Stupidiest (stū’pĭd est) adj.

1. Being the most slow to learn or understand.
2. Tending to make poor decisions or careless mistakes.
3. Characterized by a lack of intelligence or care; foolish or careless.

I am a huge fan of the “Greatest Generation” as described by Tom Brokaw and cinematically iconized by “Band of Brothers“, “Saving Private Ryan“, “The War” by Ken Burns, and countless other films showing valiant, heroic, and sheer willpower of the era. It was a heady time of American idealism, where shared sacrifice was required for the epic battle of good versus evil.

We now face challenges of similar proportions, with the global economic meltdown, intractable global terrorism, looming health care crisis and political unrest throughout the world. The eternal optimism of a new year definitely dims against the shadows of these ongoing specters. I love Apple’s mantra of “investing through the downturn” and the notion of returning to the hard core basics that have enabled our nation to be great.

For me, that means the notion that America remains the land of opportunity for all to realize their dreams.  And opportunity begins with education - and we have slipped very far down a very slippery slope. Slippery both in quality and also in time - it will take another generation to catch up with our global colleagues.

To see what I mean, tie these threads together:

• Is Google making us stupid? - Author Nicolas Carr diagnosis this social malady first in himself and then in society
• Googling before Thinking - interesting followup by Emily Walshe, a librarian and professor at Long Island University.
  
• California Schools to shut down early due to lack of funding - I seriously can’t believe that our country and my state does not value education more than this. My kids are going to get “out early” because there is no funding for their education. Can you say “Voucher”!
• 2 Million Minutes - If you want to freak about the worldwide decline of America as a super power - watch this. This puts into contrast the demise - education is truly the foundation for greatness and American society clearly does not value education as much as the rising super powers do.

Ouch.

I remain warily optimistic given America’s uncompromising to “do the right thing - after all other options have been exhausted” (quote from Churchill). I am feeling like we are exhausting alot of options in terms of our good will, our good name, and our foundational values that have made us great. I want to see education takes its appropriate place amidst the competing priorities, to see our rising generation buried in their studies versus twittling their thumbs (literally), and our society understand the relationship between our educational investment and our societal attainment.

Rise up, google generation!

Levee (lĕv’ē) n.

1. An embankment raised to prevent a river from overflowing.
2. A small ridge or raised area bordering an irrigated field.

The medical home concept is going mainstream. Not only is it a significant part of the Obama teams reform agenda, but it has hitting the front pages much more frequently.  Of interest, Seattle continues to be the hotbed of innovation around this concept (interesting, they are one of the few states that have changed their laws to accomodate “direct practice” medicine), with commercial innovators like Qliance and academic institutions creating new types of practice models.

This article from the Seattle area highlights some early successes working with insurance companies to pay a monthly fee for (a new form of capitation?) services that are increasingly showing a major impact on health (increased communication, care coordination, population/preventative health, etc) but have never traditionally been compensated.

You will recognize this model, “fee for service with a capitated medical home fee” or “compensation for enhanced practice capabilities” (I will actually peel back the onion on what these “enhancements” really are), as the model advocated by Alan Goroll and his associates in Boston. Their model envisions the smoothest path to fundamental reform as being one that works within the current insurance paradigm but with several key improvements over Capitation 1.0. These would include compensation for the enhanced practice capabilites already noted, adjustments according to patient complexity, (they have a fairly elegant patient modifier algorthm), and tying a significant dollar figure to patient satisfaction and ultimately patient outcomes (when they become available). This is a workable approach as long as the payers come to the table which apparently is beginning to happen in Seattle (with at least 50 other “pilots” nationwide).

However, at the same time we are witnessing the above success, we are also seeing Primary Care Clinics being overrun, patients locked out, and system impassibly constipated in terms of new patients moving through.  Increasing access in Massachusetts did nothing to increase capacity. I fear the current economy will only accelerate this based on this report from the California Healthline. This will in turn hurt the most structural at risk part of our health care system - the community  health clinic. These often under-funded, under-staffed, overcrowded, and overburdened facilities are home to some of the most noble of the entire profession who day in and day out slug it out in some very difficult trenches. But they are also some of brightest, most resourceful, and talented clinicians and healers we have in medicine. They represent the levees of our American Health Care system.

But their limited surge capacity will most certainly be overwhelmed in the coming flood of patients being sent their way by the prevailing financial storms. When the flood waters break, I believe Katrina will look like an afternoon shower compared to the vicious cycle of care that will ensue (no primary care, crash in the ER, most expensive place to treat, kicked to the street, no followup, and back to the ER. Rinse. Repeat. Ad Nauseam and Ad Infinitum). Ouch.

Louise McCarthy, vice president of governmental affairs for the Community Clinic Association of Los Angeles, said, “There’s not a very large infrastructure in place to handle the increasing need, even though providers will do everything they can to treat as many people as they can.” Sounds reassuring.

Given that the Community Clinic is the “medical home” of the indigent - what low cost, effective, and useful technology sandbags can be put cobbled together to hold back the waters? I like David Kibbe’s recommendations to Obama as examples of the simple, but far reaching processes that can be implemented to complete the growing support for ubiquitous EHR deployments (about time!).

What other sandbags, or better yet, what infrastructure needs to be put in place to service the Community Health Clinics as a fundamental component of our primary care system?

Bleet (blēt) n.

1. A combination of a blog post (in depth analysis of an issue) with a tweet (spontaneous expression of a mental thought)

I typically attempt to write a thoughtfully developed, artfully crafted, and intellectually provocative post concerning current topic areas of interest. However, in the age of Twitter, I am finding that blogging has become increasingly laborious.  I get a ton of interesting stuff throughout the week but only have a finite time to hit my goal of two posts per week.

So, given my penchant for definitions, here’s to my first bleet (blog tweet):

Paul Fronstin from the Employee Benefit Research Institute puts out a California Health Care Foundation assisted study regarding the Fraying Employer Based Insurance paradigm (warning PDF). Essentially, we are down to 56% of population being covered through their employer, 60% of Latino’s are uninsured, and the young invincibles unconvinced they need insurance (18-24 uninsurance rate of 35%).

When can we move to a non-employee based insurance world - auto insurance, anyone?

Treadmill  (trĕd’mĭl‘) n.

1. An exercise device consisting of a continuous moving belt on which a person can walk or jog while remaining in one place.
2. A similar device operated by an animal treading a continuous sloping belt.

Today, Dr. Jordan Shlain and I opened the morning session of the 2009 WHIT Conference by introducing the notion of Direct Practice as a model for enhancing access, reducing costs, and improving quality. For this particular audience and presentation, I set the stage by introducing three themes:

1. Health Care in Crisis
2. Patients as Consumers
3. Direct Practice as a Response

This then set the table for Dr. Shlain to share his 10 year experience as a pioneer in this field. He described very intimate stories of the deep relationships, the personalized service, and the exceptional outcomes achieved. It was a truly powerful way to introduce what we believe will be the next wave of innovation in health care delivery. He closed by publicly unveiling for the first time Current Health (which I profiled yesterday) as the first branded primary care experience coming to a west coast location near you.

Given the time constraints, we were not able to take all the audience questions. I will post responses to these on shortly:

1. What application are you using to send data to your iPhone?
2. How do we get Americans to take care of themselves?
3. You are speaking about General Practitioner from 80 years ago?
4. You seem to be talking about non-universal healthcare?
5. If more primary care docs see fewer patients with your model, how will we meet the burgeoning primary care needs of America?
6. How many patients do you see at any one time?
7. How does your model handle emergencies?

Trojan Horse (trō‘jən hôrs)

1. Greek mythology a hollow wooden statue of a horse in which the Greeks concealed themselves in order to enter Troy.
2. A person or thing intended secretly to undermine or bring about the downfall of an enemy or opponent
3. Computing a program designed to breach the security of a computer system while ostensibly performing some innocuous function.

I have been blogging and twittering from the World Health Innovation and Technology conference this week while waiting to present today. The keynote speaker before me was Scott McNealy, the Chairman and founder of Sun Microsystems. He has a long and storied history with Sun, and a well earned reputation as the “human quote machine“.

He delivered.

His talk started with several examples of his health care experience (long time user as a hockey player and father of four boys) and business experience had so many corrolaries. The fight for standards. The fight for common interfaces. The fight for privacy and security. The find for high quality, low cost, and transparency. He wove all of these together to hone in on 7 ways that Open Source can help be a foundational element in solving the health care crisis.  gave a fascinating overview of how open source is perfect model for health care.

1. Lowers barriers to entry
2. Increases security
3. Faster procurement
4. Lower cost of ownership
5. Better quality products
6. Open standards
7. Lowers barriers to exit

Cool - I started singing that song in 2002 and still believe it today.

He also went through a list of interesting analogies to drive home his points:

• “We need a HealthTone” - Everyone is familiar with the dialtone and all that it implies for innovations in human communications. Well the dialtone is rapidly being replaced by the WebTone - the figurative hum of 1’s and 0’s implying ubiquitously access to the net. We need something similar within health care - we need a HealthTone - a mechanism to allow for true data liquidity through all the various applications, services, systems, and information to speak with one another. Where is the Health Care universal jack?
• “Nobody ‘owns’ English” - He described the tired debates about which language or protocol or architecture was the most important. He discussed how ridiculous it would be to try to monetize everytime you said a word, used it in a publication, or were charged for the common communication “platform” of english. Make the communication mechanism unique and build a support business around it(He did admit to wanting to own at least one vowel).
• “Left Sided Drivers” - Government has a clear role in this. Used the analogy of car drivers all being told to go out in a public darwinian experiment to determine which side of the road is best to drive on. The mass confusion that would result is pointless - at the end of the day whether you drive on right or left is irrelevant but what IS important that it becomes a standard to which everyone agrees and it is appropriately enforced. Government should also determine that
• “Value is built into the DNA of open source. It has to be” - Went through the many reasons - including the “switching costs” (practically zero in open source) and therefore you need to complete on the value that you can provide right away all day everyday. The “RFP” is open ended and if you don’t deliver then the user can switch away to another support organization. Transparent, real time support contracts. Sounds scary, but it puts the vendors proverbial feet right ot the fire. Deliver a good experience, build loyalty, and then your customers sell for you - that is the open source way.
• “What does Oracle charge for support? Whatever it takes to win the America’s Cup” - Contrast that to this ZINGER aimed squarely at Larry Ellison. I laughed out loud when this well practiced line rolled off his tongue. Nothing like highlighting the truth with a sarcasm.
• “A Glass Trojan Horse would not have worked” -  And the winner is . . . transparency. I absolutely loved this quote. Think about it - “Security by Obscurity” is akin to the more popular “Hope is not a strategy” phrase. When things are done in the open, in a peer reviewed environment, when your reputation is on the line, and when your reputation actually affects business - behaviors start to change, quality starts to go up, processes become more efficient, and collaborative contributions accelerate transformational change.

Unfortunately, my talk immediately followed Scott’s. We only had time to exchange business cards but I would have loved to spend some time with him swapping stories about creating the first ever enterprise open source EHR company and explaining how the EHR is the operating system of the clinic, hospital, and regional health network.

Next time. Giddyup Glass Horse!

Current Health (kûr‘ənt helth) n.

1. Membership based, comprehensive primary care practice based in San Francisco area with plans to spread branded clinics throughout the West.
2. Millennial version of the classic vision of a trusted physician who makes house calls.

As I have mentioned previously, I have been involved in some really cool projects recently that I believe are at the forefront of the wave of change that will soon wash over the health care industry as the “time for change” appears to be now.

Current Health - Guardians of Your Health

With that preamble, I am thrilled to introduce you to Current Health (formerly San Francisco On Call) - The Primary Care Specialists. I have had the privilege to work with Dr. Jordan Shlain, David McKie, Vy Le, and the excellent team of physicians over the last six months to help transition the practice from a house call / urgent care focus to a membership-based, comprehensive primary care “medical home” for individuals and families who value their health as an asset.

The macroeconomic reasons for this transition at this time are well known. The American health care systems is in shambles. The United States currently spend 17% of Gross Domestic Produce on health care, a number which is anticipated to balloon to 25% over the next 15 years. Despite leading the world in terms of absolute and relative spending in the health care sector, the United States ranks ~35th in health metrics tracked by the World Health Organization. Serious questions have also been appropriately raised regarding the quality, efficiency, safety, and outcomes achieved by the US health system: 100,000 preventable deaths due to medical errors annually, approximately $700 billion spent in ineffective/unnecessary treatment, and consistent estimates of 30% waste associated with administrative inefficiencies.

These systemic challenges are compounded by a employment-based insurance model that has continued to fray as companies have been forced to reduce their health care offerings in order to remain competitive in the new global economy. This has resulted in real wage decreases, increased numbers of uninsured individuals, spikes in medical bankruptcies, increased costs due to delayed care, and misallocation of limited health resources. These challenges have directly affected health care providers who have experienced decreases in wages, job satisfaction, and control over the way they deliver care. Primary Care physicians have been particularly hard hit, and their former role as guardians of health has been minimized, displaced, or eliminated. This has lead to current and predicted severe primary care physician shortages at the same time that primary care has been identified as a necessary pre-requisite to low cost, high quality, and best outcome health care systems. Even if this shortage began to be addressed today, it will take approximately a decade to close this primary care gap.

Current Health is a response to the health system crisis in general and impending break down of the primary care speciality specifically. Our business focuses on elevating the nature of the patient physician relationship by creating a practice design whereby the patient, the provider, and optimal health outcomes are aligned. Current Health is a membership-based, direct-practice, comprehensive primary care delivery model. Our direct financial, administrative, and clinical relationship with the patient provides both the freedom and the flexibility to deliver optimal health care.  In its most basic form, it is a fresh perspective on the classic vision of a trusted physician who makes house calls.

Members pay an affordable membership for access to our practice and our physicians and are rewarded with a single point of health care accountability for all aspects of care. Members are assigned a care coordinator who oversees followups and proactive health maintenance. Members are invited to participate in their care through several engagement techniques as well as access to their personal health record which serves as the medium of communication with Current Health. Given our intense focus on delivering an unrivaled customer service experience, we ensure that our Members are informed, empowered, and connected to their physicians and the practice at all times.

Current Health plans to become a leading primary care brand that delivers on the promise of high touch service paired with unprecedented access to physicians. Our direct practice model, including centralized support of all health stores and effective use of technology, enables Current Health to democratize the concierge medicine experience for an entirely new generation of patients. Current Health creates an environment where clinical excellence, administrative efficiencies, and financial alignment can lead to best outcome care.

We look forward to documenting our journey in the coming months in this blog and other places. There will be alot of interesting things to discuss - providing conceirge experience for the masses, fee for service model, direct practice model, patient care coordination - and I look forward to helping each of you become Current.

Evolution (ĕv‘ə-lū’shən) n.

1. A gradual process in which something changes into a different and usually more complex or better form.
2. Change in the genetic composition of a population during successive generations resulting in the development of new species.

In addition to my work with Current Health, I have been actively involved as a Chief Medical Advisor to leading direct to consumer laboratory testing service MyMedLab. They have developed a cost-effective, convenient, compliant, and confidential way to obtain laboratory testing results. Their model is simple, efficient, and has been found to be effective in getting people the information they need to manage their health in concert with their trusted physician advisors.

However, as everyone knows, going Direct to Consumers is a very hard, long, and tough slog. With so much competition (in terms of other competitors, time and attention of consumers, and the difficult economic environment) this type of hand to hand combat is not practical. However, while the service was designed specifically for consumers, it is also a practical solution for consumer aggregators - namely physicians who have specialty testing requirements.

MyMedLab has been fortuante to work with hormone thought leader Dr. Erika Schwartz. A regular on the speaking, publishing, and media circuit, she has helped hundreds of thousands of women and men learn the importance of their hormone health as well as provide counsel and guidance in optimizing health. Dr. Erika was able to dramatically simplify her laboratory testing by creating a simple gender-based Hormone Profile that her consumers can purchase directly at impressive discounts. This allows her patients to follow her guidelines exactly, at a tremendous value, and in a manner that facilitates the patient-physician partnership. While the partnership was announced several weeks ago, she posted her comments regarding the relationship on her blog today:

December 8, 2008
EASY AND AFFORDABLE BLOOD TESTING TO HELP YOU FIGURE OUT YOUR HORMONE LEVELS

My thirty years of medical practice as an internist and trauma doctor have given me a high degree of understanding, confidence and reliance upon blood testing. Over the course of the past 14 years as I became experienced in the area of hormones and wellness and disease prevention, I did evaluate other testing modalities to provide me and my patients support and deeper insight into hormone levels.

I looked into saliva testing and found it too new and lacking sufficient scientific evidence (remember I’ve been working with blood tests for 30 years). I examined urine testing and while I do believe 24 hour urines are reliable and a solid source of information, they are costly and cumbersome to the patient.

While I do agree with critics of blood testing that they are only a snapshot of the dynamic picture of our hormones and bodies in constant motion and change, I am convinced that in the right context, blood testing is a valuable tool for the physician and patient willing to explore as many as possible of the infinite number of variables that define a human being.

Blood testing isn’t and should never be the only way to evaluate hormone levels. Any physician who only looks at your blood tests is missing the most important ingredient in the care of the patient, that ingredient is YOU, the patient.

Having said that, I believe blood testing is a useful guide, an initial baseline marker, a place to start in getting some internal understanding of where the patient is and then to follow the impact the hormones, diet, exercise, lifestyle regimen I work with.

I caution my patients and the doctors I work with though. Blood tests should be used in context. By that I mean in the context of listening and following what the patient tells me and how the patient feels. For instance: if the blood tests show low to moderate hormone levels and the patient is feeling great, under no circumstances would I increase the amount of hormones I dispense. However, if the blood tests show low or even normal hormone levels and the patient suffers with symptoms like hot flashes, night sweats, insomnia, mood swings, weight gain, bloating, loss of libido, headaches, etc. I will listen to the patient and increase or change the type and ratios of bioidentical hormones I prescribe. In addition keep in mind that when taking synthetic or non-human identical hormones, the blood tests are useless because HRT eliminates the normal human hormone variations. Bioidentical hormones do not annihilate the normal hormone fluctuations found in the blood tests.

Since the blood tests are part and parcel of the development of a cogent picture for your hormone health, it is crucial to work with a reliable and accessible lab.

Another critical point: the blood tests belong to you, they are your bloods after all and you should never be placed in a position where you cannot access them because your physician does not want to order them, or you cannot afford them.

With this philosophy in mind I set out to find a way to help my patients and readers find an online laboratory service that would provide access to reasonable cost lab testing, that is supportive of creating and offering the blood test panels I use on the patients I see in my office in New York, regardless of where you are in the United States.

Toward that goal I connected with mymedlab.com and am happy to inform you that this excellent service is now available to you. This is a cutting edge opportunity to take control over your healthcare by accessing the blood tests you need and want online.

The way this works is that if you go to drerika.mymedlab.com you access the exact panel of blood tests I use. Once you sign up, mymedlab will provide a physician in your state the information and without having to go to the doctor’s office, you will be referred to a lab in your area. The results will come to you in 24-48 hours and then you can use the results to work with your own physician or you may contact me for more direction and possible referral.

The cost is up to 70% less than if you went to a lab on your own because through mymedlab.com you have access to their volume discounts which they pass on to you.

Check out the drerika.mymedlab.com and see if this is an option you want to consider. From my perspective, it’s a great way to empower you to own your healthcare information and contain the costs while having direct access to the blood tests I use to determine hormone status in my patients. And finally, use the information to make you smarter and stronger so that you can take control over creating a positive outcome in your own life.  Posted by DrErika at 1:40 PM on December 8, 2008.

This evolution in the MyMedLab platform will enable the service to be opened up to a broader range of consumers who are facing expensive and complex testing requirements.  It will also facilitate the opportunity for ordering physicians to create branded profiles (discrete individual tests bundled together for convenience, cost savings, and efficiency) that can be made available directly to consumers.

MyMedLab hopes to continue to work with health care innovators to make lab testing available in the most cost-effective, convenient, and confidential manner possible to help consumers measure, monitor, and improve their health status.

Highlight (hī’līt‘) n.

1. An especially significant or interesting detail or event.
2. To make prominent; emphasize.

As I mentioned earlier, this weeks issue of Business Week highlights the implications of participatory medicine and notion of patients as partners.  Its worth the read, but if you need the quick synopsis, here it is:

1. Social Networking in General
2. ACOR (1995) and Gilles Frydman - One of first cancer social networking sites
3. BrainTalk (1993) and NeuroTalk (2006) - social network sites for neurology
4. eCleveland Clinic (launched 2005) a general mention about their online outreach efforts
5. Cure Together (July 2008) - chronic disease social network meant to connect patients with researchers
6. Daily Strength (2007) - Online patient support groups around specific diseases
7. Diabetes Mine (2004) - One of the first and most popular online diabetic communities
8. Disaboom (January 2008) - interactive resource for people with disabilities
9. Revolution Health (April 2007) and Everyday Health(2002) - recently merged health and medical information sites with a combined 125+ online tools for helping patients manage their care and medical records.
10. Google (May 2008)- allows for centralized storage of all health information in Googles cloud.
11. Healthcare Scoop (January 2007) - an ad supported Blue Cross & Blue Shield of Minnesota initiative that encourages patients to rate  specific doctors, hospitals, and clinics.
12. Health Central Network (1999) -  or-profit collection of Web sites that provide medical information, personalized tools and resources, and connections to experts and patients.
13. I Am Too Young For This! (2007) - a non-profit advocacy network for people under 40 with a diagnosis of cancer. Started by concert pianist and cancer survivor Matthew Zachary.
14. Inspire (2005) -  online networks for 35 nonprofit health care organizations funded by drug companies looking to recruit patients.
15. Lauren V. Parrot (2002) - 24 year old Ms. Parrot started monthly videos cataloguing her ongoing battle with and advocacy for people with multiple sclerosis.
16. Mayo Clinic (year?) - recognized as one of the worlds foremost medical institutions and first medical center to extensively use health care related blogs, podcasts, and Facebook pages.
17. M.D. Anderson (year?) Houston-based, international recognized leader in Cancer therapy is recognized as having utilized online forums, physician communications, and personal web pages for patients.
18. MedHelp (1994) - interactive site wherein patients can ask leading physician thought leaders questions, participate in physician led forums, and have access to medical / community generated health information.
19. Health Vault (October 2007) - allows for centralized storage of all health information in Microsoft’s cloud with specific focus on interoperability with devices.
20. Organized Wisdom (September 2007) - Human powered search whereby the cognitive capacity of “health docents” is tapped to provide personalized health search experience.
21. Patients Like Me (2005) - Highly interactive social networking site that allowsllows patients to post their medical data and search for other patients with similar medical profiles. Founded by three MIT graduates in 2005, the company aggregates the data stored on its site, strips out identifying details, and sells it to medical companies for research and marketing purposes.
22. Sermo (2006) - most successful social network open only to licensed physicians to discuss treatments, new drugs, and clinical trials. Has coalesced enough physician support (100,000 members) to become a new force within health care policy.
23. SugarStats (June 2007) - Web-based blood-sugar tracker and diabetes management that charges a basic enrollment fee as well as premium services.
24. Trusera (July 2008) - offers software tools for bringing patients with similar conditions together and for tracking responses to different treatments

I think this is a good list, based on Business Weeks limited emphasis on “communication”, but it is far from the truly impactful of Health 2.0 possibilities. While the above mentioned companies have had a tangible impact and influenc on Health 2.0 - the truly transformational companies will be the one that help consumers with their “transactional” needs.  You will notice that the most successful businesses (I specific denote business to highlight the key difference between transactional versus advocacy sites like DiabetesMine, I Am Too Young For This, etc) above - Sermo, Patients Like Me, and Organized Wisdom - have all developed “transactional” models that they are each moving toward becoming sustainable.

However, there are many more TRANSACTIONAL companies coming - ones that help the individual consumers pay for, aquire, move data, and grease the transition from patient to consumer oriented health system. I am thinking about companies like HelloHealth, Maria Health (stealth mode), MyMedLab, 23 and Me, etc.

All coming . . . will highlight as able.

Short Sell (shôrt sĕl) n.

1. The sale of a security that one does not own but has borrowed in anticipation of making a profit by paying for it after its price has fallen.
2. A short seller will make money if the stock goes down in price, while a long position makes money when the stock goes up.

Health 2.0 has officially transcended from a niche movement to part of a larger national conversation. This weeks Business Week cover article (as well as great slideshow listing many but not all of the key Health 2.0 players) showcases the increasing, ongoing, and long term implications of patients as partners in care.  While this idea is not novel, the infrastructural underpinnings (EMR’s, communication technology, data liquidity, etc) now appear to be coming together to make this a real possibility.

I highlighted the notion of how Millennial Patients, and their role as partners in care, would help bring about reform within health care in the April Issue of MDNG. I will be speaking next week at the World Health Innovation and Technology Conference on this theme as well (9AM Wednesday with Dr. Jordan Shlain) and look forward to the opportunities for health care improvement that will results as traditional passive patients become active consumers in their care.

My only quibble with an otherwise excellent article was what I still perceive as a limited definition and role of Health 2.0 in the overall health care reform agenda. The business week definition:

Health 2.0 is the use of social media and other technologies to improve communication in healthcare. These platforms may be used to connect patients with patients, doctors with other professionals, or patients with doctors. The Health 2.0 movement is about enhancing communication to improve the focus and results of the health system on the patients it serves.

If Health 2.0 gets pigeon-holed as only a social networking / “connectedness” / communication technology concept then our vision of its potential influence will be similarly and dramatically reduced to a technology infrastructure play. This would be an unfortunate short sell of a concept that can be so much more.

To me, the burgeoning Health 2.0 movement,  is about the transition to an entirely new health system, wherein entirely new types of relationships are possible - new relationships between patients and their providers; patients and their data; patients and their insurers; patients and their personal health advisors. Clearly the patient is at the center of this, is an active participant, and has taken upon themselves the responsibility/accountability associated with this new found freedom. The transactional friction is removed via transparency, interoperability, commonly accepted standards, agreed upon outcomes measures, and the liquidity of all this information flowing around securely, privately, and at the discretion of the patient.

This utopian perspective requires one to have a long view. We can’t declare Health 2.0 a success or failure based its earliest manifestions (greater participation by all the players). We need to evaluate its success by its ability to achieve excellent outcomes (better quality, lower costs, improved access, increased patient satisfaction, enhanced system efficiency, or other relevant measures) and then compare that to the price required to achieve that outcome. Ahhh, the return to the old health care value (outcome/price) equation.

Communication is an interesting part of all this, but only a single instrument in a potentially beautiful Health 2.0 orchestra.

Value Chain (văl’yū chān) n.

1. A sequence of value-enhancing activities
2. A chain of activities that gives the products more added value than the sum of added values of all the activities.

Last week I was able to participate in a very cool live podcast with the ReadWriteWeb editor Richard Macmanus. While I am still finishing up my commentary based on that experience, I did want to comment on another post by Richard who is one year into his diagnosis of Type I Diabetes. He mentioned that his favorite Health 2.0 application was MyMedLab.

In full disclosure, I serve as an advisor to the company as well as a participant on the call that was conducted. I became involved with MyMedLab while conducting my own survey of promising Health 2.0 companies, tools, and technology. I was intrigued by their Health 2.0 delivery model of leveraging the internet to remove inefficiencies of time, location, and physician approval for routine wellness laboratory testing.

I became convinced after using the service for myself. Since I hadn’t ordered lab test since my medical school entrance physical exam, and I was preparing for an upcoming physical, I ordered the baseline wellness tests I knew my primary care provider would want (conveniently organized by “profiles” - individual tests that are grouped together to provide disease or organ system specific information). I wanted to maximize my time with my doctor and come prepared with as much information to review during our appointment as I could.

MyMedLab helped me accomplish these objectives in a cost-effective, convenient, and confidential way. It was a hassle free ordering process and I had my results within 36 hours. I was able to fax this information to my physician ahead of my appointment and to actually use some of my time with him to review the data as opposed to discuss ordering the test. I immediately saw the opportunity to extend this to other appropriate settings, and other appropriate patient or physician groups who have highly specialized laboratory testing needs (hormone health specialists, bariatric patients, and even diabetic patients).

A persistent question that comes up is the appropriateness of the direct to consumer model. I have to agree with John Sharp about the age of “paternalistic medicine” going bye-bye. I discuss this at some length in a previous article entitled, “The Millennial Patient” .The easiest analogy to understand this point is to review the democratization of the financial services sector. 30 years ago, only qualified financial advisors could provide financial advice, set up accounts, trade stock, transfer funds, or manage a portfolio. Can you imagine that being the case today? Consumers have the ability to read financial information (now abundantly available), set up accounts in minutes, buy/trade stocks with a click of the mouse, move money across the globe between multiple accounts, and manage all their accounts from single portals all without leaving their desks.

Does this obviate the need for financial advisors? For many smaller or DIY investors, it has reduced the need by outsourcing these functions to the consumer. However, the experience and knowledge of a trusted financial advisor is still heavily relied upon for anyone requiring professional assistance, complex trading, or needing higher end service. They haven’t gone away, they have just had to adapt what they do, how they provide their services, and who their customers are. In essence, financial advisors have had to move up the value chain.

While this will sound heretical to some old school doctors, most wellness laboratory exams don’t need to be interpreted by a physician. In fact, most wellness exams don’t need to be performed by a physician. It is pretty straightforward stuff: Cholesterol 250 = get on some cholesterol lowering meds. This isn’t rocket science.

However, there clearly is a time and a place to call upon those practiced both in the art and science of medicine. I assert that the trusted physician advisor will be as meaningful, if not more meaningful, to you in the future world of highly personalized medicine. You might interact with her in new and exciting ways - chat, text, videoconference - but she will continue to use her expertise, knowledge, and experience to provide the advice you need on key health issues, disease states, and medical treatment plans. Physicians aren’t going away - they will just be practicing at a higher, more meaningful level than they have in the past. Physicians, like other knowledge workers, will have to move up the value chain in order to maintain their relevance in the future.

Most will. Some won’t. And for any of those clamoring that they are the only ones authorized to read lab results, send them the this link along with an email saying you are looking for a new physician.

(Oh, they don’t do email? You should have left long ago!)