Health 2.0

Health 2.0 (as well as the closely related concept of Medicine 2.0) are terms representing the possibilities between health care, eHealth and Web 2.0, and has come into use after a recent spate of articles in newspapers, and by Physicians and Medical Librarians. A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education. A possible explanation for the reason that Health has generated its own "2.0" term are its applications across health care in general, and in particular it potential in public health promotion. One author describes the potential as "limitless."

Definitions and Inclusions

As yet there is no common agreement amongst experts and participants, but from the Health 2.0 wiki (not the Wikipedia version), there are several competing & complementary definitions of Health 2.0.

The "Traditional" definition focuses on technology as an enabler for care collaboration--

"The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health" Source: Adapted from Jane Sarasohn-Kahn's "Wisdom of Patients" report, by Matthew Holt, Last updated June 6, 2008 An expanded version of the traditional definition breaks this into components--

  1. Personalized search that looks into the long tail, but cares about the user experience.
  2. Communities that capture the accumulated knowledge of patients and caregivers; and clinicians -- and explain it to the world,
  3. Intelligent tools for content delivery -- and transactions & 4) Better integration of data with content. All with the result of patients increasingly guiding their own care, "Holt's evolving view of a moving target", by Matthew Holt, updated from original September 20, 2007 presentation at Health 2.0 Conference, October 22, 2008 Scott Shreeve considers Health 2.0 as a wider system reform--

"New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care 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" - Last updated on May 25, 2007 (Source: Scott Shreeve, MD - January 24, 2007) Then there's the concept of Health 2.0 as a participatory process between patient and clinician (with a couple of notable twists) --

Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway. (Source: "Patient 2.0 Empowerment", Lodewijk Bos, Andy Marsh, Denis Carroll, Sanjeev Gupta, Mike Rees, Proceedings of the 2008 International Conference on Semantic Web & Web Services SWWS08, Hamid R. Arabnia, Andy Marsh (eds), pp.164-167, 2008, http://www.icmcc.org/pdf/ICMCCSWWS08.pdf)

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself. Ted Eytan MD, June 6, 2008, http://www.tedeytan.com/2008/06/13/1089 Definitions of Medicine 2.0 appear to be very similar but typically include more scientific and research aspects--

Medicine 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 web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups. (Source: Eysenbach, Gunther. Medicine 2.0 Congress Website launched (and: Definition of Medicine 2.0 / Health 2.0). Posted at: Gunther Eysenbach's random research rants (Blog). URL: http://gunther-eysenbach.blogspot.com/2008/03/medicine-20-congress-websi.... Accessed: 2008-03-07. (Archived by WebCite at http://www.webcitation.org/5W9GcYyWN))

Published in JMIR Tom Van de Belt, Lucien Engelen et al systematic review found 46 (!) unique definitions of health 2.0 (Van De Belt TH, Engelen LJ, Berben SAA, Schoonhoven L Definition of Health 2.0 and Medicine 2.0: A Systematic Review (J Med Internet Res 2010;12(2):e18)URL: http://www.jmir.org/2010/2/e18/)

Overview

Health 2.0 refers to a number of related concepts including telemedicine, electronic medical records, and the use of the internet by patients themselves such as through messageboards, blogs, and other more advanced systems. A key concept is that patients themselves should have greater insight and control into information generated about them. Traditional models of medicine had patient records (held on paper or a proprietary computer system) that could only be accessed by a physician or other medical professional. Physicians acted as gatekeepers to this information, telling patients test results when and if they deemed necessary. Such a model operates relatively well in situations such as acute care, where information about specific blood results would be of little use to a lay person, or in general practice where results were generally benign. However, in the case of complex chronic diseases, psychiatric disorders, or diseases of unknown etiology patients were at risk of being left without well-coordinated care because data about them was stored in a variety of disparate places and in some cases might contain the opinions of healthcare professionals which were not to be shared with the patient. Increasingly, medical ethics considers such actions to be medical paternalism and are discouraged in modern medicine.

A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2.0 setting: A patient goes to see their primary care physician with a presenting complaint, having first ensured his own medical record was up to date via the internet. The treating physician might make a diagnosis or send for tests, the results of which could be transmitted direct to the patient's electronic medical record. If a second appointment is needed the patient will have had time to research what the results might mean for them, what diagnoses may be likely, and may have communicated with other patients who have had a similar set of results in the past. On a second visit a referral might be made to a specialist. The patient might have the opportunity to search for the views of other patients on the best specialist to go to, and in combination with their primary care physician decides who to see. The specialist gives a diagnosis along with a prognosis and potential options for treatment. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a joint decision with their healthcare provider. They can also choose to submit more data about themselves, such as through a personalized genomics service to identify any risk factors that might improve or worsen their prognosis. As treatment commences, the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them, and can stay up to date on research opportunities and clinical trials for their condition. They also have the social support of communicating with other patients diagnosed with the same condition throughout the world.

Level of use of Web 2.0 in Health Care

Partly due to weak definitions, the novelty of the endeavor, and as an entrepreneurial (rather than academic) movement, little empirical evidence exists to understand how much Web 2.0 is being used in general. While it has been estimated that nearly one-third of the 100m Americans who have looked for health information online say that they or people they know have been significantly helped by what they found. this study considers only the broader use of the Internet for health management.

A study examining physician practice has suggested that a segment of 245,000 physicians in the U.S are using Web 2.0 for their practice, indicating that use is beyond the stage of the early adopter with regard to physicians and Web 2.0.

Types of Web 2.0 technology in Health Care

Web 2.0 is commonly associated with technologies such as weblogs (blogs), social bookmarking, wikis, podcasts, RSS feeds (and other forms of many-to-many publishing), social software, and web application programming interfaces (APIs) (see main article Web 2.0).

Types of Web 2.0 use in Health Care

The following are examples of uses that have been documented in academic literature.

Purpose Description Case example in academic literature Users

Staying informed Used to stay informed of latest developments in a particular field RSS, Podcasts and search tools All (medical professionals and public)

Medical education Use for professional development for doctors, and public health promotion for by public health professionals and the general public How podcasts can be used on the move to increase total available educational time or the many applications of these tools to public health All (medical professionals and public)

Collaboration and practice Web 2.0 tools use in daily practice for medical professionals to find information and make decisions Google searches revealed the correct diagnosis in 15 out of 26 cases (58%, 95% confidence interval 38% to 77%) in a 2005 study Doctors, Nurses

Managing a particular disease Patients who use search tools to find out information about a particular condition Shown that patients have different patterns of usage depending on if they are newly diagnosed or managing a severe long-term illness. Long-term patients are more likely to connect to a community in Health 2.0 Public

Sharing data for research Completing patient-reported outcomes and aggregating the data for personal and scientific research Disease specific communities for patients with rare conditions aggregate data on treatments, symptoms, and outcomes to improve their decision making ability and carry out scientific research such as observational trials All (medical professionals and public)

Criticism of the use of Web 2.0 in health

Several criticism have been raised in the use of Web 2.0 in health. Firstly, the limitations for Medical Doctors (MDs) to use Google as a diagnostic tool, which may be more effective only for conditions with unique symptoms and signs that can easily be used as search term. Secondly, long-held concerns exist about the effects of patients obtaining information online, such as the idea that patients may delay seeking medical advice. Finally concerns exist about the quality of user generated content leading to misinformation, though one study has suggested that in certain support groups only 6% of information is factually wrong and that only 3% reported that online advice had caused serious harm. Other venues of information are likely to be less useful to the general public.

Tensions in Health 2.0

Hughes et al. (2009) argue there are four major tensions represent in the literature on Health/Medicine 2.0: these are over the lack of clear definitions; issues around the loss of control over information that doctors perceive; safety and the dangers of inaccurate information; and issues of ownership and privacy.

  • The term Health 2.0 is trademarked by this conference series
  • A set of useful resource on the Health 2.0 Wiki including a list of Health 2.0 companies
  • A list of medical wiki websites including links to more than 40 medical wikis
  • Medicine 2.0 Congress, which is similar or identical to the Health 2.0 concept, but also includes "Science 2.0"
  • "Web Site Harnesses Power of Social Networks", The Washington Post, October 19, 2009
  • Health 2.0 Chapters
  • Health 2.0 Boston Chapter
  • Health 2.0 Hawaii Chapter
  • Health 2.0 Japan Chapter
  • Health 2.0 NYC Chapter