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<font size="4">What is Health 2.0:<br></font> 
<font size="2">'''''The Enabling Technologies and Reform Initiatives for Next Generation Health Care'''''</font> 


''By [mailto:scottlshreeve@gmail.com Scott Shreeve, MD]''
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__TOC__

=Introduction=
==Healthcare==

Healthcare remains the [http://en.wikipedia.org/wiki/Health_profession largest], most information complex industry in United States. Despite amazing advances in diagnostic capability, alternative drug therapy, and personalized genomic medicine, the actual delivery of care is often ineffective, unsafe, and of poor quality. Frought with clinical , financial , and administrative  challenges, managing health and wellness has become a primary concern for the government, industry, employers, and individual Americans. The growing urgency of the broken healthcare system has only worsened with the accelerating [http://www.businessweek.com/bwdaily/dnflash/content/sep2006/db20060927_387654.htm?chan=top+news_top+news+index_top+story global], political, and cultural pressures to manage health care costs and improve health care value. 

These challenges arise despite the fact that Americans spend more money on healthcare than any other country. Healthcare is the largest industry in the US, consuming nearly 17% of GDP, with major and ongoing investments in technology, science, education, and delivery systems. Despite these investments, US healthcare is characterized by system wide failures, gross inefficiencies, perverse incentives, and lack of accountability for outcomes which create a confused and crippled system that fails to meet basic healthcare needs. Even more confounding, most of the information and delivery challenges found within healthcare have previously been solved, in some cases for decades, in other major industries industries.

==Internet==
The software and computing industry represents a telling contrast to the current challenges found within healthcare industry. This industry can also be characterized by significant technology, science, education, and delivery investments. However, in contrast with healthcare, this increasing investment in the computer industry has been met with dramatic increases in quality with equally dramatic decreases in costs. Each of us has experienced this personally when purchasing personal computers over the years as the computing power and memory has exponentially increased while the cost has exponentially decreased, with a concomitant persistent rise in consumer value. 

The internet experience represents a microcosm of the overall technology impact of last 25 years. The pervasive adoption of the internet, including the ability to remove geographic, time, and efficiency constraints on the flow of information, initiated major cultural, social, and political changes in most industries beginning in the mid 1990’s. Internet investment and subsequent innovation led to a well documented technology “hype cycle” . The initial phase of the cycle began with the IPO of Netscape in 1996 and continued for an unprecedented 6 year period of irrational exuberance and speculation which ended in 2002 with the IPO of Loudcloud. The subsequent “bursting of the bubble”, led to a technical shakedown and dramatic loss of valuation due to white hot over-speculation. 

However, emerging from the internet “crash” was a plethora of companies that not only survived, but were thriving by introducing new combinations of technologies, products, and services while engaging consumers in new and previously unimagined ways. Many of these companies shared several characteristics and these emerging themes began to coalesce around a gravitational core of concepts. Consistent with the Hype Cycle predictive model, these companies found new ways to deliver on the promises of their predecessors in highly innovative ways. Far from a flash-in-the-pan flameout, the internet bubble had served as a refiner’s fire for creating the next generation internet renaissance, appropriately dubbed “Web 2.0”.

==Web 2.0==

The authoritative description of this phenomenon, “What is Web 2.0”, was authored by Tim O’Reilly in December 2005. While a singular definition remains elusive, and may be impractical, the 20-page white paper accurately describes the core principles and representative companies putting these concepts into practice. Importantly, O’Reilly also identifies Web 2.0 as more than technology, but also a social, cultural, and even political phenomena. Thus the movement is described by inclusive phraseology such as “collective intelligence”, “user generated content”, and the “architecture of participation”.

==The Health Care Hype Cycle==
Healthcare has experienced a similar hype cycle during nearly the same time period. Beginning in the mid 1990’s, the healthcare industry responded to rising healthcare costs by creating manage care organizations which engendered a culture of denial, cost shifting, perverse incentives, and diminished value for patients. The fallout from HillaryCare and the ongoing unrest created a backlash for health maintenance organization and the return of double digit healthcare inflation. The prosperity of the bubble eased some of this burden, but the crash reawakened an awareness of just how much trouble our healthcare system was actually in. This has been played out with awareness about cost/quality issues, global competitiveness issues, and the political intensity of this topic in the upcoming elections. 

The healthcare crisis is no longer something that can be ignored. The current challenges are being met with increased investment, increased participation by influential corporate entities, increased engagement by some of brightest and most capable entrepreneurs, and increased creativity from current players in the healthcare constellation. Multiple regional and national experiments have been successfully conducted, major state-wide reform initiatives have been passed, and new technologies are constantly introduced to tackle the largest healthcare problems facing our country. From this mileu of innovation, several new themes have begun to emerge. In fact, several new (and old) concepts about how to deliver high quality health care have created a gravitational core of ideas around increasing healthcare value. 

The purpose and intent of this paper is to discuss the principles of the reform movement in which enabling technologies can redefine the patient healthcare experience.

=Health 2.0=
==Definition==

Health 2.0 is an environment where personal health information will be shared between healthcare providers based on the personal preferences of the patient or their designated representative. 

The technology that must exist prior to Health 2.0 is the real ability to persist and transfer health information in context (spatial and temporal) between systems.  This is the "hard work" for health information specialists over the coming years.

==Patient Centric==
===User experience===
===Consumer Driven – too simple===
==Pervasive Information – XHR==

===Outcomes===
===Predictive modeling===
===Clinical Analytics===
==Value Driven agenda==
===Interoperability===

Interoperability is the most pervasive barrier in health information systems.  

While HL7 exists as a communications (message) format it doesn't really allow for **in context** information exchange between systems.  

A new paradigm of thinking (system development) must exist in order to preserve the semantics of healthcare information as recorded.

See http://www.openehr.org for more background on this research.

===Measure Quality===
===Align Incentives===
===Transparency===
==Managing Medical Conditions over the Full Cycle of Care==
===Metric of performance===
===True cost of care for episode of care===
==Value Added Advisory Services==
===Helping to navigate the healthsystem===
thaks

===Physician as advisor===
===Prevention/Education===
==Web 2.0 in Healthcare==
===Aggregate, Analyze, and Advise===
===Mashups / Open Source in Healthcare (easy extensibility)===

Open source applications in healthcare are a foundational requirement for interoperability.  

However, educational processes must take place as well.  Both formal and informal education is important to accomplish interoperable healthcare information systems.

===Collective Intelligence / Wisdom of Crowds===
===User Generated Content / PHR (user generated content)===

Personally entered information about a persons health status may be the most important data entered.  

However, for it to be accurate and complete the patient MUST know that that information is protected from casual access
and distributed ONLY to those persons that the patient authorizes.

In this sense, only a centralized patient record, with access controls is a feasible approach. A specific location where the patient authorizes all of their information to be sent and aggragated is a workable solution.  

The current (technically cool) approach is to attempt locate healthcare information across multiple sites using some algorithm to determine identity.

The "uncool" part of this approach is that it eventually requires some personal intervention to determine if this is really the same person.  Whereas, if a patient tells their specialist that this is the email address or web address to send my results to my primary record.  It is not very different from the current work flow of a patient telling a specialist to send that info to a mailing address, it is just much faster.

==Universal HealthCare Coverage==


I am retired from the US government and have (sort of) medical care.  As I travel around the world I realize that even my medical covereage is inadequate compared to most other countries.  It is time we realized that healthcare is a right and will actually save the US economy money in the long run.  Sure there are people that are not contributing to society and you may say you do not want to support them.  However, the reality is that you *WILL* support them, one way or another.
Return to Shreeve Health 2.0 Whitepaper.
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