Monday, October 12, 2009

Health 2.0 a-Go-Go: A Revolution By Any Other Name Would Smell as Sweet

During the standard what’re-you-doing-this-week segment of a Sunday
barbecue, I told a neighbor who works in the real world that I was
“going to the Health 2.0 Conference in San Francisco,” a sort of random
zeitgeist check on a phrase I use so often at work I don’t really
remember what it means.

"Don't know what the hell that is," he said, his jaw tightening. "But
I'm sure it'll be better than health 1.0. Anything would be better than
the mess we have now!”

Wow, I thought; he just set the world outdoor speed record for
eruption-of-health-care-anger - and in the midst of the Olympic season
for same.

My friend’s outburst was a weird if completely uninformed endorsement of
the Health 2.0 conference booting up at San Francisco’s Design Center
Concourse in the morning.

But in an era when smoldering resentment and
unvarnished rage have come to pass for political dissent (i.e., when a
simple proposal to clean up the worst messes in the health insurance
marketplace is decried as a “governmental takeover”), my left-leaning
neighbor is in accidental agreement with everyone - left or right – just
itching to CTRL-ALT-DELETE the entire health care system, for no more
intelligible reason than the whole thing sucks.

He also happens, if accidentally, to be very much in agreement with many
of us health care 2.0 types - left, right, or strawberry – flocking in
exponentially increasing numbers to the Health 2.0 Conference for three
years running. Forget the hype, the promise of orgiastic punditry, or
the funhouse atmosphere created by the event’s irrepressible creator and
THCB editor Matt Holt. Regardless of your politics or business agenda,
we are at Health 2.0 because we know that, as a society, economy, health
system, whatever – we can do better than health 1.0, should do better,
must do better.

So what exactly is health 2.0? Isn’t it really just a younger, hipper HIMSS?

Younger and hipper, maybe – because the entire point of labeling
something “2.0” is to stick out your tongue at 1.0, at your uncool
parents in stretchy jeans and Velcro shoes who, after decades of earnest
hard work, still couldn’t figure out how to computerize most of the US
health care system. “2.0” screams delineation, divergence, bye-bye. And
there seem to be as many ways of delineating “then from now” as there
are smart people, of all ages, putting serious work into solving health
care’s plethora of problems with 2.0-associated information
technologies, services and tools.

A good example is Phil Marshall of WebMD, who happened to be sitting
next to me on the airplane from Portland to San Francisco en route to
the conference. “1.0 was passive information,” he says, “2.0 engages the
patient.” Then he rattles off a long list of application and service
types that did not exist in the real world, let alone in health care, a
few years ago.

A technologist would say precisely the same thing, if in the language of
development languages and architectures that enable the same
connectivity or interactivity. A business strategist would also say the
same thing, albeit in the language of sustainable revenue models finally
emerging in the 2.0 world, after years of snappy slides and wishful
thinking. (Note to newcomers: perennial fundraising for ventures that
work perfectly in PowerPoint are not sustainable revenue models.)

But essentially Phil is spot-on: “health 2.0” means that the patient
gets to talk back. What the patient wants and needs finally matter. And
this belated revolution - from provider autocracy to patient autonomy,
from Doctor-as-High-Priest to shared provider/patient decision-making,
from bricks ‘n’ mortar medical delivery to cybercare - is bigger,
broader, and more profoundly de- and re-stabilizing to health care
organizations of all types than anything information technology could
ever bring to bear. Technology is the means to an end, despite what
decades of technologists have tried to convince the business
strategists, who in turn have tried to convince the investment
community. And so maybe, finally, the specific technologies associated
with health 2.0 are cheap enough and unobtrusive enough to get out of
the way, and let all of us focus on the point: what the patient wants
and needs.

Yes, for the next two days at Health 2.0, we will be gee-whizzing over a
mind-bending array of new applications, web services, platforms,
un-platforms, and devices - many of which actually work and are in use
today. And of course there will be lots of magic tricks, vaporware,
investor-type presentations that hinge on the missing “and then a
miracle happens” slide, and of course one demo that will explode, slowly
and spectacularly, in the hands of an erstwhile entrepreneur. But we
will also see feats of imagination in the hands of able people with
their feet in the ground, people building technologies that liberate
complex medical data from legacy systems, connect patients with
communities and clinical trials, throughput lab test-results from
primary care physician to specialist to surgeon and back again;
technologies that track outcomes, monitor progress, and send alerts to
providers, health plans, coaches and caregivers; and, when it’s all
prescribed and delivered – technologies for crashing the reimbursement
barricades erected back in the darkest ages of “managed care.” But these
technologies are the details of the 2.0 story, not the story itself.

The real story is the belated revolution of “modern” medicine. The
countless miracles and monstrosities generated in our lifetimes by
modern medicine is a hundred years old right about now, if you date its
beginning to the introduction of the first antibiotic. In the late 1980s
through the early part of the current decade, commercial managed care’s
unleashing of the toxic brew of economic power and engineering process
was supposed to be the “2.0-ing” of health care - the long overdue and
true modernization of classical modern medicine gone mad with greed,
money, inefficiency, and arrogance. That revolution was roundly rejected
not just by those targeted for the makeover, i.e., self-serving
fee-for-service providers, but by much of American society who, in a 1.0
world, had no say-so about any of it for years.

The “2.0-ing” of our health care system today - the one most obviously
associated with technology but driven by so many more economic and
cultural factors (e.g, health plan design, economic incentive
re-alignment, feminization of the physician workforce, the
democratization of information, you name it) - is radically different as
a cultural phenomenon. This time, it isn’t the health insurance
companies taking on an impervious, fee-for-service system; this time,
it’s us, the patients, the people. And thanks in part to managed care
and its introduction of often brutal methods for separating patients
from their providers, we have all learned - often with our own
co-payment dollars - precisely how much we value access, immediacy,
shock capacity, flexibility, convenience, and choice.

Once again, this has little to do with technology. People started
clamoring for the real health 2.0 revolution long before they became
“Facebook friends” with people they couldn’t stand in high school, and
still wouldn’t be able to stand if they actually had to see them again
every day. I expect that the bizarre and delicious delight that is the
Facebook phenomenon will get significant play at this year’s conference,
as it shows that notions of community inconceivable only a few years ago
are not only possible, and not only fringe, but are as re-defining as
the Internet itself in how we inhabit much of our lives. And so too it
goes in health care: we are NOT partying like it’s 1999, and thank God
for that. Technology and information, rather than money and process, are
making the belated and true health 2.0 revolution possible. But unlike
the last attempt at health care revolution, which showed up too often
dressed in the sheep’s clothing of managed care, this time most of us
actually want it.

Thanks to our technology-enabled experiences back in the real world, we
seem suddenly to have discovered that we cannot email our physicians.
And that we can’t get access to our own medical information. And that we
have to find a working fax machine to get a copy of something. Huh?
After two decades of smart people scratching their heads “why won’t docs
use EMRs? How can we get them to start using computers?” I think we
finally found a way: shame. Over the past two years, every physician I
have encountered, professionally and socially, who was finally buying
and installing their first EMR cited none of the usual homilies (e.g.,
reimbursement, quality, efficiency, modernization, etc.) for the
decision; rather, all reported being embarrassed that it took them so
long to get around to it.

Now we're really not partying like it’s 1999, when even the suggestion
to a physician friend that an EMR might worth thinking about would lead
to a tantrum or firstfight or worse. Apparently, enough politicians of
both stripes have finally made enough speeches about the subject; enough
colleagues, administrators, and people at health plans said it enough
times; and most importantly, enough patients looked at them funny when
they started writing down everything the nurse had written down five
minutes earlier, in the same “chart.”

Sometimes, the zeitgeist works just fine; sometimes it works well enough
to foment a real health care revolution.

Let the 2.0 show begin!

(cross-posted from The Health Care Blog -- Permalink)

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