Another Health 2.0 Conference has come to pass and with broken wrist limiting typing fluidity, going to keep this synopsis short and sweet.

Not sure who said first impressions are lasting impressions, but coming up on the facilities that were to house this year’s Health 2.0 conference, I had a moment of trepidation upon seeing the signage for Health 2.0 (yes, the picture to right is real) with a back-drop of a funky auto parts and repair store across the street.  Once in the cavernous hall (note to self – cavernous halls should not concurrently house exhibits and stage) all went smoothly until one opened up the laptop and alas, no Wi-fi (actually there ended up being sporadic service but it was so bad as to be almost worthless).  An event focusing on Internet tools for health and no Wi-fi – am I in some sort of perverse David Lynch movie?

On to the event itself…

Highlights:

The Health 2.0 Accelerator demonstration was pretty impressive.  In the demonstration, nine different applications were used in a fairly seamless fashion to facilitate a consumer’s interaction with the healthcare system. A simple, yet powerful demonstration of what is possible when independent software vendors (ISVs) agree on some basic open standards, in this case OAuth and CCR to securely move data around a network. This example, while still a little too cumbersome or most consumers, points us in the right direction and might make an ideal case for the Health Internet.

Ability to meet many innovators in one place.  Health 2.0 is really the only game in town today that draws a wide range of innovators to one location.  J.D. Kleinke wrote a very good post on the event where he thought maybe the event was becoming a little too corporate.  I really do not see much problem with that, in fact, would like to see more realism demonstrated by these innovators through their articulation of clear and compelling business models, but I digress.

Best Demo: A tie, HealthVault & Quicken Health are the hands-down winners for best demos (outside of the Accelerator mentioned above).  HealthVault demonstrated their new “widget store” that is available within one’s personal MSN Health & Wellness account.  Leveraging data that one has in their HealthVault account, the MSN health widgets make that data truly actionable.  Over time, one can envision a health “AppStore” in MSN Health quite similar to Apple’s AppStore for the iPhone where ISVs build a wide range of health apps for the consumer that can be readily accessed all in one place.

While I have always had reservations about Quicken Health (too limited, only addresses one problem, financial) was very impressed with the architecture of the application.  Beautiful user interface, very nice tools built right in (e.g. hover over a given lab and you get a brief abstract of the lab test and its purpose). Another nice feature was the ability to contest claims, electronically, right from within Quicken.  Having dealt with many a mis-labeled/assessed claim before, that feature alone (no more voicemail hell) practically sold me on getting this app when it is released later this year.  Upon further thought though, better check with my payer first to see if they even would allow me to contest a claim electronically.

Excellent briefings with several companies including an update with Google Health, a deep and thoughtful dive with Within3 (keep track of them, they may have something if they move fast enough), a good update from Allviant (product CarePass is in beta), a great conversation, as always, with the folks of Polka and a surprising interview (amazed at how far they have come, more in near future) with MedHelp (another one to watch).

Disappointments:

While the Health 2.0 Accelerator succeeded, the Clinical Groupware session failed.  First off, I am not sure those in the audience fully understood what the term “clinical groupware” means and why it is important to consider.  Second, there was almost no discussion on what type of underlying architecture is required to make apps run in a clinical groupware environment.  So what we were left with was some very broad statements that clinical groupware is good for you, good for the industry, etc. but nothing about how it would actually work. Then there were the vendors in this session that did little to further the discussion.  Instead of demonstrating data sharing and substitutability of their apps, key tenets for clinical groupware to work, we were shown apps working in isolation.

Payers certainly have a voice in the healthcare discussion but do they really have a voice in the Health 2.0 discussion.  Certainly the organizers of this event think so but I differ.  Ultimately, it is employers that are footing the bill and have the most to potentially gain in offering their employees such tools.  And if not employers, how about the benefits consultants who advise them?  Getting quite tired of sessions composed of payers talking about how they always want to do good for their members.  Let’s be real, they want to maintain and/or improve margins and few consumers trust them.

The apparent fawning over the latest Health 2.0 rock star(s).  At the Spring event it was Jay Parkinson and Hello Health.  This fall it appeared that we had two: Roy Schoenberg of American Well and Adam Bosworth of Keas.  I’ll give credit to American Well to at least having a product/service in the market, but do they really need to be placed on a pedestal as the poster child for telemedicine? Roy is extremely polished and presents well, but hey, they are far from being the only game in town and not sure why they had two separate stage apearances, one on each day.  As for Adam and Keas, Adam certainly has a great publicist (gets an article on Keas in the NY Times on the first day of Health 2.0, coincidence, I doubt it) and is well known in IT circles, but he has also been extremely slow in introducing his product – suppose to go GA sometime this month.  So here we have a company founder without a live product in the market again being invited up on stage on two separate occasions.  Why, I can’t figure it out as my initial assessment of Keas is that it is a fairly simple product with low barriers for competing products (e.g., if Google put their mind to it, they could do the same with their search features and Google Health pretty easily).

The venue was just a disaster, enuf said.

Where are the established HIT companies, where are the intersections between these traditional ISVs that ultimately hold the data and these Health 2.0 ISVs looking to get their hands on it to power their services.  Bridges need to be built as today, Health 2.0 sits like an island, isolated in a very broad sea.

Wrap-up:

Health 2.0 is a great networking event.  Just about everyone in this particularly market is there and its always good to connect with people face-to-face as phone calls, emails, etc. only go so far.  Content of sessions though is a very mixed bag and appears highly slanted to those vendors who pay to play (sponsors, exhibitors, etc.) and not as expansive as it could be.  Hopefully, like many things in life, the organizers of this Fall’s Health 2.0 will learn from the many mistakes made and the next one will bring more value to attendees.

Je faisais la semaine dernière référence au travail d’Ed Bennett qui suit la présence des hôpitaux aux États Unis sur les médias sociaux.

Thiphaine s’interrogeait dans un commentaire sur une vision française de la question.

Un début de réponse peut être obtenu sur le blog European Hospitals qui est le pendant européen de l’Hospital Social Network List d’Ed Bennett.

Comme Lucien Engelen l’explique sur ce blog, le but est de transposer l’analyse aux hôpitaux européens, néerlandais en tête, et d’assurer un suivi de l’engagement des établissements dans le web social :

Inspired by the American list of Hospitals of @edbennet i’ve started this list. At first to chart the Dutch Hospitals, secondly i thought it might be  a good idea the also give possibility to point to other European Hospitals and update on a quarterly basis

L’état d’avancement du projet en vidéo…

A retenir :

- 2800 hôpitaux européens  sont passés en revue dans cet état des lieux

- Ce sont les hôpitaux suédois qui sont les plus engagés dans le web social avec 11% d’entre eux publiant des fils RSS et 4% des blogs, suivi des hopitaux espagnols et danois.

- Les hôpitaux britanniques et néerlandais se démarquent par leurs présences sur une variété plus large de plates-formes sociales, dont les plates-formes vidéo

- Le secteur hospitalier français fait lui un usage très réduit du web social, seul est référencé dans l’étude le centre hospitalier de Rouffach en Alsace qui publie un blog pour les 100 ans de l’établissement. Sur ce point, le site hopital.fr de la FHF (voir mon post à l’occasion de son lancement), orienté grand public, n’est pas référencé.

Les résultats préliminaires de cette étude seront publiés à l’occasion de la conférence ReShape 2009, à Nijmegen, aux Pays Bas, les 12 et 13 octobre prochain.

Voici, repérées récemment, plusieurs études qui traduisent la place grandissante du vecteur web pour la recherche d’informations en santé.

• web social et hôpital

Le web social influence 40% des personnes prévoyant une hospitalisation aux États-Unis, et plus de la moitié des 25 – 34 ans. C’est en particulier la recherche d’informations avant de choisir une maternité qui provoque cet afflux sur les réseaux sociaux et forums.

Le web social est donc un vecteur de choix  pour toucher la population des futurs parents.

Tel est l’une des conclusion de l’enquête d’Ad-Ology Research qui compare l’influence des médias sur les choix des consommateurs US, en matière de santé notamment.

Des chiffres à mettre en relation avec la présence “sociale” en ligne des hôpitaux US : en septembre 2009, 367 hôpitaux US étaient présents sur le web, avec 186 chaines YouTube, 190 pages Facebook, 267 comptes twitter et 35 Blogs.

[sources : marketingcharts.com et l'Hospital Social Network List de Ed Bennett]

• web et recherche d’informations santé

Manhattan Research annonce aujourd’hui les grandes lignes de sa dernière étude sur le comportement des cyber-citoyens US : le nombre d’internautes utilisant le web pour rechercher des informations sur les médicaments à doublé depuis 2005 atteignant 102,3 millions en 2009. On dénombre plus de 150 millions d’utilisateurs des sites e-santé, ils sont 1.6 fois plus nombreux qu’en 2005.

Un autre fait marquant de cette étude est la multiplicité de l’information accessible, notamment due à l’explosion des contenus créés sur les réseaux sociaux par les consommateurs et patients aux-même depuis 2005.

——

Je vous livre ces chiffres avec les précautions d’usage : ceux ci ne concernent que le territoire US, je n’ai pas eu accès aux données brutes et il y a peu d’information sur les méthodos de ces enquêtes… Ils traduisent cependant des tendances observées également à mon sens de ce côté ci de l’Atlantique.

ophtalmo.tv a officiellement été lancé en ce début septembre 2009. Cette webTV médicale, consacrée à l’ophtalmologie est à ma connaissance, une première dans le paysage web santé français et francophone. J’ai demandé au docteur Jean-François Girmens, co-fondateur d’ophtalmo.tv, de nous présenter le projet et ses origines.

Un objectif clair et novateur, la rencontre d’expertises complémentaires, la constitution d’une équipe autour de ces expertises et beaucoup de travail amont sont quelques uns des ingrédients de ce projet, qui est un exemple concret de convergence entre web et médecine en France.

———————–

- Peux tu te présenter et présenter ophtalmo.tv ? ainsi que ton rôle dans le projet ?

Je suis ophtalmologiste hospitalier (hôpital des Quinze-Vingts à Paris), avec une activité essentiellement dirigée vers les pathologies rétiniennes d’une part et la recherche clinique d’autre part.
ophtalmo.tv est le fruit de la rencontre entre 2 ophtalmologistes (moi même et un ophtalmologiste libéral, le Dr Patrice Votan-Paris), autour d’un ancien cadre d’un labo oph (avec de certaines compétences en vidéos), puis un webmestre Damien Poirot (pour l’aspect technique). Outre le statut de cofondateur, nous partageons avec mon confrère la tâche de directeurs de la rédaction (ophtalmo.tv est structuré comme un journal, avec comité de rédaction et conseil scientifique), et du fait de certains “antécédents” (cf réponse suivante), je suis un peu à cheval entre le versant “rédaction” et le versant “webmestre”…

- Quelles sont les origines du projet et constats qui ont conduit à cette idée ? Comment le projet a t’il été conçu et développé ?
Tout d’abord, cela vient d’un certain cheminement que j’ai réalisé, commençant par mettre en ligne sur une page html toute simple quelques unes de mes communications, puis, pour les besoins de mon service, la création d’un site internet d’information pour mes confrères (www.fedret.fr). J’ai alors été amené à parcourir de nombreux sites ophtalmo et médicaux (anglo-saxons pour la plupart), mais aussi beaucoup surfer sur le net et utiliser de plus en plus les outils web2.0. Petit à petit, j’ai commencé à comprendre l’intérêt que de tels outils pouvaient présenter pour la pratique médicale… et ai fini par me sentir frustré de n’être que “webmestre” d’un site sur lequel je ne pouvais m’exprimer “personnellement” : mon blog était donc né (oph.girmens.fr), avec une double thématique : ophtalmologie et internet !
Suite à ces deux expériences, deux autres sites ont vu le jour : un wiki pour mon service (www.cicoph.org/wiki) et le site d’une association de patients (www.asso-ovr.fr)… et j’essaie de contribuer ça et là, dans la mesure de mes disponibilités (trop faibles à mon goût), à diverses choses (MedWorm Associate, medecine.2.0.free.fr, traduction française de webicina…)

Pendant ce temps là, le projet ophtalmo.tv est né d’une part de l’idée de mon confrère de transposer sur internet certains ouvrages didactiques qu’il avait eu l’occasion de publier, d’autre part de mon observation du web avec le développement des sites de diffusion vidéos et le fait que l’ophtalmologie se prête particulièrement bien à ce type de communication. Un site américain nous a d’ailleurs précédé, mais sur un modèle ressemblant plus à YouTube (Eyetube.net). Les deux projets se sont rejoints en discutant d’abord chacun de notre côté avec A. Danse (l’ancien cadre), puis plusieurs versions d’essai “bricolées”, et diffusées “confidentiellement” (depuis 2007) mais dont le principe a été bien accueillis auprès de confrères “testeurs” nous ont fait passer à la vitesse supérieure (validation d’un business model, étude des différentes contraintes légales, création de société, constitution des comité de rédaction et conseil scientifique, aide d’un webmestre).

- Quel est le “business model” d’ophtalmo.tv ?
Le business model est basé sur la publicité : l’accès est donc gratuit et réservé aux professionnels de santé.
Dans un second temps, nous avons d’autres idées de services associés, qui, selon les premiers “résultats”, resteront gratuits ou nous développerons des offres “premium” pour certains d’entre eux (la web TV restera elle gratuite : donc, il pourrait s’agir de “Freemium”).

- Comment vois tu le futur du web ophtalmo et plus généralement celui du web santé ?
Si je suis avec beaucoup d’intérêt (mais manque un peu de temps aussi malheureusement) toutes les possibilités offertes par le web notamment en ce qui concerne la communication inter-professionnelle (blogs, twitter, réseaux sociaux, outils de travail collaboratif, recherche documentaire, veille bibliographique, etc…), avec les patients (PatientsLikeMe), et de la part de l’industrie (notamment sur twitter ces derniers temps), je suis encore un peu réservé quant à l’utilisation et la pénétration de tels outils chez les médecins français (et en particulier ophtalmos)… mais ils vont certainement s’y mettre. L’avenir immédiat me semble donc être à la formation et l’information des médecins sur l’utilisation de tous ces outils…

———————–

Je remercie Jean-François Girmens pour sa disponibilité et souhaite une très longue vie à ophtalmo.tv !

Après 3 éditions aux USA, la conférence Health 2.0 traverse l’Atlantique et s’installera à Paris, à la Cité Internationale Universitaire de Paris les 6 et 7 avril 2010.

Deux  jours pour explorer et comprendre notamment l’apport des outils 2.0 et media sociaux et leur contribution à une meilleure communication entre tous les acteurs de la santé, le tout avec une vision européenne, sur une thématique encore trop très centrée sur les USA.

6 et 7 avril 2010 : deux jours à cocher dans vos agendas.

Tous les détails ici.

I am delighted to welcome guest blogger Eileen O’Brien of Compass Healthcare Communications. I was lucky enough to attend a fabulous one-day workshop on Mobile Marketing in Healthcare, hosted by Compass, in late April. Eileen moderated a panel of mobile experts, and summarizes the take-aways below.

At Compass Healthcare Communications, we wanted to learn more about mobile marketing as it applies to pharma so we got a bunch of smart clients, partners and industry experts in a room and started talking. Here are some of my key takeaways from this Innovation Lab.

Why pharma should care

• 90% of Americans use a cell phone and increasing numbers are adopting smartphones
• Mobile marketing is currently a novelty and response rates are high
• Inventory of mobile ad space is doubling monthly, so rates can be negotiated
• There are three times as many phones as there are PCs

Most importantly, the technology has advanced to support the incorporation of fair balance in mobile ads. A few pharma companies are about to launch consumer mobile advertising campaigns. Among them is J&J, creator of the Caregiver Connector, which is a smartphone application.

Respect the mobile device
Because of the unique and personal relationship we have with our cell phones, it’s essential that marketing messages are relevant and timely.

As mobile devices become more powerful, more people – including physicians and other healthcare professionals – are relying on them as their point of entry onto the web. User experience is no longer defined by the browser, and communication campaigns now need to work toward integrating the experience across all channels.

Pharma, physicians and mobile
For the past few years, pharma brand managers have been using mobile devices to market to physicians utilizing Skyscape and Epocrates. This trend is likely to accelerate since the latest Manhattan Research data shows that 64% of physicians use a smartphone and Skyscape data indicates 70% of physicians rely heavily on their mobile device for clinical decision support.

Parting advice
Learn more about QR (for Quick Response) bar codes. Most people with a smartphone can scan and read QR codes with the click of a camera, which can cause a web browser to launch and go to a URL. This enables a quick and easy way to provide deeper brand information.

Mobile marketing is not for every brand. However, with its ability to target and deliver a unique brand experience, it’s a channel that should be explored as part of the marketing mix.

Connect with Eileen O’Brien at eobrien@compasshc.com. She also tweets regularly using @eiobri.

[santé 2.0] Asthma Alerts Coming to Your Social Network of Choice – l’état d’Arizona compte s’appuyer sur une batterie d’outils sociaux (twitter, facebook, myspace) pour alerter les personnes asthmatiques sur les situations de pollution qui peuvent déclencher des crises.

[recherche] Study: Google does a brain good – CNN.com – l’activité cérébrale des internautes monitorée, google is good for you :

Web-savvy group had double neural activation than less experienced counterparts
Web-savvy older adults had greater activation in front part of brain
That area of brain controls decision making and complex reasoning

[wikipedia] Physicians Should Contribute to Wikipedia, Researchers Say – iHealthBeat – de plus en plus de recherches sur la santé génèrent du trafic sur wikipedia, les médecins, entre autre, doivent contribuer à améliorer l’information disponible.

[images] 2009 Swine Flu outbreak – The Big Picture – Boston.com – un incontournable parmi mes flux RSS, les séries de photos grand format de Boston.com, dont la dernière édition est ici consacrée à la pandémie de grippe A/H1N1.

De retour après un moi d’avril que je n’ai pas vu passer, biogeekblog reprends un rythme, je l’espère, plus régulier !

[recherche] NASA – NASA Nanosatellite to Study Antifungal Drug Effectiveness in Space – PharmaSat, un labo de microbiologie à 285 miles d’altitude en mouvement à 17000 miles / heure, pour tester la sensibilité de micro-organismes à des antibiotiques.

[santé 2.0] 25 Excellent Social Media Sites for Your Health – sélection de 25 sites sociaux dédiés santé avec une grande place faite au réseaux de patients.

[démographie] Hopital.fr – La France compte un million de professionnels de santé – dont 73.126 pharmaciens au premier janvier 2009 (et 308 sages-femmes hommes).

The American Recovery and Reinvestment Act of 2009 (ARRA, aka the stimulus package) contains significant funding for the provision of healthcare services and for capital improvements for healthcare providers such as upgraded healthcare IT. Potential ARRA funding for healthcare is upwards of $130 billion (this figure includes tax incentives and other mechanisms that are dependent on how many people take advantage of them). Here are five big ways ARRA aims to strengthen primary care:

• Federally Qualified Health Centers (FQHC) have already been awarded nearly $500 million in March to meet increase demand for service and for new access points. An additional $1.5 billion remains to be granted for capital improvements including healthcare IT.
• The National Health Service Corps will receive an additional $300 million, or enough to fund an additional 3,300 clinicians in medically underserved areas.
• The ARRA package attempts to mitigate the unemployment-related increase in the uninsured by temporarily increasing the federal match for Medicaid by 6.5% across the board. This increase includes restrictions intended to ensure the extra funds are used to meet increased demand and not merely used to replace existing state funding. In addition, the feds will subsidize up to 65% of COBRA premiums to individuals who lose their jobs through the end of the year.
• $1.1 billion was appropriated in the stimulus package for comparative effectiveness research. Although not specific to primary care, this research may provide empirical data to support devoting more resources to the field.
• Healthcare IT is ARRA’s major talking point, even though total funding, at $36 billion, is less than half the projected $87 billion in increased payments to states for Medicaid. As if to underscore this point, healthcare IT got its own section in the stimulus bill, the Health Information Technology for Economic and Clinical Health (HITECH) Act. Most of this funding is incentive payments to doctors and hospitals for adopting EHRs, mostly through Medicare reimbursements. Theoretically HITECH should strengthen primary care by simplifying the medical home model and making it easier for a patient’s records to follow them through referrals and hospital stays and back to their primary care physician.

Unfortunately, although these measures will undoubtedly help, especially with maintaining continuity of care, none of them do much address the major structural challenges that primary care faces.

Les média sociaux sont à mon sens, des outils essentiels pour développer les liens entre les patients actifs sur le web et le monde de la recherche en santé.

Comment twitter par exemple, et ses messages en 140 caractères au maximum, peut il être mis à profit pour atteindre cet objectif ?

Voici, deux lectures récentes qui ont attiré mon attention, pour un début de réponse :

“Whispering Tweets into a Patient’s Ear: Top Ten Suggestions for Clinical Trial Recruiters” : un post sur twitip et des recommandations sur les utilisations possibles de twitter et ses add-ons pour optimiser le recrutement dans les essais cliniques, proposé par @crgonzalez.

En résumé…

• inclure et faire valider par un comité de protection des personnes, l’utilisation d’un compte twitter dans la stratégie de recrutement d’un essai clinique.
• le compte twitter servira à diffuser de l’information sur le recrutement en cours et à rediriger vers une source d’information (site web par exemple) validée également par le comité de protection des personnes
• optimiser le message en utilisant des hashtags pertinents
• suivre l’impact du message créé, grâce aux nombreuses applications et add-ons disponibles (tweetscan…)
• et bien sûr, appliquer la netiquette twitter : être spontané, transparent, apporter de l’information et aussi provoquer les retweets et le bouche à oreille

“Now You Can Talk to Twitter and Find Clinical Trials on TrialX“. La seconde approche est celle proposée par trialx.org, site qui met en relation patients et investigateurs.

Trialx a créé un compte twitter qui permet à toute personne à la recherche d’une étude d’envoyer un tweet commençant par le tag “CT” (pour clinical trial) accompagné d’une courte présentation essentiellement basé sur âge, sexe et pathologie. En réponse est envoyé par @trialx un lien personnalisé vers les études correspondantes référencées sur trialx.org.

Cet échange peut aussi se faire par le biais d’un direct message, donc de manière privée entre un patient et @trialx.

——————–

[Autres articles sur twitter sur biogeekblog]

[Autres articles sur la recherche sur biogeekblog]

OK, total self-promotion. I wrote an article that was recently published in Pharmaceutical Executive’s Successful Product Manager’s Handbook. They called it, Practicing Safe Social Marketing: Six Steps To Online Engagement, a title I really like. It details specific ways to participate in this new world without incurring the wrath of regulatory (or at least not as much as you might with other programs). In summary:

1. Start tracking your brand online
2. Establish a relationship with a patient opinion leader
3. Support a social network in your category
4. Engage with physicians at one of their many online haunts
5. Use video to communicate and educate
6. Go mobile

Let me know what you think.

I realize that I post infrequently not because I have nothing to say, rather because I am too much of a perfectionist when it comes to writing. I have to think, write, read, re-read, re-write, re-read, re-write. I thought I had gotten over this – which is not really compatible with constant blogging – but some habits die hard. So I’m going to cheat a bit by linking you to other great blog posts in between mine.

My HBS classmate Dave O’Reilly recently started the Intelligent Medicine Blog. Check out his post on Wireless, Health and the FDA, which summarizes both an article in BusinessWeek: Dr. Wi-Fi to the Rescue and one from Mobihealthnews: FDA may regulate iPhone Health Apps. Dave’s post details the coming mobile revolution in healthcare and how the FDA might consider regulating iPhone and other mobile health applications. Well worth a read.

J’ai reçu aujourd’hui un DM d’Alexandra @accarmichael sur twitter.

Alexandra me signale la publication de ”Vulvodynia Heroes“, un livre écrit à 2 fois 191 mains, ou tapé plutôt, puisque les auteurs sont tous toutes membres du portail CureTogether.org, réseau social de patients qui se rassemblent pour partager leurs expériences et faire avancer les traitements.

Parfait exemple du concept de crowdsourcing ou de génération de contenu partagé par un groupe d’utilisateurs, autour d’une thématique spécifique, ici une pathologie féminine assez peu médiatisée.

Exemple aussi de patient empowerment, ou comment les patients deviennent réellement partie-prenantes de leur maladie, de l’acquisition de connaissances nouvelles et de sa prise en charge.

Pour en revenir à ”Vulvodynia Heroes” :

What’s Inside?

 190 women share stories, symptoms, and triggers
 Surprising data on co-morbid conditions*
 Detailed comments on treatments by real patients

All proceeds from Vulvodynia Heroes go to fund the vulvodynia data community at CureTogether.org

Je ne doute pas que cet ouvrage cette cohorte intéressera certainement les structures de recherche, publiques ou privées, actives en santé féminine.

* voir le post à ce sujet sur le blog de CureTogether.org.

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The e-Patients.net site has an excellent review of a white paper on how use by patients of online and health information-based tools is transforming health care and the physician/patient relationship. You can download the white paper (“e-patients: how they can help us heal healthcare”) at e-Patients.net and also in the Intelligent Medicine Blog information box.

Here is a summary of the major conclusions, as summarized by e-patients.net:

1. e-patients have become valuable contributors, and providers should recognize them as such.
“When clinicians acknowledge and support their patients’ role in self-management … they exhibit fewer symptoms, demonstrate better outcomes, and require less professional care.”

2. The art of empowering patients is trickier than we thought.
“We now know that empowering patients requires a change in their level of engagement, and in the absence of such changes, clinician-provided [information] has few, if any, positive effects.”

3. We have underestimated patients’ ability to provide useful online resources.
Fabulous story of the “best of the best” web sites for mental health, as determined by a doctor in that field, without knowing who runs them. Of the sixteen sites, it turned out that 10 were produced by patients, 5 by professionals, and 1 by a bunch of artists and researchers at Xerox PARC!

4. We have overestimated the hazards of imperfect online health information.
This one’s an eye-opener: in four years of looking for “death by googling,” even with a fifty-euro bounty for each reported death(!), researchers found only one possible case.

• “[But] the Institute of Medicine estimates the number of hospital deaths due to medical errors at 44,000 to 98,000 annually” … [and other researchers suggest more than twice as many]
• We can only conclude, tentatively, that adopting the traditional passive patient role … may be considerably more dangerous than attempting to learn about one’s medical condition on the Internet.” (emphasis added)

5. Whenever possible, healthcare should take place on the patient’s turf. (Don’t create a new platform they have to visit – take yourself wherever they’re already meeting online.)

6. Clinicians can no longer go it alone.

• Another eye-popper: “Over the past century, medical information has increased exponentially … but the capacity of the human brain has not. As Donald Lindberge, director of the National Library of Medicine, explains ‘If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
• In contrast, when you or I have a desperate medical condition, we have all the time in the world to go deep and do every bit of research we can get our hands on. Think about that. What you expect of your doctor may shift – same for your interest in “participatory medicine.”

7. The most effective way to improve healthcare is to make it more collaborative.
“We cannot simply replace the old physician-centered model with a new patient-centered model… We must develop a new collaborative model that draws on the strengths of both systems. In the chapters that follow, we offer more suggestions on how we might accomplish this.”

Another Health 2.0 flame-out has occurred, this time Wellsphere was picked up yesterday by HealthCentral. Not sure why HealthCentral would even remotely be interested in Wellsphere as Wellsphere is one of those companies I just could not get excited about.

Why?

Wellsphere use to SPAM me about once a month requesting that I join their community by providing a direct RSS feed of Chilmark Research postings claiming that in doing so, Chilmark Research’s visibility will grow and who knows, maybe our influence leading to fame and fortune.  Each time I received one of these emails, I would head over to the Wellsphere site and take a quick look.  Each time, I left unimpressed.

Wellsphere was not going to help Chilmark and if anything, probably hurt us as our reason for being is not general, consumer information, but technical information better suited for stakeholders/businesses currently in the healthcare sector or those looking for opportunties and entry points therein.

With the demise, or let’s call it folding in of Wellsphere into HealthCentral for an undisclosed sum, all those bloggers that got suckered into Wellsphere are now crying foul for not getting a piece of the action and there has been a lot of moaning, groaning and bitching in the health Blogosphere.

Please folks, get it through your head: Wellsphere was a business and as a business would take what actions it deemed necessary that were in the best interests of their founders and funders, not you.  You, dear Blogger readily turned over your copyrights to Wellsphere.  Is that their problem, or yours?  Take this as a lesson to pay just a bit more attention to who you partner with and what interests you share that you may both profit upon. If those interests are not readily apparent, move on.

In other news…

The leading tracker of Internet traffic, comScore, just released its scores of top growing Internet properties and Everyday Health comes in at Number 5!  Nice uptick for them that will certainly get the attention of advertisers.  Expect Everyday Health to continue to do well as advertisers pull their funding from those sites getting less traffic, moving to quality properties. Expect more Health 2.0 flame-outs as most are still too reliant on advertising to make their business models work.

In the coming era of consumer genetics, your DNA will have much to tell you about the biological bases of your health, your physique and even your personality. But will this knowledge really amount to self-knowledge? asks Steven Pinker in his article My Genome, My Self, which appeared in the January 11, 2009 issue of the Sunday New York Times.

To learn more, read more here.

First the Links

• Apple iPhone and Unbound Medicine hook-up
• This is interesting because it lead to the health webification of consumer gadgets
• Business Opportunities for the cut-price Provider
• Uninsured numbers could be an indication that pricing of insurance premiums are out of whack with a large portion of regular Americans. It could be viewed that the pricing model is worng and an enterprising person my be able to take advantage to deliver cut-price services to this increasingly “untouchable” population
• NY Times Tele-Doctor initiative in Hawaii, also here, here
• To what extent can services be delivered across the web. Some players are going to try and they should be applauded for their initiative and innovation. Should this prove successful, they should also be applauded for their graft and dedication to their ideas.

And now for the Kitchen Sink

• The Cultural Movement – Think Coronation Street
• The wart-and-all approach. I wanted to view the modern day situation through
• The Art – here, here
• The Movie won awards – Not this one though
• I really wanted to promote the New Zealand Film Commision. Some amazing film is produced under the auspicies and with the assistance of the NZFC. Big-ups.

The Kitchen Sink mentality may be a good topic to explore in relation to the financial meltdown and current economic perils.

In fact, I’ll do just that.

My dog Lily got a good walk today. My podcast selection consisted of:

• Adaptive Path – Semantic Technologies (44:08)
• eHealth Trends, Manhattan Research – Twitter for Health (5:46)
• eHealth Trends, Manhattan Research – Future of PHR (6:30)
• The Web2.0 Show – Jeff Barr, Amazon Web Service (27:35)
• NPR Live Concerts – Wilco Sampler (17:30)

That’s pretty far alright – Right round the park, up past the creek, through the school rugby field (twice). In fact it’s farther than her usual route which is approximately:

• Entrepreneurial Though Leaders – Choosing The Entrepreneurial Path, Reid Hoffman (1:03:19)
• iinovate – Chip Heath, Author of Made To Stick (14:38)

You can’t really imagine what goes on in the old grey matter when you blend all that together with walking/jogging. Its a great way to squash a whole bunch of ideas into each other. There is so much going on in the health2.0 scene at the mo… and simultaneously trying to keep up with TechCrunch + Gizmodo + ReadWrite + Church of the Customer + O’Reilly Radar + Feld Thoughts.

My solution: Walking the dog and Driving the car… this really helps suck in the necessary info and ignite the bloody great blast furnace.

Oh, and I prefer the Aerosmith version…

The New Yorker ran a great article in December last year on complexity and simplicity in the medical setting – specifically around the Critical Care environment (subsequently, the NYTimes has also followed suite with a version citing surgical checklists and safety). Both refer to the NEJM study by Dr. Atul A. Gawande.

As I sat reading this after a hard day grinding the gears, I realized my life really wasn’t all that hard if the truth be told.

Peter Pronovost is an inspiring legend. Seemingly indefatigable as a fellow earth-dweller, he is all at once an ebullient, enthusiastic personality with a realistic enough cast to understand that even the most expert of human performance is still just that… well err… human!

As some have poetically said  – “To Err is Human” and we humans, set in such overwhelmingly complexity can commit many (and grave) errors with serious outcomes for our ecosystem.  But to forgive oneself for committing the errors is truly divine. I would have to consider if modern medicine is educating certain individuals with that predilection to truly believe they are incapable of such errors – the infallible right hand of God so to speak. Is it cognitive arrogance to believe that we can remember every crucial detail in such environments as the ICU, OR or even the cockpit of a commercial airline? Failure is not an option.

The intense focus exhibited by people like Peter Pronovost, who become a super-specialist – further than a specialists -  is amazing. Its also life altering and personality changing work. When people put such intense effort into an endeavor, a lot of their personal image becomes rightly invested in that character. Following a list seems like a smack in the face of that persons intelligence and abilities.

Also,when someone has a great idea that is validated and lauded by their peers and society, it becomes hard for them to escape that idea in future. They are forever perceived as the “Wikipedia Man” or “Mr Facebook”. Does that cloud their thought processes about other, perhaps non-related, environments or actions? I would say yes it may well do.

To exhibit that form of self-reflexivity when approaching a new idea is really an awesome feat. The tendency would be to rely on the point of view that garnered such attention and accolade. It’s sure is hard to think about me thinking about thoughts. But Peter Pronovost did just that by shedding his education and super-specialist approach to see the lifesaving beauty and utility value in constructing simple lists. That’s “simple elegance”.

Just as some of our (grand)parents carry the Deppression Era mindset with them – frugality above all else -  So to does our recent successful idea/action stay with us and affect our future actions.

Where am I going with this….

I think the combination of a disciplined regiment coupled with an attitude and some aptitude will lead to great ability and this may just be the path to excellence.

Oh, and also “Write a List” man…

Article in today’s NY Times that looks at where the Silicon Valley Venture Capital (VC) firms are likely to place bets in 2009. Some highlights and our comments follow:

1) Article starts by saying almost anything Web2.0 that is ad-supported and free to the consumer will fall out of favor.  No argument there.  This new reality will not be limited to just Web2.0 companies but encompass Health2.0 firms as well.

2) Venture Capital firms are not too crazy about funding iPhone/smartphone apps and instead are investing in mobile hardware/infrastructure plays.  They are much closer to this market than we are, so maybe they know something we don’t.  From our vantage point, however, we see plenty of opportunities for new mobile apps, thus remain bullish on smartphone apps, particularly those targeting health & wellness.  Despite some 400+ health apps for the iPhone, most of those apps are simplistic, me-too apps and only a handful truly capture the imagination.  On top of that, there are the platforms for Google Android, Nokia’s Symbian, Blackberry and even Microsoft Mobile.  None of these other mobile platforms have come close to replicating the AppStore, but if they do, watch out.  There is still a deep vein to tap here that the article and maybe some VCs fail to see.

3) Despite not seeing much opportunities in the mHealth, VCs do see a lot of promise for healthcare apps, especially, at least the article infers, consumer-facing apps.  While we would like to share their optimism, we are skeptical that quick returns will come easy for several reasons including:

• Consumer adoption is a challenge on two fronts, education to drive motivation/adoption and privacy,
• Liquidity of health information is still in the dark ages and
  
• Mixed response among care providers.  While some encourage use of such tools, there is a significant number of care providers who are not supportive and even discourage consumer use of these tools.
  

Yes, there are opportunties here and yes, IT is still fairly new to healthcare, but there are some deep structural issues to overcome. VCs looking to invest will need patience, something that is rarely found.

With the proliferation of sites where people discuss all aspects of their diseases and conditions, it was inevitable that patients would talk about and even rate their medications and therapies. In the recently released CyberCitizen Health™ v8.0, Manhattan Research reported finding almost 9,000 reviews of Zoloft and over 5,500 of Seroquel on DailyStrength. Other sites mentioned in the study were iGuard and PatientsLikeMe.

I went to iGuard. If you manage or work on a pharma brand, you should take a look. The site features information, discussion and ratings for brand name and generic drugs. It was founded in 2007 by a former executive of Quintiles to “change the way that doctors, pharmacists, researchers and patients communicate about drug safety.” As a test, I looked at Plavix. Besides the basic information you would find on most drug info sites, there was many iGuard-user generated statistics. According to the site, there are over 13,000 patients tracking Plavix who, on average, have provided a Plavix satisfaction score of 7.9 (out of 10) and effectiveness score of 7.7 (out of 10). Other data:

• 28% of patients experience side-effects on Plavix
• <1% of patients experience SIGNIFICANT side-effects on Plavix
• 94% of patients are confident that the good things about Plavix outweigh the bad things
• 16% wish they were told more about this product before they started it

This is followed by pages and pages of comments and questions. I was impressed by the sheer quantity of postings.

Another site I found is called Medications.com. They claim to have tens of thousands of reviews on nearly 15,000 drugs. Here, though, I was a bit suspect because they do not disclose who runs the site. I searched the “About Us” section and found no specific people associated with Medications.com. That strikes me as odd. Still it is a worth a look to see what people taking your meds are saying.

ReadWriteWeb today released  its annual list of  social media, web and tech predictions for the year ahead. Here are my top 10:

1. iTunes adds social networking features.

2. Health web apps start getting attention from mainstream people and media.

3. Apps that do filtering, inferring and recommendation have a great year.

4. Twitter announces they have a plan to make money. They do.

5. New iPhone is released with video recording capabilities.

6. Facebook Connect becomes new de facto way to login to web sites.

7. 2009 will be like 2002 for raising money or exiting.

8. Streaming web video to the living room will go mainstream.

9. If Apple finally enables its push server, mobile social networks and geolocation enabled apps will become a major topic next year.

10. Amazon will further strengthen its position in the cloud computing market, by launching more of its Web Services and gaining more clients for existing ones.

To find out how people think around healthcare, it is best to initiate a conversation, a real live talk. A talk opens up avenues and lanes for further discussion and possibly highlights some consensus around which actions can be taken.

What do you think of the health2.0 discussion currently taking place?

Is it valid?

Is it useful?

What would you add to this relatively nascent meme?

Be glad to hear some dialogue… Cheers Nathan

Health2.0 Graphic