A reminder that Blue Spruce is a fully browser-based application development platform, currently in development, which is being built on open Web standards. The main feature of Blue Spruce is that it allows for a combination of different Web components - data mashups, high-definition video, audio and graphics - to run simultaneously on the same browser page. It's important to note that the Radiology Theatre app only requires a standard Web browser (as long as it's Safari or IE!) - so there's nothing to download for the end user, in this case doctors.

The radiology theatre is the latest in a series of prototypes for Blue Spruce. The current prototypes are focused on 3 main areas: finance, health and "heavy industry" (which it previously defined as utilities, rail, steel, etc).

This is how IBM described how the new online radiology theatre will work:

"A group of doctors can log into a secure Web site at the same time to review and analyze a patient's recent battery of tests. For instance, a radiologist could use her mouse to circle an area on the CT scan of a lung that needs a closer look. Then using the mouse she could zoom into that scan to enlarge the view for all to see. An expert on lung cancer could use his mouse to show how the spot had changed from the last scan. And then, a pathologist could talk about patient treatments based on spots of that size depending on age and prior health history, paging through clinical data accessible on the site.

The theatre allows all these experts to discuss, tag and share information simultaneously, rather than paging through stacks of papers, calling physicians to discuss scan results and then charting the results. This collaborative consultation brings together the personal data, the experts and the clinical data in one physical, visual theatre."

Perhaps the biggest potential benefit of the online radiology theatre is that it will enable experts from all over the world to consult on cases. The ability for multiple users to "cobrowse" (as IBM has termed it) means they can interact in the browser in real-time and see each other's changes.

Of course, since this is medical data, there are significant privacy implications involved in using the Internet to collaborate. But we're pleased to see that IBM's Blue Spruce is being put to such a worthy use and we look forward to seeing other applications this year and beyond.

"One of the United Nations development mandates is to use Information and Communication Technology (ICT) as much as possible to move countries forward in their development. [But] because of the economic split in the U.S. between the small percentage of ultra wealthy and the large numbers of folks in need, Americans need ICT for health care just like folks in Africa, Asia and Latin America," she said.

In 2004, the U.S. spent $1.9 trillion, an average of $6,280 per person - 16 percent of its GDP - on health care.

With one of the most expensive, yet inefficient, health care systems in the world, you have to know something is broken. Particularly when outside of the U.S., Health 2.0 is taking off.

So what is happening in health care around the world and is there anything we can learn from other nations?

Strengthening Health Communications in South America

The basic idea behind Voxiva was to provide a health care communication system to people with no Internet access. "While the Internet is great for people who have it, it wasn't a reality where we were working," Paul Meyer (co-founder Voxiva) explained.

The first system he created was for public health authorities in Peru. Using a telephone, physicians could enter details about a patient or disease and public health authorities could then access that data. Today, Voxiva works over telephone networks and can be accessed on all phones (mobile and landlines), as well as the Internet.

Over the past year, Voxiva has rolled out an entire suite of free services in Mexico, giving patients and doctors a better means of communication.

Lesson from South America: If you want to make a system that is useful, then make what people need. Don't assume that everyone is going to have a phone, or the Internet.

Technology for Sexual Health Information

In 2006, when the San Francisco Department of Public Health contacted Deb Levine (ISIS) and said that a lot of people were getting Chlamydia and gonorrhea, she did what any other researcher would do: she went and sat down in front of Mission High School (San Francisco). "I was watching the kids, and realized everyone had a cell phone," Levine said.

The ubiquitous presence of cell phones gave birth to the idea that became SexInfoSF, a text-messaging program that lets teens access sex health related resources by sending a numerical code for common questions.

While SexInfoSF is only one of the various services ISIS offers, in the main the company focuses on SMS text messaging. "There is no charge for this service," added Levine, "you'll only be charged if you don't have a bundle for text messages."

Lesson from North America: Work with the community to create culturally appropriate messages.

Monetization in the European Health Industry

Alensa, an e-commerce platform, was founded in 2005 as a way for European pharmacies to expand their retail sales by using the Internet after the company realized that very few pharmacies were online. "In talking with the pharmacists," Alex Savic (CEO, Alensa) said, "we quickly realized the most important thing to them was to see a benefit."

When Alensa created a health blogs network they knew that the medical practitioner bloggers would need to be compensated, so they came up with two ways to monetize their content, explained Savic:

1. Premium posts: While the majority of the blog is available for free, Alensa encourages their health bloggers to have paid, or premium posts
2. Widgets: by placing a widgetized version of a shop on their site, health bloggers earn revenue.

Lesson from Europe: The bottom line counts, but select monetization models carefully.

Managing Your Health Data in Germany

According to Thomas Liedtke (Head of Emerging Healthcare, ICW AG), 28-30 percent of patients are getting the wrong information.

Typically, he explained, this is the result of patients having more than one doctor; perhaps a physician, a neurologist and a gynecologist, all of whom prescribe different medicine.

ICW attempts to decrease this margin of error with their core product LifeSensor, a Web-based personal health record that enables data to be collected by and communicated to all interested parties, whatever their location. In a nutshell, it means that you get to manage your health data.

Lesson 2 from Europe: Let patients manage their health data.

England Looks After Her Own

According to Marlene Winfield, (Information Authority, National Health Service [NHS]), England's universal health care program, the NHS, is trying to bring a number of services into one place; their goal is to enable two way communications between patients and physicians. What they're working on right now is 'Health Space' a personal health organizer that will be offered to every adult who wants it.

Using the system, Winfield explained, patients will be able to book appointments online, manage their medications, e-mail physicians through a secure channel, add any self prescribed medicine to the record themselves, keep a calendar of health appointments and get reminders. "It will give them access to a real time summary record that is being updated every time they do something," she said.

This is a massive cultural change for a country that has had a national health service for so long and Winfield admits: "One of the biggest challenges is to get everyone to 'keep the faith' while we work through it."

Lesson from England: Consider a universal health care program.

Of these lessons, which (if any) do you think would benefit the US health care system the most?

"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?

Speaking to a standing-room-only audience at the Health 2.0 Conference in San Francisco this morning, Shirky explained that in going forward, we must focus on three things: information, co-ordination and collaboration. The idea expands on his recent article Health Information Technology: A Few Years Of Magical Thinking? (with Carol Diamond), which warns the health care IT establishment against the dangers of "magical thinking."

"The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist "magical thinking," such as the notion that technology will transform our broken system, absent integrated work on policy or incentives."

The problem, according to Shirky, is that we are overestimating the value of individuals accessing information, and underestimating groups collaborating.

"Patients in aggregate behave very differently than when solo," Shirky explained today. "Think about what you do when you get a bad diagnosis - you fire up Google, find out who has what you have, and then talk to them. That ability, for patients to pool their resources, is a massive change to the health industry."

Information

"Back in 1974, when the Internet was a fraction of what it is now, the acorn to an oak, there were really only two applications," said Shirky, "Telnet, and FTP. When electronic mail was introduced, it dwarfed Telnet and FTP by 75% within three months."

This taught us something, Shirky told the audience, "The most valuable thing is not computers and machines; it's people."

"The classic mistake, when people start thinking about how data will affect field X, they tend to completely ignore group access to collaboration - and this is what is most important," Shirky continued.

"While engineers are busy building technology and talking about building trust, they forget that trust is not about machines, it's about people. And whenever people decide to trust one another, information will flow." He pointed to Yahoo! Groups, which has in excess of 180K groups about health alone. "This scale indicates an enormous demand for this conversation. These people are using basic tools; they're not waiting for technology. It's about trust; humans are the trust networks, not technology."

Coordination

"The Voice of the Faithful launched in January 2002," Shirky told us, "and started with 30 people. Today, they have in excess of 30 thousand members, spread over many countries - all recruited by other members."

The Voice of the Faithful was formed when the community learned that church officials had tried to cover-up clergy sexual abuse.

"The Archdioceses in Massachusetts freaked out. He wanted to gag people, telling them 'you can say anything to the person in the next pew, but you cannot talk to people in the next town," said Shirky.

"They tried to subdivide the population, but this of course, didn't work."

People do talk, and mainstream Catholics started talking as never before; to each other and to the world.

"And when it comes to health, patient centric medicine is not just about 'me, me, me' anymore; the Internet has made it about me - and - everyone I'm talking to," said Shirky.

While many argue that this type of system is too informal and shouldn't be happening, Shirky pointed out that "you have to remember we've always had informal conversations, we've just never had this type of connection. And the majority of these conversations are brokered by fellow patients; not by working professionals."

Collaboration

"Increasingly," Shirky explained, "what is happening everywhere is the ability people have to collaborate."

"In early 2008, Los Angeles surgeon Dr. Lawrence Dorr went to orthopedic joint manufacturer Zimmer and told them he'd noticed an alarming number of patients experiencing problems after routine hip replacements, who often needed a second operation," Shirky told the audience. "Zimmer took a look at the device, said it was fine and blamed the doctor who in their opinion needed further training."

Dorr didn't like this answer. He went and posted a letter online. Patients started copying and pasting this document across the Web. It ended up as a public relations nightmare for Zimmer and led to the eventual suspension of the product by Zimmer Holdings.

"Institutions are trying to prevent 2.0 from happening," Shirky said, but it isn't working.

He pointed to a service called Medical Justice, which claims it is 'relentlessly protecting physicians from frivolous lawsuits' and offers among other things, a contract that doctors can have their patients sign which is supposed to prevent the physician from being defamed on the Internet.

"The problem of course, is that while you may be gagged by this contract, your friends are not." Shirky concluded. "Much like Zimmer, they're selling the fantasy - that patients are solo."

What do you think? Should we continue focusing on the technology, or on the information and people?