My Definition of Health 2.0 : The Transition to Personal, Participatory Health Care

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

When I went to medical school, a person’s ability to influence the health care system was linearly correlated with the length of their lab coat. Actually, in my medical school, medical students and attending physicians all wore the same length of lab coats, because I trained on the West Coast. I was exposed to the labcoat length protocol when I was a medical student and a new group of residents began training at our hospital. One of the residents was obviously from an East Coast medical school because she asked me permission to do something for a patient, and it took us both a few minutes to realize that she thought I was the “in charge” doctor because I wasn’t wearing a short lab coat. Neither of us wanted to relate in this way, and we transformed the relationship right there, in a beneficial way for our patients.

Flash forward to 2004, when my organization implemented an enterprise wide electronic medical record system for doctors, nurses, and staff. All of a sudden, we were on a common platform, and every member of the team had a contribution to make in each other’s learning of the new system. Once, when I was ordering an injectable medication, a nurse colleague came over to me and said, “here, let me show you how to do that, Ted.” Now, this new technology was creating an obvious platform for colleagues to teach each other, regardless of role. It was and is great.

In 2008, in organizations like ours where patients are regularly participating in the creation of their health record via secure e-mail and online health profiles, and participating in the creation of ideas and their health care stories inside and outside of our health care system, health care improvement is now more democratic than ever. When we combine that with management systems like LEAN (Toyota Management System) that support respect for our customers and our colleagues and use tools like visual systems and daily improvement methods, it is possible to see what the difference between Health 1.0 and Health 2.0 is. The technology has definitely stimulated this change by making it easier to participate, but the lasting intervention will be the participation of patients, their families, and every stakeholder (health care providers, businesses, philanthropies, non-profit associations, etc) in the improvement of our care system.

In 2006, The Economist referred to the transition from Web 1.0 to Web 2.0 as the transition from mass media to personal, participatory media. I think the same is true for Health 1.0 to Health 2.0.

I have spoken about the idea that physicians in my generation (Generation X) are a group that trained during an explosion of medical information. We are a group that is challenging the mental model of “omniscient physician” – we don’t want to hold all the answers for our patients because we’ll fail if we do. We want to learn something new from every patient, every colleague, and every industry, every day, so we can be good educators, too. Now we can, and we are.

18 Replies to “My Definition of Health 2.0 : The Transition to Personal, Participatory Health Care”

  1. This is as good a definition of Health 2.0 as I've ever seen. It's concise and right on the mark. The lab coat length parallel is great, too.

    (I thought I was going blind because I was looking for the comments on this post and not finding any. Holy cow, there aren't any! This is important stuff, people – we're creating and defining the new world here!)

  2. Dave, well I like it, or anything that's a few words in length and therefore easy to remember 🙂

    I needed to come up with something because I'm giving a presentation that's tying Web 2.0 and Health 2.0 together. Necessity is the mother of invention. Improvements and other dissemination welcome,

    Ted

  3. When's the presentation?

    I had dinner with a bunch of the e-patient crew in dinner last night, before Susannah Fox gives a talk (starting right about now). Lots of percolation going on. Wish you could have been there.

  4. I saw this referenced on e-patients.net and thought I'd respond… I am a little concerned about the concept of "transition" – how do we define when we have transitioned? Other than that, at last, participation… I've been an ACOR listmember and listowner for 12 and 10 years respectively. Had I known then what I know now…

    Doctors have to learn to relate to the concept of participation. Too many are stuck in the past and are threatened by patient involvement. Perhaps that's too harsh a term – maybe "concerned about" patient involvement. It takes more time. The whole healthcare model we have in the USA today is based on expedience of healthcare, not quality. I'm hoping this changes soon.

    Interesting to note that GenX doctors are coming in with a different mindset! I hope that's actually true all over.

  5. Deborah,

    And thank you for responding! I admit, when I modeled this on the Economist's definition, my laser light attention was on the word "participation," which I am glad you also appreciate.

    I didn't pay as much attention to the other words. I think Dave also thought there could be some improvement as well.

    What would you change it to – feel free to comment back, let's make this better. With much respect for your experience at ACOR and thanks for taking the time,

    Ted

  6. I might understand the use of the word "transition", as participatory healthcare is much more than being able to see what the medics do.

    However, what I miss is the fact that participatory means that the patient will have to assume his own responsibility and that the system will have to accept this paradigm shift.

  7. Lodewijk, I see the concern, which is also stated by people like Don Berwick in the book "Overtreated."

    When I say "participation" I mean it more as democratization of a one-sided leadership paradigm, i.e. away from the length of your labcoat leadership credentials.

    You could take a look at this video of Genie industries about how they do continuous improvement. What would hospitals be like if they implemented error-proofing techniques as a result of every customer suggestion?

    This is along the lines of what Dennis Quaid said, "Public Accountability Spurs Innovation."

    See what you think and please suggest an improvement to the definition based on your thinking!

    Ted

  8. Lodewijk – Thank you. Very improved! I noticed the concept of citizen – I had not considered health systems outside of the United States in my thinking, as both you and Jen McCabe have, and I really don't know what the level of engagement of patients is outside of the US. Care to comment on that – is it the same, more, less? Much appreciated,

    Ted

  9. Ted, I think that definition is a little too general to be helpful. But then again it allows us to call virtually any advance in participation Health 2.0, so perhaps I should encourage it!

    In any event, very glad to have you join the definition-istas! (See you in Dc next month)

  10. Matthew,

    Well…let me ask you then, as the Health 2.0 convener – when you walk into a room and someone asks, "What is Health 2.0 (and why should I care about it?)?" What do you say?

    This coast will look forward to your presence,

    Ted

  11. Great to see you here, Matthew.

    > a little too general to be helpful

    One bloggee's ceiling is another bloggee's floor. 🙂 For those who've been immersed in the conversation for ages, that definition might seem primitive, not deeply articulated.

    But we're just beginning to spread the word beyond the early adopters, and in my experience those who've never heard of it need a first-level description that lets them see "Huh, I guess that makes sense, but I'd never thought of it. Interesting."

    That's tied in to the reality that most laypeople don't even know what Web 2.0 is.

    Lodwijk's definition is excellent, but still leaves out the role of the Web, which I think is inescapably central to Health 2.0. Something like: "… is the combination of new Web tools, health information, and patient awareness, enabling the citizen…"

  12. Ted, it is very difficult to have a clear view of patient engagement in Europe, as every country has its own system and tradition, both in patient-doctor relationship and in the role of the various stakeholders (like insurers).

  13. Healthcare sites have been slower to evolve into Web 2.0 applications since nothing can really replace the personal aspect of a doctor's visit. There are however a number of great Health 2.0 websites that are arming the patient with medical information before visiting their doctor. infoMedMD is a new web 2.0 application (based in Boston) which uses computer logic to intelligently decipher your medical symptoms into valuable medical information.

  14. fascinating conversation! i'm coming at this from a slightly different angle – i'm a physiotherapist (physical therapist in the US) who works with children with developmental delay/disability. in this field there are emerging concepts of "family partnership" whereby the relationship between the family and health/service providers is just as or even more important for achieving outcomes than the actual program/service provided (Hilton Davis in the UK is the main influence in this area). in terms of providing care we are beginning to talk about forming a "Team Around the Child" where the family (or primary caregivers) are considered a vital part of the "team" that plan and provide therapy and other care alongside all other medical/ therapy clinicians involved in the ongoing service provision to and for that child. the concept of "transdisciplinary" practice is quite contentious, but at its core it does not mean that there is a generic health/therapy service provider who does and knows everything. instead, it is a recognition that the physiotherapist's expertise is different from the speech and language pathologist's, which is in turn different from the family's expertise (yes, families, "patients", clients..all have expertise on their own health and developmental care needs and goals!) – so when all of that different but complementary expertise is combined together into a functional team there can be better outcomes from every perspective.

    the healthcare system here in australia may still be a long way from establishing an embracing new technology such as needed for transitioning to Health 2.0 but the shift towards valuing "personal participatory health care" is slowly occurring at many levels….keep on opening up this dialogue and challenging the ways of the past so we can improve the future!

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