Where Do We Go from Here? A Health 2.0 Progress Report

By Bradley Schmidt
Published: Monday, Jan 19, 2009
Healthcare consumers may be the driving force behind Health 2.0, but are they really in control? And who knows what the final destination will be?

According to the bloggers and physicians interviewed for this article, mapping the progress of Health 2.0 depends on your view of the forces powering the movement. In my opinion, patients are without question the fuel for the machine. Without tech-savvy, proactive patients rooting around for information in online health communities, there is no market for entrepreneurs, hospitals, insurance companies, and other healthcare organizations to build, expand upon, and innovate with existing Health 2.0 networks and technologies.

The very idea of “innovation” is the point of contention. Are patients and doctors, with the creation of each new startup, writing the manual on Health 2.0 from which all future research and development will be drawn? Or are companies such as Microsoft and Google synthesizing research with their knowledge of social networking and massive technological power to create the tools that users will rely on to drive their online healthcare experience in the future?

Those in the field offer a mixed bag of responses, but in the end suggest that no one—not patients, doctors, nor businesses—is taking definitive steps to assume the industry’s Health 2.0 leadership role. John Norris, a researcher who focuses on healthcare support groups in virtual worlds and developer of john-norris.net, believes that effective, patient-driven Health 2.0 initiatives suffer from a lack of resources and an authoritative knowledge base, and companies are often too cautious with both their initial investment and decisions to get involved in earnest.

Overly cautious business involvement with Health 2.0 can be attributed to a host of causes. A lot of the promise of Health 2.0 stems from its electronic existence, giving individuals oceans of information to sample and share together for the betterment of personal healthcare. But as you’ve read in these pages and in other medical news and literature since the turn of the century, the many debates over the efficacy of the Internet and medicine, EHRs, PHRs, and everything in between, remain largely unresolved. What these debates ultimately boil down to is money. The models that show how to make wildly profitable enterprises out of EHRs and Health 2.0 do not yet exist. But when the model is perfected, investments will pay off , and the debates will end.

This is why Craig Stoltz, principal of Stoltz Digital Strategies and author of the blog Web 2.0h…Really?, says that he believes industry will ultimately push the evolution of Health 2.0. “Healthcare companies see Health 2.0 as a way to save money on customer service; entangle themselves into long-term relationships with customers; gain new customers; and create new revenue streams,” he explains. “The growth is driven more by the industry now than the users.”

Elmer Bernstam, associate professor, Health Information Sciences and Internal Medicine, University of Texas School of Health Information Sciences at Houston, disagrees. “Healthcare is not currently structured around information technologies,” Bernstam says. “For example, procedures and in-person consultations are generally reimbursed. Although there has been some success in getting paid for online activities (eg, virtual visits), as far as I know, these are the exception rather than the rule. Unless something changes, I think that Health 2.0 will continue to be a user-driven phenomenon.”

Bertalan Meskó, a medical student at the University of Debrecen, Hungary, and author of the blog ScienceRoll, thinks that might not be such a bad thing. Meskó envisions Health 2.0 as an entity that should remain first and foremost the domain of patients and physicians and fears that if pharmaceutical and medical device companies recognize the power of Health 2.0 tools, their presence will erode the ability of patients and physicians to be strong voices in the online community.

“That’s what we try to avoid by informing patients and doctors about the possible implications of Web 2.0,” Meskó says. “I’m quite confident regarding the future of Health 2.0, as I realize the so-called e-patients will lead the way here. E-patients will change the way medicine is practiced and healthcare is delivered. Medical professionals also have to realize they must meet the expectations of e-patients.”


While no clear Health 2.0 leadership has emerged, physicians and patients remain the main drivers and focus of the movement. Unfortunately, despite its benefits to these groups, they face a problem with Health 2.0’s medium, the Internet. The expansive size of the Internet is a status quo problem, but that does not change the fact that it negatively affects the patient–physician relationship.

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