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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Section II: Defining the Ethereal with the Illusory

Ethereal (ĭ-thîrē-əl) adj.

  1. Characterized by lightness and insubstantiality; intangible.
  2. Highly refined; delicate.
  3. Not of this world; of the celestial spheres; heavenly.

II. Defining Health 2.0

Some preliminary brainstorming around the term Health 2.0 shows that the concept of “healthcare” and “healthcare delivery” are dramatically changing in the United States:

Health 1.0

Health 2.0

Zero Sum Competition


Positive Sum Competition







Focus on Cost


Focus on Value

Disease Care


Health Care

Physician: Ultimate Authority


Physician: Trusted Advisor

Patient : Passive Observer


Patient: Engaged Consumer

Pay for Process


Reward for Result

Culture of Denial


Culture of Quality

Professional medical information


Pervasive medical information

The Transition to Health 2.0. This is a representative, but far from comprehensive, list of the characteristics of Health 2.0

While some have challenged the need to define the term Health 2.0, or questioned the validity of the concept, the clear shift in underlying values, outcomes expectations, and fundamental assumptions of this transition as captured not only demand our acknowledgement, but beg for further definition in order to support further dissemination. I maintain that the definitions are important; particularly so when trying to effectively communicate the ideas that will inspire the next generation of healthcare innovators to create a new healthcare delivery mechanism, financing system, and consumer experience. This semantic work sets the stage for the seminal work required at the hands of the innovators and entrepreneurs to bring the vision into reality.

As such, a trim definition of Health 2.0 has been propounded by some to be a term that “groups together the healthcare use of Web 2.0[1] This definition identifies the enabling technologies that have made user generated content both possible and relevant (ie, social networking (Daily Strength), blogs (HISTalk), mash-ups (Whoissick?), digital publishing, wiki’s (Health 2.0), etc) in the computing world, and how they have begun to infiltrate into the healthcare industry. The healthcare variations on this internet theme have been both impressive and profound. New applications that create new ways for healthcare players to interact, have not only changed the momentum in the game, but are beginning to change the game altogether. Examples of these new relationships enabled by new technologies include: Patient-Patient (Organized Wisdom), Patient-Providers (Medem PHR), Provider-Provider (Sermo), Patient-Payor (Blues Member Access), and Provider-Payer (Athena Health PayerView).

However, limiting the definition of Health 2.0 to “just a description of recognizable technologies that are an advance on the first generation of web tools[2] misses the point of what is sparking the creation of the enabling technologies in the first place. The enabling technologies of Health 2.0 make it possible to catalyze the creation of a culture of transparency, a refocusing on health care value, the publication of risk adjusted outcomes regarding measures that matter, and the advance toward next generation healthcare. The Health 2.0 technologies, become an underlying philosophy powering a growing healthcare delivery reform movement. I believe the enabling technology and the underlying reform movement are most effectively and efficiently communicated by the term “Health 2.0”:

HEALTH 2.0: New concept of healthcare wherein all constituents (patients, physicians, providers, and payers) focus on healthcare 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.” [3], [4]

Whether you prefer a more understated (realistic?) view or perhaps an overstated (futuristic?) one, the argument could be made that both are right. In the end, attempts to define the ethereal with the illusory may prove a Tantalus-like torment, or characterized as more “thermal noise”, and perhaps our efforts could be more productively spent identifying the themes that define what we are observing in the health care market. O’Reilly identified seven themes that succinctly descriptive yet convincingly effective in capturing the essence of the Web 2.0 movement. Attempting a similar feat, I have identified seven inaugural principles of Health 2.0 that illuminate the depth, breadth, and scope of both the technology and reform concepts of the Health 2.0 movement:

Web 2.0 Movement

Health 2.0 Movement

1. The Web as a platform
(Software as a service, the “network inbetween”, and dynamism of the database)

1. Patient Centric and User Generated
(The PHR as a platform and the patient as a collaborator of care)

3. Data is the next Intel inside
(Aggregation and “infoware” applications to create or add value to amassed data)

2. Pervasive Information
(XHR, Evidence Based Medicine/Standards of care, Risk Adjusted Outcomes))

4. End the software release cycle
(New era of software as a service requires focus on new business models)

3. Value Driven Agenda
(Interoperability, measure quality, pricing transparency, align incentives)

6. Software above the level of a single device (ubiquitous access to data from every source anytime)

4. Medical Condition over full cycle of care (Metric of Performance, True Cost of Care,

2. Harnessing Collective Intelligence
(Instantaneous and continuous knowledge sharing with no traditional boundaries)

5. Value Added Advisory Services
(Aggregate, Analyze, and Advise)

7. Rich User Experience
(Engage consumers with ease of customization, functionality, and rapid evolution)

6. Web 2.0 in Healthcare
(Collective intelligence, mashups, open source, user generated content)

5. Lightweight programming models
(Design for maximum hackability and reusability; loose coupling w/interoperability)

7. Universal Healthcare
Every covered, everyone paid)

While some attempt has been made to align reasonably similar concepts, this paper will not attempt to unnaturally stretch the analogy by attempting a concept by concept comparison. The balance of this white paper will introduce these themes.

[1] Matthew Holt’s definition from HISTalk post on May 18, 2007.
Scott Shreeve’s definition from his eponymous blog on January 24, 2007
This definition has limitations as well, and does nto properly address access or the financial issues that are required to be addressed for a complete discussion of next generation healthcare.

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