The Doctor Weighs In

Brian Klepper

Three weeks ago Pat and I attended a fascinating conference in San Francisco on Health 2.0, an emerging industry that promises to change the ways patients manage their own health, and the ways that clinicians and purchasers of all types make clinical and management decisions. The term Health 2.0 refers to Web 2.0, the idea that, in social networking, people will use Web-based platforms to reformulate data for their own purposes.

Jane Sarasohn-Kahn is a highly-respected health economist and commentator working at the intersection points of health care and technology. Jane and I worked together to describe the elements and functions we believe will be integrated to constitute Health 2.0's real value. We've posted this narrative and an accompanying image - its an animated PowerPoint slide that lets you watch the elements build - on several sites, including Jane's site,  Matthew Holt's The Health Care Blog and the Health 2.0 wiki.

We have invited readers to download the image and read through the narrative, and provide then feedback on this model. Please join us. Understanding how information can be leveraged to promote better, less costly care is a critical step toward getting us there.

Aggregate, Analyze and Advise

Scott Shreve MD, an Emergency Physician who has been a prominent theorist in this exciting new area, summarizes Health 2.0's primary data management functions as Aggregate, Analyze and Advise. It's a good way to think about it, and is very consistent with the description that Jane and I came up with. A short version is described below.

Aggregate

Keep in mind that the companies chasing the big, comprehensive vision that is at the end of the Health 2.0 rainbow - Microsoft, Google, Yahoo, WebMD, Revolution Health - hope to make money. They'll directly get fees for the services they provide or capture the traffic and profit from the ad revenues, as Google does. (It's worth mentioning that Health 2.0 represents an incredibly powerful development in health care technology, which has a very accessible (relatively low cost to each end-user) value proposition in terms of its ability to impact the health of large populations. This stands in stark contrast to some of other health care technologies, like bio-technology, that often have a very inaccessible (i.e., expensive) value proposition.) To get the ball rolling, though, and deliver on the promise of Health 2.0, the companies in this game first have to develop ways to aggregate patient data of all types: claims, clinic, drug, lab and image, and then map these data elements - they're from different sources and often in different formats - to a common format, like the increasingly well-recognized and accepted Continuity of Care Record.

Once aggregated and stored in centralized data repositories, they'll route that individualized information into Patient Health Records (PHRs), which help patients monitor and manage their health, to Electronic Health Records (EHRs), which help clinicans monitor and manage patients' health, and Health Management tools, which help health care professionals in non-clinical settings (like wellness specialists, case managers and disease managers) monitor and manage patients' health.

Analyze 

In addition to routing the identified patient data to its proper destinations, the stored information in the CDR will be analyzed to identify patients with health risks (like people with chronic health conditions, or people who are likely to have an acute event in the future), and to identify best practice guidelines (i.e., the treatment approaches that consistently get  best outcomes at the lowest cost). The evaluations will also allow comparison of the relative pricing/performance of providers (e.g., doctors by specialty and hospitals by service) health plans, products (drug, device, equipment and supplies by class), and interventions/treatments.

Advise 

The results of these analyses can be used to create public transparency reports on health care products and services - like a Consumer Reports for health care - and can also be used to create decision support tools that advise patients, clinicians, and purchasers of all types about how they might better manage health care quality and cost. 

The patient advice tools will also include expert information like medical encyclopedias, and user-generated information like patient or caregiver advice to other patients.

This flow and reformulation of information in Health 2.0 efforts will give every health care decision-maker far better information. This is a market-based approach that holds promise for profoundly transforming the health care marketplace for the better. Go over to one of the sites listed above, and give our graphic and the narrative a look. Then let us know how we can make it better.

Brian Klepper is a health care analyst based in Atlantic Beach, FL.