A new report in McKinsey Quarterly on “Building the Web 2.0 Enterprise” suggests that companies around the world continue to deploy more Web 2.0 tools, but they have not yet figured out how to realize desired benefits yet.

On average, the typical company responding to the McKinsey survey uses 3.4 Web 2.0 technologies including Web services, blogs, RSS, wikis, podcasts, social networking, peer-to-peer, and mash-ups (Web application that combines multiple sources of data into a single tool).

However, only 21% of respondents expressed overall satisfaction with Web 2.0 tools and an equal portion were dissatisfied. It wasn’t entirely clear from the data why that’s the case–though there was some suggestion based on data related to barriers to success of 2.0 initiatives–but there clearly is a long way to go (not surprisingly, given the nascent nature of 2.0).

From my perspective, the most interesting data relates to how companies have deployed 2.0 technologies to interface with customers (vs. for internal use or for interfacing with partners/suppliers). The top reasons from respondents:

• 73% — Improving customer service
• 71% — Acquiring new customers in existing markets
• 53% — Getting customer participation in product development
• 53% — Letting customers interact
• 23% — Providing for other customer interactions

These all seem like good reasons for health care organizations to deploy 2.0 technologies–both for economic and quality-of-care reasons.

It will be interesting to watch over the next three to five years to see how much of that change will come from inside or outside of traditional health care organizations. If the former doesn’t happen soon, I think it’s likely that the latter could dramatically change the way care gets delivered in this country.

I have to admit that I was dubious when I heard that HHS Secretary Michael Leavitt would be the keynote presenter at today’s Kaiser Family Foundation forum on “The Health Blogosphere: What It Means for Policy Debates and Journalism.” Although Leavitt has had an HHS blog for nearly a year, I didn’t view him as having a lot to say about this new medium.

As it turns out, he made some interesting remarks–for example, these are what he perceives as some of the “side benefits of blogging” a couple of hours a week–in addition to the obvious communications outreach opportunity it provides for getting the HHS message out to the public quickly (what he referred to as a “short cut in communication”).

• He can try out ideas and see what kind of responses they generate.
• He can re-use the material he blogs about for other communications purposes.
• He can serialize extensive topics (e.g., Medicare reform, drug importation, HIT, etc.) in order to communicate themed ideas in more digestible doses–which will ultimately get all the content more widely read than if they just released a long report or white paper.

Other comments at the forum discussed how the health policy blogs will lead to a very different health care reform debate in 2009 than we had in 1993-4. All factions in the coming national debate will have far more tools and vehicles for making their case; they will do it faster, and there will undoubtedly be more public interaction.

There also is no doubt that the impact of health blogs in the health care reform debate will depend on quality of blogosphere, which is a combination of at least two things: the soundness of the arguments being offered, and the ability of the bloggers to get their message out amid the noise that exists.

When Healthy People 2000 was dreamed up two decades ago, the World Wide Web was not much more than a figment of someone’s imagination. When Healthy People 2010 was issued 10 years later, the Web had become a powerful avenue for democratizing access to health information. How can we possibly anticipate what the Internet will mean when we try to evaluate the nation’s health in 2020?

That’s the start of my post on the blog that is serving as an important input for the development of the Healthy People 2020 objectives for e-health and health communication. In addition to this post, I’ll be monitoring the input to HHS on this topic for the next two weeks, so come join the conversation over there.

There was a good post on the Health Affairs blog last month by Rob Cunningham titled, “Who Speaks for the Health Care Consumer?” It’s a great question and the post makes clear that it’s a complicated answer.

As Cunningham points out, many organizations use language to connote a focus on consumers/patients even when something besides some expressed consumer desire brought them to the solution they promote–for example, many (certainly note all) models for “consumer-directed health care,” the “patient-centered medical home,” and “personal health records” (just to name a few) were developed without any direct input from consumers themselves. Cunningham cites comments made by Ed Mendoza of the California Office of the Patient Advocate that consumer activism historically has often arisen as a negative reaction–such as to paternalistic models of care delivery.

It’s a great challenge to figure out the most effective and efficient way to integrate the true patient perspective, but some health care organizations have made great progress. One example presented to our IxAction Alliance in May was PeaceHealth’s approach to PHR development.

When PeaceHealth set out to develop a personal health record (or shared care plan), they took an entirely different method of development called “user-centered design.” Rather than creating fancy electronic tools and then getting input from consumers, PeaceHealth decided to start by sitting down with their patients first and directly asking them what tasks they wanted an electronic tool to accomplish. They hammered out all kinds of practical applications and specifications before writing a single line of code.

During the Patient-Centered HIT Initiative, when Ted Eytan and I went into practices, we actually spent time shadowing patients and clinicians, observing how they interacted, and what affected their communication. As I described in a post last year, this is an approach taken by some of the most successful companies on the planet (e.g., Toyota describes it as “genchi genbutsu)–go to your customers and watch them if you really want to know what they want.

It may not be practical to do this in every circumstance in health care, but it’s certainly a good goal to put out there. It’s probably the best way we can find out what consumers want without first making them furious by providing them with what they don’t.

Dan Hoch (of BrainTalk fame) is up at The Health Care Blog with a great post today about the role medical societies can play in advancing participatory medicine.

In it, he makes six recommendations for medical societies to help promote participatory medicine. I agree with everything he wrote, and would add two more things.

First, medical societies can provide tools their members that facilitate the delivery of information therapy (Ix) and participatory medicine. Hoch actually alludes to it earlier, based on what his own medical society (the American Academy of Neurology) has done to promote patient pages, and other forward-thinking societies have already taken steps in this direction.

Most physicians want to prescribe information to their patients to facilitate more collaborative care, but they don’t have systems in place that fit that work into the process of care delivery. If one of their most trusted sources (their professional society) can make it easy for them to do the right thing, they will probably jump at the chance.

Second, as medical societies are promoting private- and public-sector reimbursement changes to better align incentives to provide high-quality care, they can make the case that participatory medicine, Ix, and related care support should be rewarded.

Along with Hoch’s suggestions, medical societies that do this can play a critical role in advancing the practice of participatory medicine and Ix.

I had a fun meeting yesterday with some smart folks from the Robert Wood Johnson Foundation that brought up some questions about Ix that could use some clarification. When we talk about information therapy (Ix), we often drift into “evidence-based information” to help with some specific health condition.

That certainly is an important component of Ix, but it’s too limiting in many circumstances. When we talk about the “proactive delivery of the right information to the right person at the right time,” that has to encompass whatever the information needs of the consumer are.

What we know from talking with consumers–and from a variety of other research and projects–is that people have health- and health care-related information needs about so many things that have nothing to do with the best evidence-based health information.

• How do I find out if this procedure is covered by my insurance?
• Who should I go see for this condition?
• How do I get there?
• What can people who have had this condition tell me about what it’s like to live with it?

The list of questions is virtually endless. The point is that information therapy refers to getting good information to people for whatever the consumer needs for his or her well-being and health/health care-related decision making.

This became clear in the Medicare Health Support project designed to support the chronic care needs of the frail elderly with multiple conditions. It turned out that a majority of their needs were not clinical. They needed help getting transported to their appointments, filling medication prescriptions, getting meals prepared for them, and generally alleviating a great deal of social isolation. They still had great information needs, but they needed to be tied to other resources.

In this context, it is no less important that the Ix consists of “good information,” but it does mean that “evidence-based” is sometimes too limiting a criterion for high-quality information in the context of Ix. We need to make sure that we find ways to measure the quality of the information regardless of what kind of guidance consumers need.

The one sure way to make sure that we are truly meeting the consumer’s information needs at particular moments in care is to continue observing their behavior and asking them what would help them live healthier, higher-quality lives.

In the past couple of months, I’ve attended a couple of forums at which Peter Orzag, Director of the Congressional Budget Office talked about CBO’s expanding emphasis on health care. One of the points he made at both appearances was that (paraphrasing) CBO probably needs less Econ 101 and more Psych 101. Orzag wants CBO to increase its analytic capacity in “behavioral economics,” in part because he realizes that one of the keys to addressing the US federal health care cost problems requires addressing the behavioral psychology of health care actors.

It was a little hard to figure out how much of the behavior he’s talking about is providers vs. consumers (or others for that matter), but I do think both are critically important for addressing health care costs. Ix initiatives, of course, often are built on the foundation of the science of behavioral psychology (maybe a little more advanced than 101).

It will be interesting to see how CBO goes about understanding consumer behavior as the health care reform debate evolves over the next year-plus. It’s clear that Ix initiatives could play an important role in helping to drive behaviors that ultimately lead to more efficient and rational care delivery.

According to new data from Manhattan Research (as reported here by iHealthBeat), 36% of US physicians reported that they communicated online with patients in the first quarter of 2008. That’s up from 31% in 2007 and 25% in 2006.

That 11 percentage-point increase is a 44% jump in adoption over two years–a steady rise. It may signal that we’re nearing a tipping point for adoption of a technology that is a foundation of so many effective Ix applications. Secure messaging and other forms of electronic and asynchronous communication make possible so many enhancements to the traditional clinician-patient relationship.

As online communication takes hold, it will be important that delivery systems, technology companies and other organizations develop creative solutions that facilitate the integration of clinicians’ personalized notes/comments/opinions/recommendations with high-quality health content and navigation to additional resources.

The combination of clinician personalization and accurate, comprehensive, understandable and tailored content will allow for mass personalization of Ix. Paul Wallace (IxCenter Board Chair) and I wrote about strategies for doing this in an IxCenter white paper from a few years back that you can download from our Web site.

Aniruddha Malpani, a physician from India and one of the most active international Ix supporters, posted on his blog today his commandments for remaining healthy. His first commandment is “information therapy,” which which I couldn’t agree more.

It got me thinking…What are the 10 commandments for effective information therapy? Here’s a starting point for this list, which is heavily informed by the work of the IxAction Alliance’s Ix Payer Workgroup that has spent more than a year putting tight definitions around the definition of what constitutes Ix in different contexts. I hesitate to call something that is designed as a starting point for discussion as “commandments,” but there are considerable advantages to not having to (literally) carve your commandments in stone (tablets).

1. Thou shalt not limit consumers’ access to health information.
2. Thou shalt target information to an individual’s moment in care.
3. Thou shalt tailor information to an individual’s particular needs (including, but not limited to: literacy level; learning preferences; cultural differences; language; etc.).
4. Thou shalt proactively deliver information to individuals in accordance with their needs.
5. Thou shalt (to the greatest extent possible) provide high-quality (accurate and comprehensive) information.
6. Thou shalt provide information to consumers that facilitates their navigation of the complex set of choices related to all aspects of health care delivery.
7. Thou shalt provide information that supports people in at least one of three ways: informed decision making; skill building and motivation for healthy behaviors; and/or patient comfort/coping/acceptance.
8. Thou shalt provide information that empowers consumers.
9. Thou shalt build any approach to care delivery, information sharing, and electronic tool development around the needs of consumers/patients/members/employers (people!).
10. [For you to propose–WHAT DO YOU THINK BELONGS HERE?]

I look forward to commandment amendments from all of you.

Last week, I attended the launch of the World Health Organization (WHO) “Safe Surgery Saves Lives” campaign. It’s an impressive international project that has tremendous potential for reducing surgical errors by the simple inclusion of a checklist into the process of surgical care.

As the initiative’s lead, Harvard surgeon and noted mainstream author Atul Gawande said, the idea is to borrow from the processes adopted by the much safer airline industry. Checklists went a long way in reducing flight errors so long ago that they are now fully ingrained in the process.

The Surgical Safety Checklist is brilliant in its simplicity and in the way it directly addresses many problems that arise with surgery, but I also think there’s a big missed opportunity on WHO’s “first edition” of the checklist. The third column–the “Sign Out” process–doesn’t specify any patient engagement. The closest it comes is, “Surgeon, anaesthesia professional and nurse review the key concerns for recovery and management of this patient.”

My understanding from people involved in the process was that the first stage of the campaign specifically decided to focus on the “intra-operative” aspects of safe surgery to the exclusion of patient participation and education. No doubt there are plenty of errors that can be solved by getting the surgical team all on the same page, but failure to engage patients is a major lost opportunity.

As WHO prepares for its “second edition,” I hope that at the very least, they add an additional box to check on the “Sign Out” column of the checklist that would read, “Patient’family provided an information prescription regarding instructions for post-operative management and what signs should trigger contact with providers or other actions.”

With Consumers Advancing Patient Safety President Susan Sheridan advising WHO, I know that they are getting excellent and passionate guidance about consumers’ information needs. I just hope that they listen to it as they go forward to maximize the potential impact of the Safe Surgery Saves Lives campaign.