Improving health care:
Journal of Participatory Medicine
will document methods that work
for patient/provider collaboration

Launch at Connected Health Symposium
features essays by visionaries in
health care, Internet, high tech, business, and sociology

Patient engagement and patient empowerment are popular topics, with hundreds of thousands of Google hits, but there’s precious little information on how to do them well. A new academic journal being launched this week, the Journal of Participatory Medicine, aims to change that.

 Created by experienced pioneers of the “e-patient” movement, the Journal will be introduced this week at the Connected Health Symposium in Boston, hosted by the Partners HealthCare Center for Connected Health. The Journal is an official publication of the Society for Participatory Medicine, founded in 2009 by the patients and physicians who have worked together for several years at e-patients.net.

“Because health professionals can’t do it alone”

Participatory Medicine is a new approach that encourages and expects active patient involvement in all aspects of care. It builds on the work documented at the e-patients.net blog, whose slogan is “Because health professionals can’t do it alone.” The group’s landmark 2007 paper “E-Patients: How They Can Help Us Heal Healthcare” tells many stories of engaged, empowered e-patients who substantially improved their own outcome and the outcomes of others by supplementing or even going beyond what their physicians alone could do.

 That paper and subsequent blog posts have further documented the stresses and information overload faced by physicians today, and flaws in today’s care delivery system and personal health data, including many anecdotes of patients who made a pivotal difference through active engagement. Now, the Journal of Participatory Medicine will move the field from anecdote to science, with articles on principles, methods and evidence-based outcomes.

Authoritative and accessible; peer-reviewed by patients and health care professionals

 The Journal will be written and peer-reviewed by and for all stakeholders: patients, healthcare providers, caregivers, researchers, payers and policymakers. Physicians who have practiced in the participatory model report greater satisfaction when they work with patients who are actively engaged. Similarly, participatory patients say they feel empowered, heard, and more in control.

Free continuous updates online

The Journal will publish continuously and will be freely accessible to the public at http://jopm.org. Following the inaugural issue in early 2010, articles will be published as they are reviewed, accepted, and edited; there may also be single topic special issues. Email alerts will inform subscribers when new material has been posted. Anyone can sign up to receive these alerts at http://jopm.org/register.php

 Available online now is a collection of invited essays that serve as the “launch pad” from which the journal will grow. In their opening editorial “Why the Journal?” the editors write,  “We consider this introductory issue an invitation for you to join us as we create a robust journal that will serve a growing community of concerned individuals and professionals.”

Mission: To transform the culture of medicine

The Journal’s mission is to transform the culture of medicine by providing an evidence base for participatory health and medicine. It aims to advance both science and practice, focusing on six content areas: research articles, editorials, narratives, case reports, reviews, and updates on related research in other media. It will explore how participation affects outcomes, resources, and relationships in healthcare; which interventions increase participation; and the types of evidence that provide the most reliable answers.

Importance of a broad-based peer review process

The Journal uses a new, broad-based peer review process to significantly improve on traditional academic journals. While still managed by experienced journal editors, JoPM’s peer review process will be open to a far broader set of minds for scrutiny of methods and analysis. Improved accuracy and effectiveness are vital as the population ages and healthcare costs continue to rise.

 In the first issue of JoPM, Richard Smith MD, editor of the prestigious British Medical Journal for 25 years, writes that “most of what appears in peer reviewed journals is scientifically weak.” This echoes the words of Marcia Angell MD in The New York Review of Books, who wrote in January “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Considering the pivotal role that journals play in policy and treatment decisions, JoPM’s broad-based process aims to improve the reliability of the process and the resulting research.

Bringing thought leadership from many disciplines to healthcare

Because of the complexity and size of the healthcare challenge, the Journal of Participatory Medicine invites participation from all disciplines that can help.

 Leadership of the Journal and the Society is shared between physicians and laypeople.

• Co-Editors are Jessie Gruman, PhD, Founder and President of the Center for Advancing Health, and author of AfterSchock: What to Do When the Doctor Gives You—or Someone You Love—a Devastating Diagnosis; and Charles W. Smith, MD, Executive Associate Dean for Clinical Affairs and Professor of Family and Community Medicine, University of Arkansas for Medical Sciences, and Founder of eDocAmerica.
• Deputy Editor is Alan Greene, MD, Founding President of the Society, Co-founder of DrGreene.com, Clinical Professor at Stanford University and Chief of Future Health at A.D.A.M., Inc.
• Managing Editor is Sarah Greene, publishing and new media entrepreneur with three startups in science, health, and medicine acquired by Wiley, Elsevier, and Thomson Healthcare.
• Founding Co-Chairs of the Society are Daniel Z. Sands MD, MPH of Cisco Systems and Beth Israel Deaconess Medical Center, and his patient “e‑Patient Dave” deBronkart, of ePatientDave.com and TimeTrade Appointment Systems.

Some of the articles featured in the first issue:

• Investor and futurist Esther Dyson on “Why in the world ‘participatory medicine’?”
• Longtime JAMA editor George Lundberg MD and former AARP board chair Joanne Disch PhD, RN: “Why healthcare professionals should be interested in PM”
• Kate Lorig RN, Dr.P.H., Director of Stanford School of Medicine’s Patient Education Research Center: “Why people should be interested in PM,”
• David Lansky, CEO of Pacific Business Group on Health and former Senior Director at the Markle Foundation, on “Why payers should be interested in PM”
• Kurt Stange MD, PhD, Case Western Reserve University and editor of the Annals of Family Medicine, and Gilles Frydman, founder of the ACOR.org network of cancer communities, on “Building an interdisciplinary field of inquiry and practice”
• Richard Smith MD, former editor of BMJ, and Musa Mayer, famed breast cancer activist, on “The Value and Questions of Peer Review”
• and many more articles

Launch is the closing event at Connected Health Symposium

The official launch of the journal will occur on Thursday, October 22 at 3:30 PM as part of a panel discussion about the “Changing Role of the Patient in Health Care and the Changing Rules of the Game for a New Publication.”

 Moderated by Co-editor Jessie Gruman, the panel will include Gilles Frydman, Founder and President of ACOR (Association of Cancer Online Resources) and Editorial Board Member; Dan Hoch, MD, PhD, Dept. of Neurology, Mass. General Hospital, Co-founder of Braintalk, and Editorial Board Member; Deputy Editor Alan Greene, MD, and Co-editor Charles W. Smith, MD.

 The Society chose to launch its journal at the Connected Health Symposium because of the long and sustained commitment Partners HealthCare and the Center for Connected Health have had to exploring innovative and effective ways to deliver quality healthcare outside of traditional medical settings.  According to Gilles Frydman “Many of the editorial advisers and board advisers for the journal have been working with the Center for Connected Health for years. We are delighted to be partnering with them for this launch.”

About the Society for Participatory Medicine

The Society for Participatory Medicine was founded in 2009 to learn about and promote PM through writing, speaking, social networking, and other channels. It builds on the work of Tom Ferguson, MD, who envisioned the e-patient movement within months of the birth of the Web browser.

Society membership is open to anyone who shares the belief that PM should be the operative model for healthcare, that all involved parties share in a collective decision-making process, and that the patient is central to that process. Through PM we can teach patients to take responsibility for their own health and providers to effectively invite patients into this.

About the Center for Connected Health and the Connected Health Symposium

The Center for Connected Health, a division of Partners HealthCare in Boston, develops innovative and effective solutions for delivering quality patient care outside of the traditional medical setting.  The Center engages in pioneering research in a wide range of connected health-related areas and works to advance the field through its convening and publishing activities. The term “connected health” reflects the range of opportunities for technology-enabled care programs and the potential for new strategies in healthcare delivery. The Connected Health Symposium asks how information technology – cell phones, computers, the Internet and other tools – can help people manage chronic conditions, maintain health and wellness, and age with independence.

Journal of Participatory Medicine: http://jopm.org or www.facebook.com/JourPM

Follow the journal on Twitter: @jourPM  and #WhyPM

Society for Participatory Medicine: http://participatorymedicine.org or www.facebook.com/participatorymedicine

Connected Health Symposium: http://www.connected-health.org/events/symposium-2009.aspx

I’m announcing my support for the Declaration of Health Data Rights, which was launched today. More information is available at HealthDataRights.org. The declaration reads:

In an era when technology is allowing personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

• Have the right to our own health data
• Have the right to know the source of each health data element
• Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; If data exist in computable form, they must be made available in that form
• Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

I support the principles of the Declaration. Clearly, to me, this is one important step (out of many) to empower consumers with information. We know, however, that being able to access clinical and administrative data is just the beginning of that process.

As I’ve written before, we need to build on data access rights to help translate data into understandable, meaningful information. Then, we have to build tools to translate good information into user knowledge. Finally, with that base, we need to create strategies for converting knowledge into behavior.

I had the opportunity to meet with Aneesh Chopra — our country’s first Chief Technology Officer — last week. The CTO serves as Associate Director of the Obama administration’s Office of Science & Technology Policy (OSTP), which “serves as a source of scientific and technological analysis and judgment for the President with respect to major policies, plans and programs of the Federal Government.” OSTP will also lead interagency efforts on a wide range of science and technology policy issues, certainly to include health information technology (HIT) in collaboration with David Blumenthal in the Office of the National Coordinator for HIT.

Chopra — whom I’ve known for years from our days together at the Advisory Board Company — is not only really sharp but very creative in thinking into the future about how technology can evolve. The opportunity is enormous, but capitalizing on it requires more than just technology development but policy planning as well. One could argue that the pace of technology advance over the last several decades arguably has outpaced our imagination, yet we haven’t harnessed those breakthroughs in the form of health care productivity or quality gains.

The New York Times Sunday Business section explored the government’s role in stimulating innovation yesterday. Steve Lohr cites Chopra’s interest in building “innovation platforms” to spur growth, but Lohr notes that there are at least nine countries that have been more aggressive than the U.S. in using government to drive innovation: Australia, Brazil, Britain, Chile, Colombia, Finland, India, Norway and Singapore.

The Center for Information Therapy (IxCenter) also has been focused recently on how stimulate more robust innovation in the field of information therapy (Ix). In some ways, this was a natural evolution of our partnership with Health 2.0, LLC, in preparing for the first-ever “Health 2.0 Meets Ix” conference we held two months ago. There, we explored (among other things) how innovative health 2.0 tools could be combined with Ix strategies to create new models for health care delivery.

We also have launched two collaborative projects with IDEO — the innovation design firm responsible for creating everything from the first Apple mouse to the Swiffer — in our search for rapid-cycle innovation in Ix strategies. Thanks to a grant from the California HealthCare Foundation, we will work with IDEO to develop Ix strategies to overcome barriers in implementing innovative consumer engagement strategies with safety-net populations in California. We will address text-messaging applications and other approaches to information prescribing.

Another experiment involves applying the IDEO model to Ix innovation design with our IxAction Alliance in its monthly webinar. In addition to trying to develop a robust model for Ix innovation design, we also are testing out whether we can apply the highly intensive in-person workshops and collective observation of users to the virtual and dispersed nature of our monthly IxInsights webinars. That has major policy planning implications in terms of the scalability and efficiency of how we stimulate innovation nationwide.

The IxCenter will be actively pursuing robust approaches Ix innovation design strategies over the coming months, and we’ll certainly be sharing everything we learn in this space. In the interim, it would be great to get suggestions and other input from readers on the best strategies for rapid-cycle, breakthrough innovation.

The latest version of the e-health bible was published today by Susannah Fox & Sydney Jones at the Pew Internet & American Life Project. For nearly a decade, many of us have relied on Pew’s data to understand consumer needs with respect to health information technology (HIT). Susannah gave a sneak preview of some of Pew’s new data at our April “Health 2.0 Meets Information Therapy Conference,” but there’s nothing quite like getting to sink your teeth into 70 pages of Pew data.

Some of what’s most interesting is what has changed in the last 8 or 9 years. In recent conversations I’ve had about Healthy People 2020 or other prognostications about the next decade of HIT developments, we sometimes forget how quickly the world changes technologically speaking. Comparing Pew’s 2000 data to Nov-Dec 2008 sample of American adults:

• Internet access: Jumped from 46% to 71%
• Looking online for health information: Jumped from 25% to 61%
• Broadband access: Jumped from from 5% to 57%

Just as importantly, however, there’s a little bit of plus ça change, plus c’est la même chose. Despite the growing popularity of the Web, more people turn to a health care professional (86%) and a friend or family member (68%) than the Internet (57%).

Perhaps what I’ve always found most important about the Pew data is understanding the impact of the Web on how consumers make health decisions. After all, if a Google search falls in the forest and nobody does anything with the tree they downloaded, has it really made a difference?

Indeed, Pew data demonstrate that the information found on the Internet does influence decision making for a majority of consumers who go online. Of those people:

• 60% say the information found online affected a decision about how to treat an illness or condition.
• 56% say it changed their overall approach to maintaining their health or the health of someone they help take care of.
• 53% say it lead them to ask a doctor new questions, or to get a second opinion from another doctor.
• 49% say it changed the way they think about diet, exercise, or stress management.
• 38% say it affected a decision about whether to see a doctor.
• 38% say it changed the way they cope with a chronic condition or manage pain.

And, on the critical “help or hurt” question, 60% of online health users say they or someone they know has been helped by following medical advice or health information found on the Internet, in contrast to just 3% who say it has caused harm. The former figure has nearly doubled since 2006, whereas the latter has stayed the same.

I’m not disappointed (but not surprised) that consumer engagement tools seem to not have done a great job so far. Only 19% of online health users have signed up to receive updates about health or medical issues. We clearly need to do a better job of meeting people where they are at in order to get them more engaged in online management of their health.

Finally, for understanding the impact of demographics on Americans’ use of the Internet, broadband, and cell phones, there’s nothing that tells the story as well as Pew’s access thermometers, which have now been updated with December 2008 data.

(Methodology Sidebar: Pew — in part made possible by its partnership with the California HealthCare Foundation — deserves special credit for two methodological advances. First, Pew now surveys (I think they added this a year or two ago) using both landline and cell phone samples, recognizing that an increasing and unevenly distributed portion of the US population cannot be reached by landline (this issue got a lot of press — particularly from places like Pollster.com and 538.com — during the 2008 presidential primaries and general election, as many thought that could lead to underestimations of the Obama vote). Second, they did Spanish-language interviewing to capture information from the second most prevalent language spoken in the US. This substantially improves the validity of all of Pew’s demographic comparisons that involve Latinos.)

Thanks to Pew for continuing to facilitate a data-driven conversation about consumer behavior with respect to the Internet.

*I could have also titled this post, “Happy Mothers’ Day: OBOS — The Mother of All e-Patients.”

For Mother’s Day, at the request of my own mother (Ruth Kertzer Seidman), I made a donation to Our Bodies, Ourselves (OBOS). My mom has often asked that we make contributions in her honor for special occasions, and made a special plea this year — as many non-profits doing great work are struggling during this deep recession.

I was thinking about OBOS in the context of so many discussions in recent weeks about the nature of the e-patients movement (see related posts here, here, and here). It would be hard to overstate the groundbreaking work of OBOS (previously known as the Boston Women’s Health Book Collective, BWHBC) in the role of consumer empowerment and user-generated content.

Nearly 40 years ago, in an era when women were doubly patronized — as patients and as women — by their doctors, BWHBC decided to take matters into their own hands and create materials to empower women to take control of their own bodies and manage their own health. BWHBC founders were not doctors and most had none/limited health sciences training.

(Full disclosure about my connection to BWHBC: My aunt, Esther Rome (NY Times obituary here), was one of the BWHBC founders and remained an active part of BWHBC until she died of breast cancer at age 49 in 1995, having courageously battled the disease for 7 years that also struck her mother at a young age. Esther was determined to be present for her younger son’s bar mitzvah before passing away a month later. My mother — a lifelong feminist with exceptional management skills (and information scientist, but that’s another matter) — chaired the BWHBC Board of Directors 1999-2001. I can remember attending BWHBC 10th (as a pre-teen) and 20th (as a college student) anniversary parties, and I don’t remember a time when versions of OBOS and spin-off BWHBC books were not on the lower bookshelves of the house in which I grew up. In other words, feminism and consumer health empowerment were ingrained in me since somewhere between diapers and kindergarten.)

The result was phenomenal: OBOS has sold more than 4 million copies and it has been translated into 19 different languages. It was arguably the most profound demonstration of consumer empowerment and user-generated content at the time and was instrumental in changing the dynamics of the doctor-patient relationship, particular for female consumers.

Recent discussions with today’s most passionate e-patients often involve a discussion of how important e-patient communities are for people with rare health conditions (”the long tail”). There’s no doubt that’s been true in many cases — for those people with unusual health challenges, these social networks have been poweful, invaluable and (in many cases) life-saving.

But OBOS wasn’t about the long tail. Quite the contrary. It was about the day-to-day health and quality-of-life issues that women face, such as a patient-centered approach to pregnancy & childbirth, breastfeeding, healthy eating, sexuality & sexual health, mental health, domestic violence, menopause, etc. For women (and men who care about women), there’s not much further from from the long tail than these issues.

By the time my generation was coming of age, OBOS was almost like a bible for women on college campuses and elsewhere (in fact, the NYT obit of Esther Rome referenced above called it a “bible to a generation of young women”). As it took on that status, it also faced some new criticism. In OBOS’s early years, critiques primarily were lobbed from the entrenched powers that be (particularly of a paternalistic OB/GYN medical community). A couple of decades later, some of the criticism came from Gen-X & Gen-Y feminists (and even some older) who perhaps had a different view on what “empowerment” really means. Most notably, whereas the original e-patients (rightfully) were highly skeptical of the medical industrial complex, some feminists of the next generation wanted to balance that skepticism with a more open approach to the potential of modern medicine to help them deal with their personal health issues.

But OBOS undoubtedly has done so much more good than harm. And it certainly lay the groundwork that can come from the empowerment of medically disenfranchised consumers.

I think its evolution also may provide lessons for how the modern e-patients movement evolves. In many ways, a corollary may be how many in the e-patients community (who have saved countless patients’ lives primarily through consumer sharing of information) are now leading the charge toward the critically important concept of “participatory medicine.”

To my mom and all mothers around the world: Happy Mother’s Day! I wish you all a life of good health and health empowerment.

In yesterday’s New York Times Magazine, David Leonhardt’s interview with President Obama revealed his perspective on the role of consumers in a reformed health care delivery system. Leonhardt asked Obama how people “will experience medical care differently on the other side of health care reform.”

First, Obama answered generically — from a policy perspective:

“First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being  — that, I think, can be helpful.”

Obama definitely understands the basic premise that engaging consumers more actively in care management is critically important for improving the effectiveness and efficiency of the health care delivery system.

That made his more personal comments — reflecting his own experiences as a patient and a caregiver — even more interesting.

“I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.”

It was interesting that Obama reports on what some might view as a fairly traditional view of the hierarchical relationship between doctor and patient. Obama may be like the majority of Americans in this respect. He certainly believes that consumers should be empowered and engaged, but he believes that the reality of the existing health care delivery system renders that model somewhat infeasible, at least in many cases.

What I think is unclear from the interview is whether Obama is satisfied with that situation — that is, he doesn’t want the responsibility of that decision making — or he is frustrated that the system doesn’t provide him with better resources.

Obama further explains at least partially how government can play a role in helping to improve care delivery.

“And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.”

Obama believes (and he goes on to explain considerably more detail on this subject) that part of the solution for supplier-induced demand of health care services is for the federal government to do comparative effectiveness research (CER) in a non-politicized environment. Once again, though, it’s not exactly clear how Obama believes CER should be communicated to lay people. He no doubt believes in some level of shared decision making — using CER to facilitate more evidence-based and informed discussions between clinician and patient.

He suggests later in the interview that there should be some degree of communication directly with consumers about CER findings when he says, “…If a provider is pushing [one medication approach] on you, then you should at least ask some important questions.” Hopefully, we’ll find out more about how he and HHS think this should be done in the next couple of months.

Returning to Boston each April for Patriots’ Day has become something of a ritual for me. On Monday, I’ll be lining up on the starting line in Hopkinton for my 12th straight Boston Marathon (that would just be getting warmed up for the likes of Ben Beach, whose streak has been running 3 decades longer).

But this year, the marathon is just a warm-up for a more unique experience — the first-ever “Health 2.0 Meets Information Therapy” conference.  In the virtual spontaneous combustion that transpires in preparing for an event like this, it’s hard to step back and think about the big picture of the conference.  Finally, with the plane having returned to the gate for a maintenance check, I’m going to take a few minutes to put a few of these thoughts down here.

I owe a thank-you to Scott Shreeve, facilitator-extraoardinaire, for getting my mental juices flowing on this account. On Thursday night, he asked me and my two co-conveners (Matthew Holt & Indu Subaiya) what our vision was for the “Great Debate” he’s moderating on “Building Health 2.0 into the Delivery System.”  In a late-night frenzy, I typed (somewhat free associating) into the laptop my vision for the last session of the first day:

500 people will walk out into the cool Boston air, stroll through Back Bay with colleagues grappling with how Ix can help integrate Health 2.0 strategies into the delivery system. They should approach the question with a sense of realism of the challenges but optimism of the potential.  They should have new ideas that are ready to jumpstart a conversation with colleagues “back home.”  They should be ready to actually take action in changing how they deliver health care.

I’ll admit that’s a lot to ask for 90 minutes.  But I honestly think we have a shot at it — maybe not for everyone there because different people have different reasons for coming, but for enough that we can truly spark some game-changing momentum in health care delivery.

The world of patient-centered care, consumer engagement, patient empowerment, and robust new technologies are coming together at this point in history, and the potentially synergistic movements and communities of information therapy (Ix) and Health 2.0 are merging for two days in Boston to catalyze change.  It’s time to see what can happen.  Fasten your seat belts!

By Matthew Holt,  Joshua Seidman, & Indu Subaiya

On April 22–23 in Boston, two ideas are going to come together. Health 2.0 has been defined in different ways, but is most often considered to be the use of lightweight online technologies which allow consumers to access and exchange health information via the now familiar search, communities and tools. Information therapy (Ix or information prescriptions) involves the proactive delivery of the right information to the right person at the right time, usually as part of the care delivery process.

However, while both Health 2.0 and Ix are focused on improving patients’ participation in care, they tend to come from different backgrounds. Ix tends to be “prescribed” to the patient, often by a clinician (although system-triggered Ix and  consumer-prescribed — either “self-prescribed” or recommended by a peer, caregiver, etc. is also part of the definition). Ix innovations have had the greatest penetration in organized systems of care with robust provider and patient HIT applications like Kaiser Permanente and Group Health Cooperative in Seattle.

Health 2.0 had its start with non-health care organizations delivering content, communities and tools to consumers online—often in the absence of the health care system paying much attention. Thousands of communities about every conceivable health condition exist online, hundreds of sophisticated tools have been developed for consumers and clinicians to use, and now the ability to create and store patient data online is becoming much more prevalent. But in general it’s been savvy consumers, followed by technology and media companies who have been leading the charge.

In addition, Ix has been focused on delivering the “right” information, often implying “evidence-based,” although “right” can have other definitions as well. In Health 2.0 communities, there’s often wild disagreement about what the evidence base actually shows, and what the correct course of action is. Last Tuesday’s post in Well (The NY Times patient blog) about the complexity of understanding the correct course of action in PSA testing for prostate cancer is a typical example.

So can these two movements live together? Better yet, are there synergies that can help them to thrive? Is this a case of the proverbial combination being greater than the sum of their parts?

We are going to find out in Boston on April 22–23 at the Health 2.0 Meets Ix conference, hosted by the Center for Information Therapy and Health 2.0, LLC . We are also going to find out whether the current health care system is ready to adopt Health 2.0, Ix, or some combination. The format will be a series of Great Debates.

Health Affairs is our media partner in this event, and Susan Dentzer will play a large role in helping to moderate these debates. But as a teaser, several of the debaters will reveal some of their cards in this blog, the Health Affairs blog, The Health Care Blog, and several other blogs in the coming weeks. We think you’ll enjoy the debate!

Sometimes the greatest insights derive from the most obvious observations. Especially when they’re delivered by an articulate spokesperson, who speaks plainly from both data and his own experience. A presentation from California HealthCare Foundation President Mark Smith, MD, MBA, — available for viewing here — had some real gems.

The presentation, “Clinic of the Future: Will Yours Be One?” was directed at community health center clinicians and administrators, but many of his points apply to a broad spectrum of clinical practices. (You can also find the slides here.)

Smith shares examples of what some of the future of health care could look like but recognizes that most of clinical practice hasn’t changed since he was a resident a couple of decades ago. He asked the audience, “For those of you older than 30, what do you do even remotely like you did in 1990?” In other words, the tools we use to communicate, schedule trips, shop and do just about everything else are different than from that era, but most of health care delivery looks just about the same. No doubt there’s something wrong with this picture.

He got even more specific with respect to information therapy (Ix), again with a question that is not exactly groundbreaking and could be a guide for the future of health care delivery: “Why do most people go to the doctor’s office?  For information.  Do we get information the same way we used to? No, we do not.” But, he notes, the democratization of information has not substantially changed how most doctors practice today.

Smith talked through some examples of trying to create more consumer-centered approaches to organizing care and information. For example, for Minute Clinic, he dispensed with clinician concerns that consumers would take serious health problems or medical emergencies to walk-in clinics: “Patients aren’t that dumb; patients aren’t going to Wal-Mart if they’re having a heart attack.” He cited data in support of this as well.

Smith noted that these new health care organizations and online resources are specialized by level of severity, not by organ systems. That allows them to effectively “orient the intensity of their interventions to their patients’ needs.”

I’m vaguely reminded of some product tag line from many years ago (I can’t remember what it was for), “So smart it’s simple.” Sometimes all this health care redesign stuff seems like it shouldn’t be so complicated.

I’m looking forward to attending the apparently sold-out Health 2.0 conference next week in San Francisco. I’ll be moderating a session on Content, Navigation and Advocacy (see day 1 of agenda here) with a great collection of panelists and demo presenters.

As my increasing blogging about Health 2.0 suggests, the IxCenter is increasingly interested in the intersection of the Ix and Health 2.0 movements, and all those in attendance next week will be the first to learn about a really exciting development along these lines.

Many of the questions ruminating through my head as I think about what will be discussed next week include:

• How can the evolving delivery system retain the best of Health 0.0 and 1.0 (e.g., trust and personal relationships) on the route to Health 2.0 (with much greater user-focused functionality)?
• To what extent are Ix and Health 2.0 synergistic vs. dichotomous? More importantly, what are the keys to maximizing those synergies?
• How do you actually build Health 2.0 into existing care delivery systems?
• What are the pros and cons of the “expert” vs. “wiki”approaches to knowledge creation in health care?
• What’s the future role of the doctor? Is it true to its Latin roots (literally, “to teach”)? Is the physician role a navigator, a contextualizer, a consultant, or something else?
• To what extent will human vs. automated infomediaries guide consumer decision making and navigation in the future?

Tune back here next week and also to the IxCenter home page for new and exciting Ix-Health 2.0 news!