of the polio vaccine's annivarsary.

Is it arrogant to propose the Health 2.0 movement has the potential to make an impact as big as Dr. Salk's vaccine? Undoubtedly. But then again, refocusing on the patient has the power to positively impact healthcare delivery in a way that hasn't yet been quantified.

Maybe there isn't a cure for what ails healthcare, but Health 2.0 may very well be a vaccine.

The "Three Musketeers" who organized Health 2.0 NL are equally committed to the cause below, and left Saturday's event with a deeper commitment to linking worldwide consumer-centric healthcare events and supporters.

The big 'unspeakable' problem we're all trying to address (from Salk's vaccine to Health 2.0) is this - healthcare is an inherently reactive organ trying to be a predictive one. (So is medicine 2.0 - so is Wall Street for that matter...)

In a dingy, dark, suitably 2.0 loft building (Volkskrantgebouw) in Amsterdam (see Flickr photos here) a group of almost 50 people gave up their Saturday afternoon (on a rare gorgeous, sunny day in Holland) and tried to figure out how to move Health 2.0 from the visionary stages to the very real implementation phase.

There were balloons, vibrant voices, now-infamous junk food and tooth-destroying beverages (soda, coffee, beer, and sugar free Red Bull for the addicts in the house) - also more Macs than an Apple Convention. The only way this would have been more of a true "dot-0" event is if one of us took off our shoes mid presentation (or wore Adidas sandals a la Mark Zuckerberg).

Although there was plenty of buzz, here is why Health 2.0 will become a force to be reckoned with in Holland:

Everyone at Health 2.0 NL was fully committed to grounding the nebulous concept (for ourselves) and opening up the discourse for all to define the movement (consumer-centric care, human-to-human marketing, web 2.0's content+community).

Yet, we all kept an eye on potential benefits of implementation in practical terms for various market segments (providers, payers, patients, govt., etc).

It was a perfect meeting of the minds - we had both prophets and producers.

I speak for most there when I say we 'got the buzz,' but also that we moved pretty darn quickly to asking tough questions about Health 2.0 -including:

• "what does this actually look like in practice?"
• "which is most important, clinical results or customer relationships?"
• "does our system even need quality/clinical improvements in Holland?"
• "what does Health 2.0 NL have in common with US Health 2.0? How are they different?"
  
• "what do successful Health 2.0 business models look like - for providers? for payers? for govt? for patients?" (case studies - can it make money? can it make people healthier? can it reduce costs?)
  

We're trying to define, direct, and then disseminate Health 2.0 efforts, opening the door for consumer/patient discourse, in the real world here in Holland.

To do that, there are 3 types of people needed to move consumer-centric, human-to-human care (Health 2.0) forward:

1. Innovators - inspiring creators/visionaries ("us)
2. Interrogators - inquiring critics ("them")
3. Implementers - those who harness benefits of clashes between innovators and interrogators and "do"

When I was preparing for Health 2.0 NL, I assumed we'd have a crowd of all Type 1 people - inspiring visionaries.

I'm happy to report I was utterly wrong. We had plenty of interrogators. Some attendees provided tentative stabs at what implementation would look like in their organizations (consulting firms, marketing/communication firms, web/tech firms, hospitals, insurance firms, students, etc).

This means in Holland we're not just excited by the possibility of being involved in something 'big,' we're focused on harnessing H2.0 and developing ways to evangelize to providers and payers and bring offerings to consumers "where and when they live" at a price SOMEONE is willing to pay (who pays for consumer-centric care is an entirely different animal).

At Health 2.0 NL this weekend, I suggested the success of this movement requires not only continued coordination of efforts among the three types of people above, but an equally strong commitment to integrating two types of complementary (rather than competing) initiatives:

1. efficiency and;
2. empathy.

For more details, you can view my amusing (I hope) PowerPoint here at SlideShare (and access the complete suite of presentations - and I guarantee they're much more professional and constructive - given this weekend here at the Health 2.0 NL group).

Tip: Ignore the joke slides and head straight for the meaty definitions - without the dialogue I use during the presentation they're not useful (unless you really like photos of ninjas or MGs).

For the purposes of advancing consumer-centric care, efficiency initiatives improve clinical outcomes, while empathy initiatives improve the consumer-centric patient 'experience.'

In other words, efficiency+empathy initiatives combine the hard 'science' of medical practice (and medicine 2.0) and the 'softer' side of a service design that addresses a patient's total wellness interaction with a provider, product, or service.

You'll see in most coverage of the event that people here in Holland are asking excellent questions about implementation - including when the next Health 2.0 Unconference NL will be held.

For a taste of what we're in for check out 31volts - and read the guys' review here (thanks Marcel and Marc).

A people who inspired the term 'going Dutch' are appropriately focused, of course, on costs of implementation and exploring business case models that work.

As a result, we'll be scanning the globe for successful Health 2.0 companies who bring in revenue and provide positive ROI to speak and sponsor the next events (look for a larger conference in early 2009).

I can talk until I'm blue in the face about companies that I think fit the bill, but I'm biased - I've been to both US and NL events.

Let's take a closer look at what the Dutch attendees are looking for:

Jacqueline Fackeldey, of Fackeldey Finds, had an excellent presentation on a concept she invented called "hotealthcare," which is built on an empathic "human-to-human" approach.

You can find Jacqeline's show at the Slideshare group link, and here's her coverage of the event itself (in Dutch).

If you're doing human-to-human marketing in healthcare, we want to know more.

Head over to MedBlogNL for coverage of the event with 2 more PowerPoints also available at SlideShare.

If you're a provider or payer adopting or adapting eHealth initiatives (and especially if you're implementing them into brick-and-mortar practice), we want to know more.

The Dutch blog Zorg voor Klanten has nice, concise feedback here.

If you're organizing a health 2.0, medicine 2.0, web 2.0, business 2.0, or other 2.0 event that boils buzz down into substantive business cases, we want to know more.

My favorite comment, tweeted live from Dorrit Gunters, says: "Health 2.0 is gezellig."

It's difficult to translate the 'gezellig' concept exactly into English, but loosely it means Health 2.0 is comfortable, Health 2.0 is 'cozy' with a sense of the 'right' kind of closeness.

If your organization is making healthcare interactions more comfortable for consumers (or providers!), we want to know more.

Here's a longer review (in Dutch) by Erwin Blom, a review at Medical Facts, and coverage at Medisch Contact.

If you're an inspirer, innovator, interrogator, or implementer who wants to be involved in the next Health 2.0 event, we want to know more.

If YOU want to know more, contact one of your 3 intrepid organizers:

• Jen McCabe Gorman (jennifermccabegorman@yahoo.com | twitter.com/jenmccabegorman)

• Maarten Den Braber (mdb@twister.cx | twitter.com/mdbraber)

• Martijn Hulst (martijnhulst@gmail.com | twitter.com/martijnhulst)

* If you'd like to chat in person, I'll be blogging from the World Healthcare Congress in DC next week.

A special note:

Transparency and access to information and care are central tenets of Health 2.0, or consumer-centric care.

All the materials the Health 2.0 Unconference NL has posted online are open-source, but please adhere to the Creative Commons license. (Dutch) Basically, graphs, photos, etc. may be reposted, reused, and recycled with attribution (especially if it has someone's name on it or photo next to it).

Some final food for thought...

If we conceptualize Health 2.0 (consumer-centric care) as more than a movement - as a concrete subset of the current healthcare industry - many products and services do (or will) fit in this sector - not JUST health information technology (HIT).

The great news is that the timing is right to push transparency in the hospital/healthcare marketplace; big players are beginning to quantify the benefits of transparency (whether it be in a hospital, on the factory floor, or in a graphic design firm).

These benefits extend to more than patients - they also extend to providers in the healthcare environs (and have the potential to provide hard HR benefits such as reducing turnover).

One example: Deloitte just released the 2008 Ethics & Workplace study (hat tip to Lisa Haneberg@Management Craft, who got me started flapping my wings with this blog last year). The study reports over 80 percent of respondents agree leadership openness creates a more ethical culture.

Another example: In Singapore, Sun Microsystems just supported a healthcare/tech mashup (hat tip to Maarten Den Braber).

At the practical level, what we're all talking about is the development of a comprehensive suite of PET (Patient Empowerment Tools).

Whether Health 2.0 products are offered virtually or at a 'real world' brick and mortar healthcare/wellness site, whether they're hardwired into hospital infrastructure or more nebulous web-based applications, these goods and services put the patient at the center.

Which is exactly what we're trying to do here at Health 2.0 NL. If you're a person who is also a patient, and a consumer-centric service or product has empowered you to become a partner in your care - we want to hear from you.

A brief note: If you write a review of Health 2.0 NL, link to any blogs/presentations/photos, or respond to any of the information above in a web-based format, please be sure to use the tag 'health20nl' so we can continue to build the community.

To Niels Schuddeboom, Jacqueline Fackeldey, and Jeroen Kuipers, Marston @ SugarStats, and Peter @ BubbleFoundry - you are amazing and we'll have a blast with things as we all move forward together.

One final note of thanks, and perhaps the most important one.

I've already mentioned our fabulous four sponsors, but I need to heartily thank everyone present this weekend who put up with my deplorable lack of Dutch and graciously presented ideas and feedback in English.

Your generosity in making allowances for my language difficulties definitely made the day "gezellig," and I've found a new home here in Health 2.0 NL.