Health 2.0
Encyclopedia
Health 2.0 are terms representing the possibilities between health care
, eHealth
and Web 2.0
, and has come into use after a recent spate of articles in newspapers, and by Physicians and Medical Librarians. A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source
and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education. A possible explanation for the reason that Health has generated its own "2.0" term are its applications across health care in general, and in particular it potential in public health
promotion. One author describes the potential as "limitless."
The "Traditional" definition focuses on technology as an enabler for care collaboration--
"The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health"
An expanded version of the traditional definition breaks this into components:
Scott Shreeve considers Health 2.0 as a wider system reform--
"New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care"
Then there's the concept of Health 2.0 as a participatory process between patient and clinician (with a couple of notable twists) --
Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway.
Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.
Definitions of Medicine 2.0 appear to be very similar but typically include more scientific and research aspects—Medicine 2.0: "Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.
Published in JMIR Tom Van de Belt, Lucien Engelen et al. systematic review found 46 (!) unique definitions of health 2.0
Health 2.0 is evolving fast as the technology landscape evolves. As does the desire by healthcare professionals and by patients to embrace new technology and new services. However, already there are signs of Health 3.0 emerging. Health 3.0 is defined as delivery of healthcare which leverages the use of elements of Semantic Web
such as location awareness
, the emerging Internet of Things
and embedded sensors. Doctors 2.0 are also leveraging social media as a powerful tool. Dedicated social networking sites for doctors like Sermo, SocialMD, Ozmosis etc. are doctor-only social networks. Here the doctors get a chance to interact and share knowledge with other doctors. Doctors are entering into the field of blogging, where they share their experiences in the form of case studies, give insight about diseases, discuss common healthcare issues, and offer simple remedies for them.
, electronic medical records, mHealth
, Connected Health
, and the use of the internet by patients themselves such as through messageboards, blogs, and other more advanced systems. A key concept is that patients themselves should have greater insight and control into information generated about them. Traditional models of medicine had patient records (held on paper or a proprietary computer system) that could only be accessed by a physician or other medical professional
. Physicians acted as gatekeepers to this information, telling patients test results when and if they deemed necessary. Such a model operates relatively well in situations such as acute care, where information about specific blood results would be of little use to a lay person
, or in general practice where results were generally benign. However, in the case of complex chronic diseases, psychiatric disorders
, or diseases of unknown etiology patients were at risk of being left without well-coordinated care because data about them was stored in a variety of disparate places and in some cases might contain the opinions of healthcare professionals which were not to be shared with the patient. Increasingly, medical ethics
considers such actions to be medical paternalism
and are discouraged in modern medicine
.
A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2.0 setting: A patient goes to see their primary care physician
with a presenting complaint, having first ensured his own medical record
was up to date via the internet. The treating physician might make a diagnosis or send for tests, the results of which could be transmitted direct to the patient's electronic medical record. If a second appointment is needed the patient will have had time to research what the results might mean for them, what diagnoses may be likely, and may have communicated with other patients who have had a similar set of results in the past. On a second visit a referral might be made to a specialist. The patient might have the opportunity to search for the views of other patients on the best specialist to go to, and in combination with their primary care physician decides who to see. The specialist gives a diagnosis along with a prognosis and potential options for treatment. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a joint decision with their healthcare provider. They can also choose to submit more data about themselves, such as through a personalized genomics service to identify any risk factors
that might improve or worsen their prognosis. As treatment commences, the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them, and can stay up to date on research opportunities and clinical trial
s for their condition. They also have the social support
of communicating with other patients diagnosed with the same condition throughout the world.
exists to understand how much Web 2.0 is being used in general. While it has been estimated that nearly one-third of the 100m Americans who have looked for health information online say that they or people they know have been significantly helped by what they found., this study considers only the broader use of the Internet for health management.
A study examining physician practice has suggested that a segment of 245,000 physicians in the U.S are using Web 2.0 for their practice, indicating that use is beyond the stage of the early adopter
with regard to physicians and Web 2.0.
, wikis, podcasts, RSS feeds
(and other forms of many-to-many
publishing), social software
, and web application
programming interfaces (APIs) (see main article Web 2.0
).
(MDs) to use Google as a diagnostic tool
, which may be more effective only for conditions with unique symptoms and signs that can easily be used as search term. Secondly, long-held concerns exist about the effects of patients obtaining information online, such as the idea that patients may delay seeking medical advice. Finally concerns exist about the quality of user generated content
leading to misinformation, though one study has suggested that in certain support group
s only 6% of information is factually wrong and that only 3% reported that online advice had caused serious harm. Other venues of information are likely to be less useful to the general public.
Health 2.0 Hawaii Chapter
Health 2.0 Japan Chapter
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
, eHealth
EHealth
eHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
and Web 2.0
Web 2.0
The term Web 2.0 is associated with web applications that facilitate participatory information sharing, interoperability, user-centered design, and collaboration on the World Wide Web...
, and has come into use after a recent spate of articles in newspapers, and by Physicians and Medical Librarians. A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source
Open source
The term open source describes practices in production and development that promote access to the end product's source materials. Some consider open source a philosophy, others consider it a pragmatic methodology...
and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education. A possible explanation for the reason that Health has generated its own "2.0" term are its applications across health care in general, and in particular it potential in public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
promotion. One author describes the potential as "limitless."
Definitions and Inclusions
As yet there is no common agreement amongst experts and participants, but from the Health 2.0 wiki (not the Wikipedia version), there are several competing & complementary definitions of Health 2.0.The "Traditional" definition focuses on technology as an enabler for care collaboration--
"The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health"
An expanded version of the traditional definition breaks this into components:
- Personalized searchPersonalized searchPersonalized search refers to search experiences that are tailored specifically to an individual's interests by incorporating information about the individual beyond specific query provided. Pitkow et al...
that looks into the long tail, but cares about the user experience. - Communities that capture the accumulated knowledge of patients and caregivers; and clinicians—and explain it to the world,
- Intelligent tools for content delivery—and transactions, and
- Better integration of data with content. All with the result of patients increasingly guiding their own care
Scott Shreeve considers Health 2.0 as a wider system reform--
"New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care"
Then there's the concept of Health 2.0 as a participatory process between patient and clinician (with a couple of notable twists) --
Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway.
Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.
Definitions of Medicine 2.0 appear to be very similar but typically include more scientific and research aspects—Medicine 2.0: "Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.
Published in JMIR Tom Van de Belt, Lucien Engelen et al. systematic review found 46 (!) unique definitions of health 2.0
Health 2.0 is evolving fast as the technology landscape evolves. As does the desire by healthcare professionals and by patients to embrace new technology and new services. However, already there are signs of Health 3.0 emerging. Health 3.0 is defined as delivery of healthcare which leverages the use of elements of Semantic Web
Semantic Web
The Semantic Web is a collaborative movement led by the World Wide Web Consortium that promotes common formats for data on the World Wide Web. By encouraging the inclusion of semantic content in web pages, the Semantic Web aims at converting the current web of unstructured documents into a "web of...
such as location awareness
Location awareness
Location awareness refers to devices that can passively or actively determine their location. Navigational instruments provide location coordinates for vessels and vehicles. Surveying equipment identifies location with respect to a well-known locationa wireless communications device...
, the emerging Internet of Things
Internet of Things
The Internet of Things refers to uniquely identifiable objects and their virtual representations in an Internet-like structure. The term Internet of Things was first used by Kevin Ashton in 1999. The concept of the Internet of Things first became popular through the Auto-ID Center and related...
and embedded sensors. Doctors 2.0 are also leveraging social media as a powerful tool. Dedicated social networking sites for doctors like Sermo, SocialMD, Ozmosis etc. are doctor-only social networks. Here the doctors get a chance to interact and share knowledge with other doctors. Doctors are entering into the field of blogging, where they share their experiences in the form of case studies, give insight about diseases, discuss common healthcare issues, and offer simple remedies for them.
Overview
Health 2.0 refers to a number of related concepts including telemedicineTelemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
, electronic medical records, mHealth
MHealth
mHealth is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information...
, Connected Health
Connected Health
Connected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their...
, and the use of the internet by patients themselves such as through messageboards, blogs, and other more advanced systems. A key concept is that patients themselves should have greater insight and control into information generated about them. Traditional models of medicine had patient records (held on paper or a proprietary computer system) that could only be accessed by a physician or other medical professional
Health profession
The health care industry, or medical industry, is the sector of the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, palliative, or, at times, unnecessary care...
. Physicians acted as gatekeepers to this information, telling patients test results when and if they deemed necessary. Such a model operates relatively well in situations such as acute care, where information about specific blood results would be of little use to a lay person
Laity
In religious organizations, the laity comprises all people who are not in the clergy. A person who is a member of a religious order who is not ordained legitimate clergy is considered as a member of the laity, even though they are members of a religious order .In the past in Christian cultures, the...
, or in general practice where results were generally benign. However, in the case of complex chronic diseases, psychiatric disorders
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
, or diseases of unknown etiology patients were at risk of being left without well-coordinated care because data about them was stored in a variety of disparate places and in some cases might contain the opinions of healthcare professionals which were not to be shared with the patient. Increasingly, medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
considers such actions to be medical paternalism
Paternalism
Paternalism refers to attitudes or states of affairs that exemplify a traditional relationship between father and child. Two conditions of paternalism are usually identified: interference with liberty and a beneficent intention towards those whose liberty is interfered with...
and are discouraged in modern medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
.
A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2.0 setting: A patient goes to see their primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
with a presenting complaint, having first ensured his own medical record
Medical record
The terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction....
was up to date via the internet. The treating physician might make a diagnosis or send for tests, the results of which could be transmitted direct to the patient's electronic medical record. If a second appointment is needed the patient will have had time to research what the results might mean for them, what diagnoses may be likely, and may have communicated with other patients who have had a similar set of results in the past. On a second visit a referral might be made to a specialist. The patient might have the opportunity to search for the views of other patients on the best specialist to go to, and in combination with their primary care physician decides who to see. The specialist gives a diagnosis along with a prognosis and potential options for treatment. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a joint decision with their healthcare provider. They can also choose to submit more data about themselves, such as through a personalized genomics service to identify any risk factors
Risk factors
A risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. In these models, the rate of return of an asset is a random variable whose realization in any time period is a linear combination of other random variables plus a disturbance term or...
that might improve or worsen their prognosis. As treatment commences, the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them, and can stay up to date on research opportunities and clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s for their condition. They also have the social support
Social support
Social support can be defined and measured in many ways. It can loosely be defined as feeling that one is cared for by and has assistance available from other people and that one is part of a supportive social network...
of communicating with other patients diagnosed with the same condition throughout the world.
Level of use of Web 2.0 in Health Care
Partly due to weak definitions, the novelty of the endeavor, and as an entrepreneurial (rather than academic) movement, little empirical evidenceEmpirical research
Empirical research is a way of gaining knowledge by means of direct and indirect observation or experience. Empirical evidence can be analyzed quantitatively or qualitatively...
exists to understand how much Web 2.0 is being used in general. While it has been estimated that nearly one-third of the 100m Americans who have looked for health information online say that they or people they know have been significantly helped by what they found., this study considers only the broader use of the Internet for health management.
A study examining physician practice has suggested that a segment of 245,000 physicians in the U.S are using Web 2.0 for their practice, indicating that use is beyond the stage of the early adopter
Diffusion (business)
Diffusion is the process by which a new idea or new product is accepted by the market. The rate of diffusion is the speed that the new idea spreads from one consumer to the next. Adoption is similar to diffusion except that it deals with the psychological processes an individual goes through,...
with regard to physicians and Web 2.0.
Types of Web 2.0 technology in Health Care
Web 2.0 is commonly associated with technologies such as weblogs (blogs), social bookmarkingSocial bookmarking
Social bookmarking is a method for Internet users to organize, store, manage and search for bookmarks of resources online. Unlike file sharing, the resources themselves aren't shared, merely bookmarks that reference them....
, wikis, podcasts, RSS feeds
RSS (file format)
RSS is a family of web feed formats used to publish frequently updated works—such as blog entries, news headlines, audio, and video—in a standardized format...
(and other forms of many-to-many
Many-to-many
Many-to-many is a term that describes a communication paradigm and an associated media form. It is the third of three major Internet computing paradigms...
publishing), social software
Social software
Social software applications include communication tools and interactive tools. Communication tools typically handle the capturing, storing and presentation of communication, usually written but increasingly including audio and video as well. Interactive tools handle mediated interactions between a...
, and web application
Web application
A web application is an application that is accessed over a network such as the Internet or an intranet. The term may also mean a computer software application that is coded in a browser-supported language and reliant on a common web browser to render the application executable.Web applications are...
programming interfaces (APIs) (see main article Web 2.0
Web 2.0
The term Web 2.0 is associated with web applications that facilitate participatory information sharing, interoperability, user-centered design, and collaboration on the World Wide Web...
).
Types of Web 2.0 use in Health Care
The following are examples of uses that have been documented in academic literature.| Purpose | Description | Case example in academic literature | Users |
|---|---|---|---|
| Staying informed | Used to stay informed of latest developments in a particular field | RSS, Podcasts and search tools | All (medical professionals and public) |
| Medical education | Use for professional development for doctors, and public health promotion for by public health professionals and the general public | How podcasts can be used on the move to increase total available educational time or the many applications of these tools to public health | All (medical professionals and public) |
| Collaboration and practice | Web 2.0 tools use in daily practice for medical professionals to find information and make decisions | Google searches revealed the correct diagnosis in 15 out of 26 cases (58%, 95% confidence interval 38% to 77%) in a 2005 study | Doctors, Nurses |
| Managing a particular disease | Patients who use search tools to find out information about a particular condition | Shown that patients have different patterns of usage depending on if they are newly diagnosed or managing a severe long-term illness. Long-term patients are more likely to connect to a community in Health 2.0 | Public |
| Sharing data for research | Completing patient-reported outcomes and aggregating the data for personal and scientific research | Disease specific communities for patients with rare conditions aggregate data on treatments, symptoms, and outcomes to improve their decision making ability and carry out scientific research such as observational trials | All (medical professionals and public) |
Criticism of the use of Web 2.0 in health
Several criticism have been raised in the use of Web 2.0 in health. Firstly, the limitations for Medical DoctorsPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
(MDs) to use Google as a diagnostic tool
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
, which may be more effective only for conditions with unique symptoms and signs that can easily be used as search term. Secondly, long-held concerns exist about the effects of patients obtaining information online, such as the idea that patients may delay seeking medical advice. Finally concerns exist about the quality of user generated content
User-generated content
User generated content covers a range of media content available in a range of modern communications technologies. It entered mainstream usage during 2005 having arisen in web publishing and new media content production circles...
leading to misinformation, though one study has suggested that in certain support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...
s only 6% of information is factually wrong and that only 3% reported that online advice had caused serious harm. Other venues of information are likely to be less useful to the general public.
Tensions in Health 2.0
Hughes et al. (2009) argue there are four major tensions represent in the literature on Health/Medicine 2.0: these are over the lack of clear definitions; issues around the loss of control over information that doctors perceive; safety and the dangers of inaccurate information; and issues of ownership and privacy.External links
- The term Health 2.0 is trademarked by this conference series
- A set of useful resource on the Health 2.0 Wiki including a list of Health 2.0 companies
- A list of medical wiki websites including links to more than 40 medical wikis
- Medicine 2.0 Congress, which is similar or identical to the Health 2.0 concept, but also includes "Science 2.0"
- "Web Site Harnesses Power of Social Networks", The Washington Post, October 19, 2009
Health 2.0 Chapters
Health 2.0 Boston ChapterHealth 2.0 Hawaii Chapter
Health 2.0 Japan Chapter