Some more reflections on Health 2.0

By Matthew Holt

It’s late at night and I’m red-eye-ing it to Boston to the Partners Center for Connected Health Symposium. Just like at Health 2.0 last week there’s going to be about 1,000 people there. And while originally the session I’m leading on Social Networks was going to be about it for Health 2.0, the agenda has morphed quite a bit and several of the people and players who were on at Health 2.0 are also going to be in Boston. (Although my understanding is that the polite Harvard guys won’t torture them into demoing the way we make them do it!)

That tells you a couple of things. First, smart people think alike. While Connected Health started out as being mainly about remote monitoring and its place in disease management, the core group of consumer-facing tools that make up an increasing share of Health 2.0 are entering into the DM and Connected Health realm. Second, the semi-automated DM systems that are primarily call-center driven are suffering some more realistic expectations compared to the famous $34bn plus forecast from Forrester a while back. And that of course is highly highly related to the perceived failure of Medicare Health Support.

All of this leads to the underlying tension that Health 2.0 puts squarely on the table. Is the future of health care going to be led by self-organizing groups of patients and their representatives, or will it be dominated by technologically-extended versions of the major health care organizations who are now responsible for care delivery?

My suspicion is that the answer is both.

A few quick other points about the Health 2.0 Conference.

Indu & I received effusive praise from just about everyone we spoke with, but also a few criticisms. So let me try to answer some of them here.

There’s been a little too much tittering about some of the problems faced by some of the online demo-ers. First off with over 100 live demonstrations—many of which included brand new never-seen before software, you can expect some problems. It’s extremely unfortunate that there was a problem with the Internet that slowed down the first plenary session demos, and as the conference organizer, we must hold up our hands for not being quite thorough enough with the hotel’s Internet service to ensure that it was perfect.

But nonetheless WebMD, Aetna, PDX, & Kaiser were able to show new and cutting edge technology (even if some of the response time lagged a little) and Microsoft’s problems were due to a password miscommunication. We managed to solve the Internet problems at lunch the first day, and after that—with one exception where the individual concerned went off the reservation—every main stage Internet demo went fine and although I wasn’t at every break-out, my understanding is that those Internet demos went fine too. And while Yahoo may have “chosen wisely” by showing a screen shot, the only reason they showed a screen shot is because that application has not yet been built, and they were only allowed to show that as an example to help the audience understand the context of their announcement with Healthgrades.

Nonetheless, those people chortling at the problems Peter Neupert had are missing the point. With Healthvault, Microsoft has made an extraordinary effort to move the entire online health field along—and even people who’ve been very critical of Microsoft’s technology and behavior in other areas admit that the stance they’ve taken towards giving users control over their data and controlling their own data’s privacy seems absolutely genuine. I’ll be doing a detailed test-drive of the newly upgraded HealthVault in the coming weeks (to match the one I did earlier this year of Google Health), and while I’ll not be pulling any punches, I will start with the bias that more online health information and tools are progress on the road to a better health care experience and a better health care system. Meanwhile here’s Sean Nolan’s take on the day…and what you should have seen.

Similarly, I’ve noticed one or two complaints that the technologies shown in the consumer tools panel were either not real or viable in the current market. I’m absolutely open to criticism about my fashion sense, the panel’s timing (we ran over—our fault, not our demoers), and whether the skit about Matilda’s life made sense. We clearly tried something very ambitious. But it was never our intention in putting together that panel to show that these were all either perfect tools or that the companies which built them were all necessarily going to succeed.

What we (I hope successfully) showed was a series of extremely complex tools ranging from iPhone-based content delivery systems (ADAM’s new iPhone application), to genomics results, communities & counseling (23andme, Navigenics), to online multi-modal live visits (American Well), to complex programs for managing wellness (Keas), lab tests (MyMedLab), treatments (DoubleCheckMD), drug-pricing, choice and regimens (DestinationRx & Pharmasurveyor), and money (Quicken).

These tools are all real. They’re either in production, or very advanced development, and they all represent a huge advance on tools available for consumers today. In fact the only “canned” presentations were the two calls from Silverlink and Eliza—for technical reasons you cannot precisely “time” a inbound call from their systems which meant that a real inbound call would not have fitted in the rigors of the skit. But both those companies deliver millions of those calls each week, so they’re clearly not vaporwear.

The question of market viability is of course one all those companies need to face. But in a health care system in which crazy bad behaviors and useless technologies are heavily rewarded every day, is it a bad thing to suggest that we need to change incentives so that tools which have the potential to so greatly improve patient experience are put on a level playing field?  I think not.

But the point of the panel was to show the potential for improving the patient experience, not to question 12 companies’ business models. We did that, very successfully I might add, the day before in the Scott Shreeve “lets get real” panel. And getting big businesses—especially pharma companies—on a panel to discuss how they are spending their money is not easy.

And for sure everyone brings their own bias to the conference. Hope Leman got all pissy about PatientsLikeMe’s policies and business model, and was bitter that librarians weren’t well represented.  Fair enough. We should do better to include more of those perspectives next time.

Others complained to me that there were no patients. A fair criticism, although our spring fling in March included 4 actual patients sharing their experiences throughout the day, and most of the speakers and demoers relayed great stories or information about their users. And of course Edelman was able to show its new data about patients an their engagement. Still others wanted more about physicians or more about policy….

The upshot is that Health 2.0 is a conference focused on showing how technology allows people to find health information, to organize with others, and to manage their health. Everything we add in another dimension—while very valuable—takes time away from the many many organizations that want to show their technology. And we want them to show it.

There’s only so much time in a two day conference, and I’d rather err on the side of showing more technology that may make a difference, than having more people talk about how great it’s going to be, or telling the crowd what’s wrong with this approach.

For sure we’re going to be changing the format the structure and the content to reflect requests from our audience and to reflect the changes we see. So this is not static.

But yeah, I admit it. I’m biased. But in case you weren’t watching, the current health care system is not exactly in good shape. Health 2.0 tools and services have the potential to change at least some of it.