I went to the Health 2.0 conference September 20th, and I’ve been mulling what I saw there.
There were health information aggregators like Google, Yahoo, Microsoft, and WebMD. I think we all agree that these players are doing a mediocre job. As you would expect from public companies with a lot of pressure on quarterly financial results, WebMD, Yahoo and Microsoft pages seem optimized for revenues, not optimized for answering people’s questions. Also, the language on these sites is inconsistent, so you never know if what you’re going to get on the next click is what you want or not. Google is the one that is trying interesting things, as this link shows and as we’ve mentioned before on this blog.
There were lots of social networks for patients at Health 2.0, the best being Patients Like Me, covering conditions like ALS, MS, Parkinson’s, and HIV. They said they’ll soon be expanding from those four conditions which is good news. In general, social networks for patients seem to exhibit a tendency to become whining sessions. Don’t get me wrong, when I’m sick, I like to bitch too. But the long-term, hard-core members of these sites — the ones who end up shaping the tone of the content — tend to be the personalities that never get enough of bitching, it seems.
There were a bunch of doctor rating sites, like Xoova.com, Careseek, HealthGrades, and RevolutionHealth. I think this is an admirable thing to do, but rather than rating doctors as bad or good, I’d like to see people rated on their expertise in relation to particular topics and diseases. Who are the experts in the world? Which are the expert organizations or hospitals in a particular condition? Of the professionals within driving distance of me, who is the most expert in the specific thing I’m interested in?
And there were some social networks for doctors, like Sermo, Medical Alliances and Within3. These sites are a bit like LinkedIn for MD’s — professional networking. Cool, but do these guys really have time to get online and chat away? I suppose if it furthers their research, but man, are those MD’s busy. Sermo has a unique and suprising business model — pharmaceutical companies pay them to listen in on doctors’ email and bulliten board conversations on Sermo to hear first what they are saying about conditions and drugs etc. It’s market research for pharma companies. Interesting.
Vimo was a thinly disguised healthcare-insurance-lead-generation site. Smart to go for the money, but tough for Chini Krishnan to pretend he’s trying to help consumers. It’s like LendingTree, where “when banks compete, you win,” but in this case “when health insurance companies compete, you win.” The fact is they are just selling your contact info for $8 or $16 or $22 to these carriers so they can pester you. Ouch.
There were lots of search engines, all optimized for something different. Kosmix’s RightHealth, in particular, appears optimized for revenues. Healthline seems comprehensive, but I’m still not sure what they do that’s different from Google, other than reduce search spam (and Google is working on that as well).
Then there were various insurance companies, content publishers, and associations who were locked in the past and locked in to how they make money today. There is so much money, the systems are so complex, the number of people and organizations that are affected by any change so numerous, and the moral imperative so strong to “do no harm,” that it’s clear why our system feels at once screwed up and at once impossible to change.
There was a lot of discussion about the future and helping people, but the smell of money in the room was palpable. Most of the people on the stage were stuck in this painful tension, talking about all the good they were doing for people, while their faces and voices revealed a desperateness to punch across some invisible line into a place where the cash flows like rain, as it does for many companies in the health industry. It was a common tension in the presenters, and one I came to believe is endemic to this industry, not just in Health 2.0 companies.
The health industry has a dual mission: help people who are often very desperate for you help — and also make money. In this way, being in the health business is not like the auto industry, or the movie industry, or the finance industry, or the electronics industry, or almost any industry, really. There is a moral imperative that comes to bear, but the reality is that we want to have the most talented people in the world working on saving lives, right? And those people could go become investment bankers or real estate developers and make millions, so we need to pay them a lot to focus on improving health. Thus, businesses in the health area need to make quite a bit of money to support the talent and the R&D required to keep pushing the edge. It’s a powerful tension.
As a final note, I had an interesting conversation with a woman who had been trying to change the system from the top down for 30 years, and was finally giving up. She was starting to pin her hopes on some bottoms-up ideas, and she felt the biggest thing we could do to change the system from the bottoms up would be to create a “computer program to diagnose people.” So a person could type in their symptoms and some other personal data (anonymously) and the system would pop out probabilities for various diseases and conditions you might have and what further tests you could do to refine the probabilities. Does anyone know of any efforts to do something like that? I’d love to talk with them.
Ooga Labs 
Thanks for the informative post James. Our young family latched onto our country’s healthcare juggernaut in a big way when our son was born eight years ago and suffered a severe brain injury. I’ll second this quote of yours…
“There is so much money, the systems are so complex, the number of people an organizations that are affected by any change so numerous, and the moral imperative so strong to ‘do no harm,’ that it’s clear why our system feels at once screwed up and at once impossible to change.”
However, I’ll challenge the assumption that high pay will attract the best and brightest. My sense is that big bucks attract people who want to make a lot of money.
Healthcare should be mission-driven and filled with incentives that attract people who burn with a passion to solve real problems and help people. From my limited view, it appears that the big money just gets in the way of real progress as it attracts layers of people who don’t add enough value.
And don’t get me started on the “jock”/military-esque/hierarchical culture upon which western medicine is built. Talk about dysfunctional… and a mammoth challenge.
Michael, your insights are spot on as usual. Suggesting we push medicine toward the moral-imperative/mission side of the tension, away from the money side, makes sense. How could that get done this late into the evolution of the industry? Perhaps only through a revolution from outside the current system, not trying to fix our current system, but aiming to build a new way, founded on new principles, attracting the mission-driven people and giving them the psychological and emotional rewards sufficient to keep them fulfilled and passionate. It would likely be technology driven. Historically, technology provides the wedges to stop an old system and bring in a new. It would likely be bottoms-up, distributed in nature. It would likely use the new technology to leverage a powerful force hitherto untapped (such as other patients, or piles of information currently buried and not accessible, matching systems, voices from inside the medical machine that are rarely heard, etc.), more directly address the concerns of the sick and their families, to more directly provide the right information at the right reading level, to allow for better benchmarking during treatment, allowing for getting more opinions more easily, to allow orders of magnitude more patients to access the best experts (help the experts scale, in other words), to allow for treatment across national borders and time zones. Well, the list goes on. I bet it can be done.
Great post, James. I share some of the skepticism about what’s out there now and their real contributions to the problems in the healthcare system. The forums and social networks in development are interesting but aside from presenting bits of anecdotal information, I don’t see a lot of value. At least with the websites that offer comparison shopping for different products and services, there’s some quantifiable financial benefit to the patient. I think we need to get a bit more creative than simply looking at what’s successful in tech and transferring that to healthcare. Their problems are not our problems and our problems are not their problems.
I’d love to hear more about the ideas from the woman you spoke with. I think she’s on the right track in trying to address basic issues at the ground level. The core problem with trying to replicate Web 2.0 concepts for healthcare is that healthcare relies on multiple intermediaries who are the gatekeepers, rather than the patient/consumer. Doctors provide the choices and insurance companies decide the “budget”. This is completely different from say an Amazon.com-type concept where the consumer does their own research, makes their own decisions, and purchases the product directly. The woman you spoke with hit on the right idea – substitute the choice-providing intermediary (doctor) with a machine-based algorithm because at some level, doctors act as human experience/intuition algorithms for deciding treatment!
If you want to see a Web 2.0 company that is changing the space, check out understand.com.
Cheers,
Mike
Hey James you should check out what my friend doctor friend Jay Parkinson is doing: http://www.jayparkinsonmd.com/ It’s obviously small scale, one doctor moving his practice onto the net, but it’s fresh thinking and it completely cuts through the impersonal nature of corporate health care. I think it’s an interesting idea that I hope other forward thinking doctors start to copy.
p.s. Discovered your blog through your viral video.
p.p.s. yo.
As a young physician in training I find it hard to believe how slow the medical world is to accept technology even when it’s free and safe/secure. Social Networking btw patients and between doctors is fine but shouldn’t be mutually exclusive where you’ve got sites with patient only talking to patients and docs only to docs. A situation where you have the blind leading the less blind…
One way that hasn’t been approached (I think) is to develop an electronic medical record that is secure so that only designated physicians and healthcare professionals and the patient themselves have access to it. By keeping it online anyone who is given access can get at it. Being able to contact a physician with a correction to clinic visit or past medical history entry would greatly advance the health care delivery system and provide a more accurate and “higher level” of care. What do you think? Sound like somethink ooga should be working on???
One could even provide this free or charge to patient and physicians by using patient and physician specific advertising (a group hard to get any face time with!!!)
Let me know if you want a hand with this…
toodles,
Bijal Mehta, MD, MPH
Dept. of Neurology
SUNY Buffalo
Resident (pgy-3)
Health 2.0 is derived from the term Web 2.0, which implies a 2nd generation/release of the Internet.
The ‘2.0’ part was established within computer programming – as a new edition of a an application is released, it is common practice for the programmers to add an incrementing number at the end of a program’s name, to label the new version.
Web 2.0 implies the ‘2nd release’ of the Internet, which of course is not based on anything concrete. The Internet being made up of millions upon millions of interconnecting computers running lots of various programs, but is more of a concept to describe the type of programs/applications/functionality one can now locate on the Internet.
The Internet was initially complied of mainly static pages of data. Soon to follow was email, web forums and chat rooms where discussions could take place. Web 2.0 refers to a trend on the Internet that saw a step forward in the way users conduct communicate over the Internet, which includes the use of blogs, videos, podcasts, wikis and online communities where people with common interests get together to share ideas, media, code and all types of information.
Web 2.0 technologies such as social networking, blogs, patient communities and online tools for search and self-care management look as though they will permanently alter the healthcare landscape indefinitely.
As with Web 2.0, there is a lot of debate about the meaning of the term ‘health 2.0’. The Wall Street Journal recently attempted to define Health 2.0 as:
“The social-networking revolution is coming to health care, at the same time that new Internet technologies and software programs are making it easier than ever for consumers to find timely, personalized health information online. Patients who once connected mainly through email discussion groups and chat rooms are building more sophisticated virtual communities that enable them to share information about treatment and coping and build a personal network of friends. At the same time, traditional Web sites that once offered cumbersome pages of static data are developing blogs, podcasts, and customized search engines to deliver the most relevant and timely information on health topics.”
While this traditional view of the definition imputes it as the merging of the Web 2.0 phenomenon within healthcare. I personally believe it’s so much more. In my opinion, Health 2.0 goes way beyond just the permeant social networking technology to include a complete renaissance in the way that Healthcare is actually delivered and conveyed.
Source – http://www.rxpop.com
James –
I think you might find this fascinating if you haven’t see it allready. Wife works for this local company and they have created a model which will have a positive impact on the approach to healthcare.
http://www.archimedesmodel.com
James,
Interesting observations and congratulations on translating the criticisms into a tangible project to advance the sector, with MedPedia.
You hit the problem on the head in that the money isn’t well aligned with the ethical goals of the sector. Also, I think you hinted at, but didn’t explicitly state, that sick people will always want more until they are “better”– and our current system is based on throwing as much hope at them that money can buy.
I think the foundations are wrong and we won’t really be able to address the disconnects until we realign the money with bottom-up engagement in good health.
To paraphrase Jennifer Aniston in the “Break-up”, I don’t want you to just exercise and eat your vegetables, I want you to want to exercise and eat your vegetables.
My take is the emphasis of bottom-up wellness and optimization of health will provide a counterbalance to the top-down insurance model of “managed” health. My soon to be launched startup is one of the few looking to change the economics, painful though that process may be. Glad to see a fellow contrarian doing something interesting and well needed.
–Vijay
Hi James,
Someone pointed me to this blog posting and when I read the last paragraph of your post I nearly fell off my chair! The product that you describe already does exist, and its called FreeMD.
You can see it at http://www.freemd.com
The product is 100% physician created and runs off an Expert System that has successfully triaged millions of people over the past 15 years. FreeMD represents the firm’s (DSHI is the creator of the product) first attempt to create a product of this kind exclusivley for the consumer health market (FYI, I am a former 7 year WebMD executive who now has his own online health firm, Q. Wild & Co. I have been working closely with DSHI for several years.)
I would love to get your thoughts on the product. It might have some interesting synergy with Medpedia.
Cheers,
Josh Wildstein
PS: If interested, you can read my latest “Health 2.0” thoughts as published here: http://seekingalpha.com/article/79615-failure-to-deliver-meaningful-roi-online-for-pharma
James,
The 2008 Health 2.0 conference is around the corner. Some of last year’s participants and attendees have gone under or changed strategies. Few have traction and fewer generate any meaningful revenue. The handful of funded companies will burn their last few dollars unless they can make a case (to their investors, employees) that there is a real business model.
One of the fundamental issues is that healthcare companies are challenged before getting out the gate: developing a solid revenue model for a “consumer healthcare play” is limited by federal and state regulations which then limit what and how you can offer healthcare services to consumers.
Doctors are too busy to fill out profiles and are not keen on being rated by websites. Some have sued. Few will post their (reasonable/real) prices as they lose bargaining power with insurance plans and may be violating their insurance plan contracts (insurance plans consider prices with doctors their confidential negotiated rates).
Consumer adoption of healthcare services like an “Opentable for Doctors” or a “Expedia for Healthcare” is still a long way off. It’s not technology. It’s trust. The majority of us have few interactions with healthcare. When we need information we will go to trusted, although imperfect sources: our family, friends, and a handful of websites (WebMD, Mayo Clinic, etc). Trust takes time, having lots of money or cutting edge technology doesn’t necessarily accelerate the process.
The industry still relies on a non-market based model of healthcare delivery and would like for it to stay that way. Vested interests (and revenue) are a powerful force that will probably relegate today’s Health 2.0 startups as interesting experiments.
Bleak outlook for Health 2.0 companies. But we saw this in 2000 during the dotcom era when many B2C and B2B healthcare startups failed. Perhaps a few lessons learned then seem to have been forgotten.
There is a long and storied history of decision support tools and the challenges with physician adoption. However, now may be a great time to put those tools in the hands of patients and caregivers. Converging trends will finally drive this adoption — medical treatment protocols being rigorously tested with evidence-based medicine, the power of community built information, the walled gardens of electronic medical records beginning to crack, and the self-obsessed Boomer generation facing their medical consumption maxima.
You should check out the decades worth of work that Dr. Larry Weed has created at UVM Medical School. The Boston Globe did a good article back in 2002 entitled “What your doctor doesn’t know could kill you” http://www.boston.com/news/globe/reprints/071402_whenyourdoc/
Plenty of good physicians and geeks are working on this in Boston, so I’m glad you are forging alliances out here in Beantown, too. Best of luck!