Mark My Words

Before I get into the meat of this post I should briefly explain my position in relation to its content. I admit to primarily being a technologist with a growing level of exposure (both in a physical and digital sense) into the health care domain. My degree in Informatics (now no longer taught) was from a School of Computing and so I have had exposure to such terms as Web 2.0 and the Semantic Web. This included the technologies used to empower these “versions” of the World Wide Web (WWW), knowledge- and ontology-based representations of data, data mining, knowledge discovery, personalisation and user adaptive systems.

The aim of the post is to add some of my own thoughts on what I believe is meant by Health 2.0. I realise that some great minds have helped shape the current definitions including the Wall Street Journal, Michael Porter and Michelle Teisberg, Scott Shreeve (@scottshreeve), Matthew Holt, Laura O’Grady, Jane Sarasohn-Kahn (@healthythinker), Lodewijk Bos (@icmcc) et al. and Gunther Eysenbach (Medicine 2.0) amongst many others but without disruptive people (like myself) rocking the boat these definitions will never evolve.

Web 2.0

Two of the most influential sources (to me) on the topic of Web 2.0 are a post from 2005 by O’Reilly Media (@timoreilly) and a YouTube video entitled “The Machine is Us/ing Us”:

The most important concepts to come out of both resources are:

• Form is separated from content, meaning that users do not need to know how to manipulate code to upload content to the WWW. We’re not just talking about text, this has exploded into a growing array of audio, photo and video formats. XML facilitates automated data interchange between services meaning multiple sites can “mash” data together.
• Tag-based bookmark (“folksonomy”) services have flourished such as delicious and Digg which aim to eliminate directory-based (taxonomy) methods of storage. They also facilitate “social” bookmark sharing enabling us to connect to other like-minded individuals across the world.
• We are the web. We are teaching the machine and the machine is us/ing us. Web 2.0 is about linking people through the web and using it as a platform where we control our own data.
• Web 2.0 is about harnessing collective intelligence where network effects from user contributions are the key to market dominance.
• Web services are critical to supporting lightweight programming models, syndication not co-ordination, and are designed for “hackability” and “remixability”.
• Useful software written above the level of the single device will command high margins for a long time to come. (I will refrain from saying “the cloud” as I don’t believe it is as mature a term as it could be.)

O’Reilly also made suggestions about the core competencies of Web 2.0 companies. How many of these apply to your health care business?

• Services, not packaged software, with cost-effective scalability.
• Control over unique, hard-to-recreate data sources that get richer as more people use them.
• Trusting users as co-developers.
• Harnessing collective intelligence.
• Leveraging the long tail through customer self-service.
• Software above the level of a single device.
• Lightweight user interfaces, development models, AND business models.

A lot of sites seem to use social networking and Web 2.0 interchangeably. This one’s for another day but I think this confuses things. Social networking applications such as Facebook and MySpace offer a service to users to enable them to share content online, much the same as blogging hosts do. These services facilitate Web 2.0 but are not Web 2.0 itself. Although Web 2.0 is inherently “social” it should not be characterised by services built on the platform. The same confusion is apparent between the Internet and the WWW. With the WWW being an application built on top of core Internet functionality. What are your thoughts on this? Is it OK to mix the two definitions?

Health 2.0

There appears to be two streams of thought on Health 2.0. The technologist’s view is about “making it easier than ever for consumers to find timely, personalised health information online”. With Health 2.0 web sites now offering collaborative functionality such as blogs, wikis and podcasts to facilitate this transition from static pages. Patient empowerment, not consumer-direction, is the key with a reliance on interoperability of services.

Gunther Eysenbach’s model of Medicine 2.0 (closely related to Health 2.0) focuses around three poles/tensions: consumer/patient, health professionals, and (biomedical) researchers. Although there is a mish-mash of terms inside the core of the model, all from different generations of WWW evolution, I like the idea of the concentric rings: apomediation, participation, openness, and collaboration. Maybe it would be nice to see the model placed onto a time-axis like the Gartner Hype Cycle models? After all, the pace of change of technology is so fast that some of these applications will become obsolete in the coming years.

In tandem with the technologist’s view, Scott Shreeve’s model of Health 2.0 (see below) removes any specific mention of underlying technologies (wise, as they are evolving every minute) but includes (technological) innovation implicitly inside many of its sectors. The model is very business orientated and looks to be inspired by the work of Michael Porter and Michelle Teisberg on value chain analysis. (Another great read from Michael Porter (2001) is his seminal text in the Harvard Business Review on “Strategy and the Internet” which may also help you to understand Scott’s model better and also if you’re interested on developing an Internet strategy.)

Scott’s definition of Health 2.0 is:

“[The] New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

The issues I have with the definition is that it excludes the general public (unless that is what is meant by payers) who may be part of The Staying Healthy Pathway which focuses on health in the long-term and not the short-term. For these people Health 2.0 is about preventative care, but as the value of “good health” is indefinable it is lost in the definition. Secondly, the definition assumes a market-driven society where competition drives innovation e.g. in the United Kingdom in public care and the National Health Service (NHS) this is not quite the case.

The problem I see with Health 2.0 (as is the problem in most other sectors) is that we are focussing too much on technology solutions looking for problems, rather than problems looking for technology solutions. If we take a step back and assess the playing field before asking “why is hospital X not on Twitter yet?” or “why is Doctor Y not on Facebook?” and focus on “why should hospital X be on Twitter?” and “why should Doctor Y be on Facebook?” then we can look to make greater contributions. That way, we can look to be pro-active by playing the ball back into the court of the technologist by saying “we have problem Z and we need you to find us a solution” rather than remaining re-active and accepting anything that they put in front of our noses and looking for where it may fit.

To this end, my attempt at a definition of Health 2.0 is:

“Health 2.0 is a continually evolving cycle of health care innovation enabled by the empowerment of the public, patients, health care providers and suppliers, and researchers through increased collaboration, participation, apomediation, feedback and transparency of value-enabled health care interactions.”

I hope you enjoyed this post and please feel free to add comments on what Health 2.0 means to you, and to critique my definition. The definition encompasses the thoughts of many of those who came before me but adds the requirement of feedback to support evolutionary innovation with a focus on “value-added health care interactions”. “Value” is this context is used deliberately to mean anything that may be perceived of as “good” for any of the people it affects.

I was also hoping to extend my thoughts on the Semantic Web and Medicine 2.0 but I will save this for another day…