Thursday, April 23, 2009

Health 2.0, Medicine 2.0, and Other Matters Large and Small

I have a friend, Brian Klepper, prominent health care analyst and principal of Health 2.0 Advisors ( To see how his mind works, read the blogs that he and his online running mate, David Kibbe, MD, are currently writing in, open letters to David Blumenthal, MD, the new National Coordinator of Health Information Technology(HIT) for the Obama administration.

As I read it,HIT's objective is to put an electronic health record system in every hospital and every doctor’s office by 2014 by using carrots (increased Medicare payments for “meaningful use” or “certified” EHRs) and sticks (lowered Medicare payments for non-users).

Brian called yesterday from Boston, where he attending and giving a keynote at the Health 2.0 conference from April 19 to April 23.

If you’re unaware of Health 2.0, and its online running mate, Medicine 2.0, collectively sometimes called Web 2.0, I invite you to read their respective website. Health 2.0 and Medicine 2.0 are terms used to describe the massive Internet-sharing of health and medical information among everyone with interest, from health and medical professionals, to patients, to caregivers, to the businesses (pharmaceutical manufacturers, health insurance) which support them.

Health 2.0

Health 2.0 and Medicine 2.0 are separate organizations.

Health 2.0, founded in San Francisco in 2006, is more diverse than Medicine 2.0 and thinks of itself as a social networking site for online user individuals dedicated to restructuring health care using the Internet for providing the tools and framework To give you a “feel” for where Health 2.0 is coming from, here is verbiage promoting their current conference.

“Health 2.0 Conference and the Center for Information Therapy (Ix®) are delighted to announce their first joint conference. The two organizations have been discussing the tensions and synergies between Information Therapy and Health 2.0. And they've been looking for a way to collaborate and integrate all the hundreds of ideas about the role of patients in the transformation of health care. So it makes great sense to put the two organizations together for one great conference.

" That conference will be April 22-23, 2009 at the Boston Park Plaza Hotel.

The theme: ‘The Great Debates on the Next Generation of U.S. Healthcare.’
• Health 2.0 & Ix: Tensions & Synergies
• Knowledge creation: Experts vs User-Generated Care
• Navigating the health care system: Human intermediaries vs. automation & algorithms
• How do you build Health 2.0 into the delivery system?
• What is the future role of the doctor?
• What are the incentives for Health 2.0 and Ix?”

“There'll be a stellar line-up of cutting-edge demos, compelling speakers and lots of surprises. Confirmed speakers include Don Kemper (Healthwise), John Halamka (Beth Israel), Rob Kolodner (ONC), Dan Hoch (BrainTalk), Esther Dyson (EDVenture), Paul Wallace (Kaiser Permanente), Jamie Heywood (PatientsLikeMe), and many, many more. In addition Health Affairs Editor and America's leading health care journalist Susan Dentzer will moderate a debate about the future of incentives for Health 2.0 and Information Therapy.”

In Boston will be small players- consumer groups, entrepreneurs, doctors, health system leaders – and the big Internet boys – Google, Yahoo, Microsoft, Cisco, and WebMD – all networking, niche-seeking, and noodling-together – to discern where things are going. In a sense, this is an Internet-based free for all in search of larger mission – reining in the health system, making it more rational and consumer-oriented.

Medicine 2.0

Medicine 2.0, which will hold its annual conference in Toronto in Toronto on September 17 and 18, thinks of itself as a more global and academic than Health 2.
But as you can tell from the following self-definition there is overlap with health 2.0.

“Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers. Patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic and virtual realites tools to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness wtith and between these user groups”
Medicine 2.0 focuses on academics and peer-review and approval , as differentiating points distinguishing it from mere Health 2.0 “tradeshows.” At least, that’s the sense I get from their website language.

“The Congress is organized and co-sponsored by the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations.”
“This conference distinguishes itself from ‘Health 2.0’ tradeshows by having an academic form and focus, with an open call for presentations, published proceedings and peer-reviewed abstracts (although there is also a non-peer reviewed practice and business track), and being the only conference in this field which has a global perspective and an international audience (last year there were participants from 18 countries).

An academic approach to the topic also means that we aim to look "beyond the health 2.0 hype", Different “World Views” of Practicing Physicians and Web 2.0 participants
trying to identify the evidence on what works and what doesn't, and have open and honest discussions.”

Different “World Views” of Practicing Physicians and Web 2.0 Participants

As I read the promotional material on the Health 2.0 and Medicine 2.0 websites, one thing that strikes is lack of talk about the tensions between their approaches and the current approach of physicians, so I have decided to create a chart showing these changes in relief and the conflicts

Current Physicians Web 2.0 (health 2.0 and medicine 2.0)

Care based on periodic visits and encounters. Care based on continuous Internet- monitored care.

Doctor using experience and intuition knows Patients and consumers using Internet
best. and system data know best.

Professionals control care. Patients and consumers are the
source of control.

Too much infiltered information can Information is therapy.
be a bad thing.

EHRs are not ready for prime time, EHRs have arrived and simply have
cost too much, and slow and disrupt be tested, debugged, "certified,"
normal practices. subsidized through Medicare rewards.

Patients should betreated individually. Patients are part of populations and
should be treated on the basis of
population-based outcomes.

Decision-making should be based on Decision-making should be evidence
training and experience. based,

Do no harm based on your individual Judgment should be a system
judgment. property.

Secrecy is necessary to protect Transparency in all things is
privacy and to avoid malpractice. necessary, no matter wha.

You can trust doctors to do the right You can trust only data to
thing and charge the right prices. determining the right decisions
and the right prices.

Medical relates to what you can do to and Health applies to the whole
for patients inside your realm of control spectrum of health and can be
and becomes highly uncertain once the patient measured, monitored, and
pateint leaves the hospital or office. quantitated.

The medical system cannot be held A good health system is responsible
responsible for all disease outcomes, for disease prevention, health
which are uncertain and unpredictable. mainteance, and disease outcomes,
and the Internet will make work.

Medicine is an art full of uncertainties. Health care is a management science capable of exactitudes. capable of exactitudes.

Doctors react to patient needs. Health care should anticipate needs.

New technologies should be directed New technologies should promote
towards saving lives and restoring function, safety, prevent disease, make care
rather than simply saving money. more efficient and should save money.

Health information technologies are one Health information technologies
piece of the clinical puzzle, and often are the missing and biggest piece
a small piece at that. of the clinical puzzle.

Doctors should cooperate but what they Doctors should practice as parts of
do often requires individual decisions at cooperative clinical teams.
the point of care.

Electronic docummenting is not the same Good doctoring requires electronic
as good doctors. documenting.

Practice is poetry with freedom. Practices is prose with discipline.

Practice variation is inevitable and due Practice variations are unwarranted,
to socioeconomic differences. Making can be ended with stardardization
them uniform is futile. and homogenization, and will save
30% of total health costs.

And so the philosophical battle is joined - somewhere between Web 1.0 and Web 2.0, between paper and the Internet, between realism and idealism.

The point of this little chart exercise is that physicians immediately involved in medical care and in diagnosing and treating individual often think very differently form those who seek to restructure health care into a system based on remote Internet-data and its algorithmic components and on information empowered health consumers.

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