One of the interesting trends highlighted in the report was the rise of "niche therapies", which Web technology is helping to enable. The report notes that "while mass media campaigns were successful in raising awareness of conditions of interest to a broad base of individuals, promoting niche drugs requires precision targeting and fostering one-to-one relationships with patients." This is where the Web has come into play - in particular social media, search marketing and behavioral targeted advertising.

The report states that healthcare companies are starting to experiment with online video and other rich media promotion, although it also warns that the regulatory challenges inherent in the healthcare system apply to new media too.

How are web technologies being used by Pharmaceutical companies? They are using social networks like Facebook, advertising on niche health blogs, creating YouTube channels, and monitoring content online (e.g. Wikipedia). Also, the report notes that "a growing number of patients are rating prescription drugs and treatments on sites like iGuard.org, DailyStrength.org, PatientsLikeMe, and WebMD." For example, the report states that there are currently almost nine thousand reviews of Zoloft and over five and a half thousand reviews of Seroquel on the site DailyStrength.org.

Another emerging trend is use of mobile. The report says that consumers who use their cell phones and PDA/smartphones to look up health and medical information is now at over 10 million U.S. adults.

Integrate Your Stuff Here

Krasner cited MyCareTeam, a third party diabetes management application which she says is using Google Health to "to integrate their stuff into our repository for health records."

According to the press release in May about this integration, the MyCareTeam product allows users to transfer their glucose readings, lab values, medication, and other information from their software into their Google Health accounts. It is mostly a manual process, however Krasner pointed out that users can upload their data "automatically using LifeScan OneTouch meters". She admitted though that Google is "still in the very early stages, so these services are still growing and developing."

Online Health Constraints

The issue with moving health records online though is that there is a lot of rules and regulations to contend with. However Tenderich asked Krasner why Google isn't doing more, for example by offering a secure messaging system to allow patients to discuss their health issues with their doctors. Krasner's reply shows how this is too much of a red tape jungle for even the mighty Google to overcome:

"This goes back to the health records platform model. We're not in the business of offering secure messaging back and forth with doctors. What we're doing is giving people options to use great services that do offer that functionality.

For example, we integrate with web sites from the big retail pharmacy chains and provider sites like CVS, Walgreens and Quest Diagnostics labs. You can't order refills directly through Google Health, but you can import your prescription history, and you can send data back to the pharmacies via their sites."

So users have to leave the Google Health site when they need to make a medical transaction or even communicate securely with health professionals.

Business Model? Pffft, Search!

Luckily, Google Health's business model isn't reliant on any sophisticated online health technology. What is the business model? Why, sending Google Health users to Google's search property of course!

Kraser admitted that "there is no direct monetization model for Google Health", rather their model "is simply that when people sign up, it tends to encourage users to do more searches on Google.com. That's where we make our money. Every page of Google Health has [a] search box on the side. If you click on it, it takes you out to Google.com."

But "none of your health data goes with [it]", she assured.

So it's slow progress in the online health world, if Google Health is anything to go by. The good news though is that it allows smaller more health-focused startups, like MyCareTeam, to create innovative applications and hook them into Google Health, Microsoft Healthvault, and other bigco initiatives - using APIs and the platforms the big companies are able to offer.

Click here for a good cause: Ask Google for a World Diabetes Day Doodle

"Twelve months ago," Jane Sarasohn-Kahn said, "the most important things on American voters' minds were the war and health care. Two days ago, the most important thing on American voters' minds is the economy. Health care and the war have taken a backseat."

This doesn't mean however, that health care plays second fiddle to the attendees of the Health 2.0 Conference in San Francisco this week - it's still their driving force. The rules of engagement however, as Clay Shirky pointed out in his keynote on Wednesday, are changing.

Additionally, the financial meltdown is aggravating an already weak health system as people forgo or postpone essential health care due to loss of insurance or inability to pay.

The answer, according to the survey, is engagement: "Effective health engagement can build trust, and conversely, trust is the key to deeper engagement," said Nancy Turett (Edelman).

While the Edelman study serves as a basic guide, the leading providers of health information services have also been monitoring and implementing changes.

WebMD and Aetna

Wayne Gattinella (CEO WebMD), pointed out that health on the Web is no longer only for the electronic literate, a fact that demonstrates the power of electronic information. "Additionally, health care is not only about personal issues anymore," he said, "but financial as well. Patients want to know how to reduce out-of-pocket costs; they want more information."

Mark Bertolini (President, Aetna), said the company is hoping to help customers improve communications with their health insurance providers by giving them the option to transfer their personal health records to Microsoft's HealthVault - "our main focus is on portability," he said.

The Big (Internet) 3 - Microsoft, Google, Yahoo

Of course, the big three - Microsoft, Google and Yahoo - have plans of their own.

Microsoft, according to Peter Neupert (Corporate VP, Microsoft HSG) is focused on making HealthVault, a platform that allows providers to look at patient information [with their consent], easier to use for physicians and consumers.

Roni Zeiger, (Product Manager, Google Health) told the audience that the most important thing they've been hearing is "we want our data," since the launch of Google Health, a site that allows people to store health information. "This is incredibly hard," he explained, "people want data, but they also want two more things: it must be easy, and it must be useful."

Michael Yang (VP & GM Yahoo! Health), said that the biggest changes in the past year are awareness and recognition: "It's amazing to see how much demand there is for health."

While these five companies are paving the way to make personal health records available on the Web, the question remains whether we as a society can get used to the idea.

What do you think?

At least as interesting are the Hitwise numbers about percentage of traffic driven by search to sites in various categories. Health and Medical sites get 44% of their traffic from search engines, 29% from Google alone, says Hitwise. The lowest category for search traffic is Business and Financial sites, where only 17% of traffic is from search, 10% from Google. That category, though, is also the one seeing the biggest growth in search traffic - up 21% year over year, with Google's search traffic to these sites up a whopping 30%.

Entertainment and Travel both saw big growth in search traffic over the last year as well (see chart, click for full chart with additional columns), while Health and Medical and Shopping and Classifieds saw search traffic grow the least.

Take-aways for me are that the world of Business search optimization and ad buying must be going strong and Health and Medical are probably search-saturated. How else would you read this chart?

More Noise to Signal.

According to the Wikipedia blog, the 2009 swine flu pandemic page "got about 16,000 page hits on April 23, and this number increased to a dizzying 2.86 million page hits only a week later." The article began as a mere stub and has since expanded to a 21 page article with multiple iterations and discussions.

The NIH is the U.S. Department of Health and Human Services' primary agency for conducting and supporting medical research. Contributions from the group will likely help dispel myth from fact and increase awareness for early detection and preventative health.

In the past, a number of media stories from the American Medical News, Reuters Health and Seattle's KOMO TV News have criticized Wikipedia for its lack of credibility. There have also been a number of breakaway efforts to recreate the Wikipedia experience amongst subject experts including Toxipedia, Medpedia and Citizendium. Nevertheless, with Wikipedia's monthly unique traffic of 300 million visitors, it simply makes more sense for medical experts to travel to an information epicenter rather than asking millions to modify their behavior.

While no responsible medical professional would ever suggest Wikipedia as the sole information source for self-diagnosis and treatment, the NIH's recognition of Wikipedia's value might spur on other agencies to consider the site in health outreach strategies.

Microsoft has bought Medstory because it's an "intelligent" and "intuitive search technology". The NY Times says that Medstory's "search software applies artificial intelligence techniques to medical and health information in medical journals, government documents and on the Internet."

This acquisition follows Microsoft's purchase last July of "health-intelligence" vendor Azyxxi. Mary Jo Foley is also reporting that Microsoft's Health Strategy group "has been building "Windows Live Healthcare" offerings, some of which could be free and ad-supported, and others of which could be paid and subscription-based."

While the web-based health industry is a potentially huge market (just ask Jim Clark of Netscape and Healtheon fame), which probably is the main reason for Microsoft's interest in it, an equally valid reason could be that Microsoft wants to corner the vertical search engine niche for health - before Google gets to it.

What is Holding People Back?

According to Erika S. Fishman, Manhattan Research's Director of Research, besides privacy concerns, one of the biggest hurdles to overcome for the adoption of PHR is a lack of motivation among Americans to use these records unless faced with live threatening illnesses.

Meredith Abreu Ress, Manhattan Research's VP of Research, also doesn't expect to see PHRs to take off this year. As she points out, its hard to see what would motivate patients to curate their own health records when most doctors still have "your entire medical history in a coffee-stained manila folder."

Obama: Electronic Health Records for All Americans

As Greg Sterling pointed out over a year ago, the success of PHRs will be "tied in to the political outcome of universal healthcare initiatives." President-elect Obama has made electronic health records a cornerstone of his administration's proposed health policy, but some groups are already voicing concerns about the privacy implications of creating electronic medical records for all American.

According to CNN, in American, only about 8% of hospitals and 17% of physicians keep electronic records of the kind that Obama envisions and that President Bush also proposed in 2006. The administration hopes to make all medical records available in electronic form by 2014.

CC-licensed Image of 'health card' courtesy of Flickr user juhansonin.

As we shall see, the two tech rivals - Google and Microsoft - have much in common when it comes to their online health apps.

As with Google Health, Microsoft is essentially building a platform for other, smaller services to tap into. Neither bigco wants to get involved in the tricky world of health records compliance and prescription. Both are encouraging more specialized health-focused services to do that legwork - and Google and Microsoft will provide the tech infrastructure and focus on ordinary users.

Like Google, Microsoft is emphasizing that it's still early stages in this market. Said Keith Toussaint:

"We knew going in that introducing a new type of consumer health solution is a long-term endeavor; we have to be in this for the long haul. Health is, as you know, a HUGE ecosystem -- trillions of dollars, hundreds of millions of consumers/patients, hundreds of thousands of physicians, thousands of hospitals, hundreds of insurance plans and so on. We also knew the greatest value of HealthVault to consumers will come when we can offer connectivity throughout the health ecosystem and give people the ability to use their personal health information in a wide range of health and wellness applications and share it with the providers and plans of their choice. We're still in the early phases of developing the HealthVault ecosystem but we're making great progress."

Toussaint admitted they are essentially competing with Google "to find the best developers" for their HealthVault platform, but that "we're not in some kind of hot market share battle now because it's so early."

Indeed Toussaint used the comparison of Coke and Pepsi to illustrate their nascent competition with Google:

"Leading hospitals like Beth Israel Deaconess Medical Center are actually integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing. And why not program with both? It's fine as far as we're concerned; this whole space is still so small, and has such huge potential, that we can both grow huge and succeed without bumping heads. Later on, head-to-head competition will probably be more important."

So it seems that it's difficult to 'taste the difference' between HealthVault and Google Health. They are both platforms, neither tries to be a healthcare provider or conduit between healthcare professionals and patients, and both have search as their business model. There are differences in the two services when you drill down, but at a high level they're very similar.

Let us know if you've used either system and if so what your experience has been.

Image credit: Senor Adventure

One of the major upsides to having health information stored online is that it makes keeping track of your health easier. As Alan Newberger, an engineer at Google, pointed out this morning in a blog post announcing Google's health product, he didn't realize he had seasonal allergies until he connected the dots between the "cold" he got last April, and the one he got the year before at the same time. "I've often been overwhelmed when trying to determine or track a condition, because my personal record of health information is either nonexistent, or it's spread on forms and receipts from (at least) a dozen doctors and five insurance companies," he wrote.

Having your health information in one place can greatly eliminate hassles when doing things like switching doctors, or moving from a general practitioner to a specialist. If transporting relevant medical data to your new doctor is as simple as a couple of clicks, that can save you a lot of time and headache. Easier access for trusted doctors or emergency medical workers can also mean faster and more accurate diagnoses and less chance of mistakes in the operating room (such as administering a medication to a patient to which they are allergic).

But the big drawback to storing medical records online is privacy. As the Associated Press points out, third-party services aren't covered in the Health Insurance Portability and Accountability Act, a 1996 US law which created standards about how medical information can be shared. What that means, according to Pam Dixon of the World Privacy Forum, is that anyone who trusts an online medical records service could be making it easier for the government or a legal adversary to gain access to their medical records. Further, information not controlled under HIPAA might theoretically be used for marketing purposes.

Google isn't the only one getting into online health records. Steve Case's Revolution Health, WebMD, and Microsoft all have similar products. When Microsoft announced their Health Vault initiative last October, we touched on many of the same issues.

We agreed with Greg Sterling of Search Engine Land, who noted that online health records initiatives like those from Google or Microsoft are inextricably tied in the US to the success or failure of universal health care plans. People will be far more likely to feel comfortable putting their health records online knowing that their insurance coverage won't be in jeopardy should that information leak out.

As we wrote in October, it is very likely that eventually health records will be stored online. The benefits are too great and the companies pushing for it have very deep pockets and wield a lot of power. But there is still a lot of leg work to be done before people will trust companies like Google and Microsoft with their health information.

Would you trust Google, Microsoft, or any other company with your personal health information? If health care was guaranteed to you regardless of your medical history would you be more apt to store health records online? Leave your thoughts in the comments.

I have no doubt that eventually health records will be stored online. Easier access and sharing of health information between doctors and hospitals is something that can lead to better and quicker diagnoses, less headaches when changing doctors or moving to a new town, and less chance of a serious condition being missed by a doctor. Many large companies are betting on the future of online health information portals, Google, Intel, and Cisco all have initiatives underway in this area. But there are major hurdles toward gaining public trust and acceptance, not least of which is security concerns.

Personal health records are something most people guard very closely -- as closely as financial account information. I agree with Search Engine Land's Greg Sterling, who points out that the success of HealthVault or any similar endeavor is tied very closely to the outcome of universal health care proposals in the United States. People will be far more likely to feel comfortable putting their health records online knowing that their insurance coverage won't be in jeopardy should that information leak out.

HealthVault stores data on its own infrastructure, separate from other Microsoft properties, and users have control over who gets access to their personal information. Health searches done on the site are conducted anonymously and not linked to users' personal data. Microsoft acknowledges that users are unlikely to add much personal information to the site regardless of privacy protections promised by the company, but they hope that users will give permission for their doctors to utilize the site as a central storage repository for health information.

In that vein, Microsoft announced a number of partners for the site including NewYork-Presbyterian Hospital, Johnson & Johnson, the Mayo Clinic, Diet.com, and Texas Instruments. The partners fall into three main categories: hospitals and doctors, web sites, and device manufacturers who will allow users to automatically upload readings from medical devices such as blood glucose monitors or heart monitors to their personal HealthVault accounts.

On the search side, the new HealthVault health search vertical is rather impressive. Searches on the site combine relational refinements (i.e., search for "wheat" and the site will recommend that you search for "celiac disease" as well), article content from sources like Wikipedia and the Mayo Clinic, and web results in an attractively laid out search results page. The site also serves up sponsored results and book recommendations from Amazon.

Tying into HealthVault, members of the site can save search results to a personal "health scrapbook." Article and web site results are added to the scrapbook individually, allowing users to pick and choose their favorite information and create a private, personal resource for whatever it is they're searching.

Conclusion

I personally would be very hesitant to store medical records online. Having once been almost burned by my health insurance company because they had access to health records, I am very protective of my medical records. I generally think that a lot of people feel that way about their personal medical information.

Would you trust Microsoft, or Google, or Intel, or any other company with your personal health information? If health care was guaranteed to you regardless of your medical history would you be more apt to store health records online? What do you think of HealthVault's search? Better or worse than competing search engines in the health vertical? Leave your thoughts in the comments below.

If you think that "data portability" and standards for an open web hold a lot of promise to fuel innovation in social networking, just imagine what a secure, standards-based, data landscape could enable in health care.

The Continua Alliance, made up of companies like Nokia, Intel and Panasonic, along with IBM and Google, highlighted a handful of factors in the announcement. The technology will be useful in a wide variety of case types ("including chronic disease management, health and wellness, and elderly care"), in the US and around the world. By leveraging online services, the platform will enable healthcare providers to leverage scale in ways that otherwise isolated medical monitoring can not. And by putting the software into widespread use, the group hopes to make significant headway in supporting open standards and "interoperable healthcare products and solutions." That's on top of all the standard consumer benefits of online health records. (See coverage at Medgadget for more details and a link to the press release.) The companies don't yet have any name for the platform but say it's tested and ready to deploy.

The group also said that supporting the development of Google Health was one of its goals, but we hope that the technology will support the development of an entire ecosystem of complimentary, competing and interoperable health data services.

That kind of language is both similar to what advocates of social networking "data portability" use and represents the kind of steps we'd love to see more of from big vendors in all kinds of technology sectors.

Open, standardized data, backed up by certified security measures and serving as the foundation of a new era of innovation is a fantastic vision. If you think that big players in social networking have a financial interest in data lock-in, though, just imagine the resistance that "data portability" could face in the multi-trillion dollar medical industry.

The companies collaborating on this platform believe that consumer demand for informed care, combined with the vendor participation already gathered, will force the rest of the industry to open, down to every medical practitioner challenged by patients to use portable data in treatment. That seems like a sound strategy to us.

ReliefInsite is a site that allows people to map, monitor and analyze their pain. It drew perhaps the most attention at the conference.

One other buzz-worthy app was Pharma Surveyor, which helps people understand and personalize their medication regimens.

On Call Medical Group isn't so much of a tool for consumers, as a group of doctors making house calls who happen to use nifty tools.

And of course, there were a host of community sites - some focusing on doctors and services, like Vitals and HealthGrades, and others focusing on treatments and information like WEGOHealth, Trusera and CarePages. Others were somewhere in between, like MedHelp.

Now that consumer and web companies like Google and Microsoft have climbed in the ring, there's a definite cool factor in health 2.0 - as evidenced by Adam Bosworth and Esther Dyson being in the room. The fact that Adam's new venture, KEAS, is in the healthcare space should speak volumes to anyone wondering if this whole thing is for real.

Health 2.0 Trends

A few trends coming out of the conference. First of all, employers are currently driving the show. 'Consumer owned healthcare' isn't quite here yet. Just like with financial services and the 401k, early adoption will come through employers. Next trend: corporations and pharma are getting into social networks. And that's causing tension. People participating in grass roots sites like Matthew Zachary's I'm Too Young for This, selected by Time Magazine as one of the Top 50 Websites (2007) are very sensitive to the 'big corporation' ethos and it often repels them. If a social networking site attempts to integrate drug ads, they'll have to be very, very careful; a point made by members of various online communities and Zarachry himself.

Final trend of note: Google and Microsoft. Many great ideas about health care fail. The system is complex; heavyweights are entrenched. Google and Microsoft represent a threat to some and an opportunity to others. In either case these two Internet heavyweights in health will be something to watch over the course of the next year.

Written by Josh Rosenthal, Ph.D., founder of www.Sprigley.com and a speaker at Health 2.0

I encourage you to check out the 5-minute video, embedded below. Admittedly it means more to me than most people, because I actually have diabetes. But it's an eye-opening video for anyone wanting to know how the Internet and web 2.0 can help change the healthcare system, right now.

Not a Magical Elixer

OK, let's be clear - the Internet is just an enabler. Of course there is a lot of work to be done to remove the piles of red tape and inefficiencies in healthcare. But it's good to see healthcare gradually become web-enabled and the video celebrates this. If nothing else, consumers have much more healthcare information at their fingertips via the Web and are able to gather and socialize with people in specialist social networks such as Diabetic Connect. Amy also noted in her email to RWW that the Web is "changing our relationship with the medical establishment & pharma companies, so they finally view us as consumers, demanding the right products and treatments to help us live better." Here's the vid:

See also:

• Health 2.0 - Apps & Trends to Watch
• Health Care at SXSW - Health Getting Hot With Tech Crowd
• Top Health 2.0 Web Apps

Following on from my post entitled Gettin' Paid: A Future for Content Creators? Redux, I noticed (via Darren Rowse) that Yahoo already has a beta blog service running. Yahoo's Health Expert Blogs is not disimilar to what weblogsinc and Gawker do - blog about a certain topic under a business brand. Indeed there are signs that Yahoo is about to launch a Technology blog network.

However it's not at the level of what I had in mind in my Gettin' Paid post. I am envisaging a network of independent experts, each with their own unique brand. This may be a pipe dream of mine, but I still hold out hope that Yahoo or perhaps AOL (with Feedster's help) will implement what I dream of. btw Yahoo and AOL, I'm available for consulting work to help you do that! ;-)

Yahoo's Health Expert Blogs are certainly one step ahead of Microsoft's Filter network. The fact that Yahoo names its bloggers, and indeed centers each blog around the expert that writes it, is fantastic. e.g. Rodney Yee's Yoga blog has some great writing in it. All it needs though is some unique branding and design to bring out Rodney's personality even more. The design of the Yahoo Health blogs is bland and doesn't do justice to the 'voice' of the blogger. That's why I'm pushing a vision of independently branded bloggers, yet still identifiable as part of a network of bloggers who write about a defined topic.

A note about the terms I'm using: each topic has a number of niches. There is 1 blogger per niche but, for example, 10 bloggers per topic. So there is real potential for a Yahoo or an AOL to collect together groups of like minds ("experts") and get the best of both worlds - independence and network effects.

Yahoo or AOL (or another bigco) should let the bloggers keep the unique brands they've built up, but fold groups of them under their wing as blog networks - and pay them! The bigco's benefit by gathering experts into networks and promoting them on their homepages. And they get great content :-)

If I had to come up with a term for this - it'd be a Network of Niches. Which I define as: a group of niche bloggers, each with their own unique look n' feel but collectively part of a branded network of like minds.