The Internet has evolved beyond its origins as a collection of interconnected websites with static information.
Convenient, remote information access; interconnectivity; and a host of other key features has led the healthcare industry to embrace the Internet, as evidenced by the proliferation and success of for-profit sites like Medscape, publicly funded sites such as the National Institutes of Health, and disease-specific groups like the Neuroleptic Malignant Syndrome Information Service and Tourette Syndrome Association.
However, the Internet has evolved beyond its origins as a collection of interconnected websites with static information. It has become a medium through which relationships are established, information is shared and aggregated, and communities are developed. SecondLife, a virtual online world, has become a popular destination not just for recreation, but business as well. Blog authors now have a large readership base on par with some newspaper columnists. User-generated content is fast becoming the dominant online business model. The healthcare industry has embraced this trend, utilizing the Internet to do everything from publishing electronic versions of clinical journals to conducting business online with Web-based forms for prior authorization of medications and enabling patients to fi nd the right healthcare provider in an insurance network. This trend has been referred to as Web 2.0, and many new healthcare companies have adopted this paradigm, calling it Health 2.0.
Sharing the bounty of Web 2.0
Tim O’Reilly, an advocate for free and open source software and the author of many “gold standard” technical manuals, is widely acknowledged as the originator of the Web 2.0 concept. Th ere are several signifi cant principles of Web 2.0, the first being the idea of the “Web as a platform.” An analogy is that Skyscape is a document platform company but not a publisher of electronic texts.
Another important principle of Web 2.0 is that “the service automatically gets better the more people use it.” This is how the additive eff ect of more computers increases not only the number of websites, but actually provides a service. For example, the Folding@ Home project of Stanford University harnesses the idle computing power of computers and powerful gaming systems such as the PlayStation 3 on the Internet to study protein folding and misfolding via a distributed computing system. Participants can check on how much they have contributed and see how they rank against other contributors. In the spirit of competition, the hardware site ExtremeOverclocking is hosting a competition to see which group reaches 5 million points first.
In a similar vein, another principle of Web 2.0 is that the Internet as a medium has created the opportunity to harness the collective intelligence of the entire online community. Wikipedia is a prime example of this concept. The name comes from “Wiki,” a Hawaiian word for “quick,” and “pedia,” as in encyclopedia. In Web terms, a wiki is a collection of pages designed to enable anyone to contribute or modify content. Users can add pictures, video, and create links to information on other sites in addition to adding explanations, definitions, and other content. Wikipedia is a popular destination because it provides information on an unbelievably wide range of topics. Sharing resources online in large virtual communities is another key feature of Web 2.0, as exemplified by sites such as Del.icio.us, Flickr, and Digg. At Del.icio.us, after users create an account, they can bookmark favorite sites and “tag” them with keywords, enabling other users on Del.icio.us to search for and discover these sites.
Del.icio.us keeps track of how many other people save these sites as well, which provides another measure of which websites and content the community deems most relevant. In addition, Del.icio.us users can join up with one another to create networks and alert others in their network of new sites. Digg takes a similar approach, in that users tag and submit interesting and useful sites for appraisal and comment by other Digg members, who rate them either as digg (positive) or bury (negative). Digg users can search based on most popular story, least popular story, newest story, oldest story, and most-commented-on story.
Peerclip is a healthcare-based sharing tool that works in the same way as Del.icio.us and Digg but it is restricted to physicians, nurse practitioners, and physician assistants only. RSS, or “really simple syndication,” is another popular method of sharing content. Easy to download and use, RSS readers enable users to subscribe to “feeds” that deliver news and other information from their favorite websites and other information sources. In essence, RSS feeds enable the user to have multiple sources of information pulled into the reader program, which also tracks which content is new and which has been read. For example, PubMed offers the option of sending search results as an RSS feed, so that any new journal that meets the user-generated search terms will appear in that person’s RSS reader.
What is Health 2.0?
Depends on who you ask. A variety of healthcare thinkers and pundits have off ered competing defi nitions of Health 2.0. Matthew Holt, founder of the Health 2.0 Conference, and proprietor of the Health Care Blog, sees Health 2.0 as a user-generated phenomenon. Scott Shreeve of Crossover Health says that Health 2.0 companies provide the venue to transform healthcare, whereas Jos Bakker of Philips Medical Systems sees Health 2.0 as the next evolution in the Web space for the healthcare domain. Perhaps the best way to understand the Health 2.0 trend is to review some of its leading companies.
One of the new trends in Health 2.0 is improved healthcare information searching. Health-specific search engines, such as Healia, Medstory, and Healthline, improve on existing search engines like Google by searching not only the Internet, but specific sites, including ClinicalTrials.gov and PubMed, with specific health-related terms from medical taxonomies. These taxonomies likely include Medline’s Medical Subject Headings (MeSH), Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), and the National Cancer Institute (NCI) Thesarus. These search engines also search specific sites that have earned Health On the Net (HON) and Utilization Review Accreditation Commission (URAC) certification. The health search engines employ specific algorithms to implement the medical taxonomies, as well as utilize health experts, to refine the search terms (especially consumer-focused terms). Organized Wisdom takes a slightly different approach. Instead of relying on algorithms and semantic analysis, it adds the wisdom of trained expert search guides and physician reviewers.
MySpace and Facebook are among the most wellknown social networking sites on the Internet. Many patients have gravitated to these sites to create a presence on the Internet for themselves, as well as to establish links to their friends and business colleagues. In the Health 2.0 world, social networking among patients has taken on new meaning. At DailyStrength, patients can create an online journal, join an online support community, and invite family and friends to join. Activities are communicated via e-mail alerts to community news and friends. Members give virtual “hugs” to help support one another, providing support almost 24/7. At PatientsLikeMe, the social context takes the sharing of patient experiences further; although it focuses right now on Parkinson’s disease, multiple sclerosis, HIV/AIDS, and amyotropic lateral sclerosis, patients on the site not only share their symptoms, but also data on their treatment, which are tracked. Th is information is then plotted graphically over time, which helps others see the outcome of treatment on specifi c symptoms. MedHelpalso provides support communities for patients but adds topic-based forums featuring physician experts.
LinkedIn is the largest professional network online, with more than 20 million members. It offers a variety of services, including job postings, the ability to post questions to one’s network or the larger community, and discussion forums. One of the key features is the ability to see network updates, such as the new connections of your primary connections, as well as any changes to their profi les. The site is extremely popular with recruiters, who typically have over 500+ connections. But the medical community represents less than 4% of total users. In the Health 2.0 space, Sermo is the largest online healthcare community, with more than 60,000 members.
At this site, physicians pose questions and answers so that clinical findings and unusual events can be shared, with the collective knowledge advancing patient care in a peer-review manner. Physicians are verified when they join but can maintain a relatively anonymous profile. Pharmaceutical companies and other groups can pay to access the observations and clinical insights posted on Sermo. Ozmosis also pools and shares clinical pearls similar to Sermo, but its revenue comes from medical technology companies that sponsor forums seeking user experiences.
iMedExchange also allows members to share clinical pearls but adds sections for business practice and personal interests. Within3 has a more professional focus compared to the sites above. Its goal is simply networking, and not collective information aggregation. Within3 has both research and clinical communities, as well as individual and institutional members, national and international members, and groups with the idea of facilitating information exchange, whether it’s a clinical trial or referral for care.
Although the definition of Health 2.0 may be a moving target, the essence is that the “Internet as a platform” concept creates opportunities for both patients and providers—the whole is greater than the sum of its parts. It has become a dynamic entity, with many similar sites that are also diff erent in subtle ways. Which sites will prevail and dominate is too difficult to predict in the post-dot-com era, but certainly the time to try is now, instead of waiting.
Dr. Luo is the Physician Editor-in-Chief of MDNG: Psychiatry Edition, and chief of consultation and liaison psychiatry in the department of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior.