Google says it's shutting down the projects because they got very little traction but health industry tech innovators say that Google Health may have been ahead of its time, did a poor job reaching out to a now growing ecosystem of developers and ought to be put on slow life support or open sourced instead of being shut down. When it comes to patient-centric cloud-based electronic health records, the opportunity remains large, the need severe but the challenges are substantial.

What it Means to Lose Google Health

Medical information heavy-hitter John D. Halamka MD says Google Health was a real trailblazer in its time. Dr. Halamka is the Chief Information Officer (CIO) of Boston's Beth Israel Deaconess Medical Center, the CIO and Dean for Technology at Harvard Medical School, the Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP) and a practicing Emergency Physician.

"Google Health is truly innovative and broke new ground when it created interfaces to hospitals, labs, and pharmacies in 2008," Halamka wrote today on his blog. "I was there at the beginning and can definitively state that it was Google's reputation and vision that broke down the political barriers keeping data from patients...Google Health [still] has the best user interface, feature set, and ease of use of all the stand alone personal health records." (It should be noted that Israel Deaconess Medical, one of Dr. Halamka's employers, was one of Google Health's launch partners.)

Halamka says Google Health "really moved the industry" but other observers express disappointment that the project barely got out of the starting gate.

"It will take someone the size of Google and not in the health space to create something that's more standardized in the health space, where everything is so proprietary and money driven," says Shwen Gwee, founder of the blog Med 2.0.

"Unfortunately, it's always been Google's philosophy to fail fast and cut off the arm that isn't doing any work. Early adopters were interested in using Google Health, but it took too long to move. I wonder what would happen if they launched it now, with everything that's coming out around open and standardized data. I wish they would donate the platform, open source it, issue a challenge or something, and see what others could do with it."

The request that the Google Health platform be open sourced is something we heard from multiple industry players. People feel burned by the loss of a big opportunity due to the impatience of a big, slow company.

"Google is cutting and running too early from Google Health..in the long term I believe this to be a big mistake," says Mark Scrimshire, co-founder of the HealthCamp Foundation, an organization that puts on events around the world to hack on the future of healthcare.

"Health was always a long term play. An industry mired in regulation and conservative approaches, things were never going to change quickly. However, momentum is building. We are [now] seeing a tremendous uptick in innovations that make use of Government Health Data [for example].

"Personally, I still use Google Health on a daily basis. My Fitbit and numerous other health related data sources feed in to Google Health and pass data out to other services like Keas.com [a workplace wellness program]. I recently moved my Pharmacy because I could have my data automatically piped in to Google Health.

Right: HealthCamp's Mr. Scrimshire, before and after using Google Health.

"Google Health - what we call an untethered Personal Health Record - was NOT a destination in and of itself. Instead it was more useful as a conduit through which we could channel our health data.

"As Meaningful Use requirements kick in as a result of the implementation of the Affordable Care Act we can expect to see Patient Portals popping up like daisies and consequently a growing need to provide a place that Patients can bring together all these disparate data sources in order to get a comprehensive view of their Health. It is not happening yet, but expect to see changes happening in 2012 and people starting to look for solutions to help them get their arms around their health data. The problem for Google will be that by cutting and running now who will trust them in the future if they decide to come back to the table?"

A spokesperson for Google declined an offer to respond to any of the issues raised in this article prior to publication, saying the company preferred that its announcement today speak for itself.

Why Did Google Health Fail to Gain More Traction?

There are many different theories about why Google Health didn't grow faster.

"As much as there's a massive consumer-empowerment movement, in order to get ongoing and broad adoption of something in healthcare, one needs to lead with the clinicians. Take a look at ZocDoc, for example. They are having success with appointment scheduling by leading with doctors/dentists who then, in turn, bring in their patients. Without provider adoption first, they would have had limited success with consumers."

Matthew Holt, Co-Chair of the organization the Health 2.0 Network says he thinks insurance companies were in part to blame. "Google became disappointed when they found out how hard it was to get Insurance agencies to share their data voluntarily," Holt says. "They made some progress but not enough."

The most common critique we heard though was of Google Health's work with tech developers.

Healthcare blogger Faisal Qureshi said on Twitter this afternoon, "Google Health failed at not reaching out to vertical developers, Android fixation & not learning how MSFT partners."

Brian Ahier, a hospital IT evangelist in Oregon echos that sentiment:

"While Microsoft has assembled a list of companies that make products (glucometers, blood pressure monitors, etc.) and offered software that pulls in data from hospitals and labs, compatible with their HealthVault product, Google has made little to no headway in this area.

"I remember a few years back Google did fairly well when compared to Microsoft but HealthVault has continued to mature and Google has been stalled for some time."

Ahier says that Google's decision to pull the plug on Google Health will ultimately be a bad thing for the whole industry.

We spoke to a number of people who agreed that Google launched a stronger health data product than Microsoft, but that Microsoft's HealthVault has since surpassed Google Health.

"The problem with Google Health is that it offers no incentive to use it, it positioned itself as a data repository and not much else," says Brian Dolan, Editor of MobileHealthNews. "Some of the other consumer apps and devices are filling the gaps and they have their own back end systems and APIs, they're all sharing with each other. These other sticky consumer health apps are driving uptake and driving adoptions."

One of those startups and a platform in-and-of itself is Boston-based fitness tracking service Runkeeper. Founder Jason Jacobs says of Google Health's closure,

"Sensors are starting to proliferate across categories, but someone still needs to tie this data together and provide the users a holistic view. Google's vision for data aggregation and the good that can come from it was right, but data aggregation isn't the only piece, the consumer-facing system that people love has to be there. And that is the hardest part.

"Google was a pioneer in many ways with Google Health, and helped turn people on to the need to solve the problem of health data fragmentation. While they may not have achieved the consumer adoption they were hoping for, someone is going to crack the consumer nut in health in a Facebook-like way, and the world will be better off for it."

Or, as RunKeeper's @HealthGraphAPI Twitter account said upon learning the news, "Don't worry folks, we'll take it from here..."

Surely someone will take it from here, right?

The software, an Internet-based healthcare transaction interface, allows doctors to upload and save medical data, to share test results with patients, and to analyze information with their colleagues. Patients in this system can manage their healthcare, schedule appointments, request prescription refills, research medications, access articles, and communicate with doctors - all securely, quickly, and cost-effectively. Our question: Why aren't systems like these in place everywhere right now?

More than just a task manager, the interface allows physicians to access a messaging system that includes audio and video chats, kind of like Skype. Using this part of the service, physicians could conduct online consultations with their patients via webcam. It's unclear whether the system would also allow homebound patients to send vital statistics such as weight and blood pressure to physicians automatically through the use of monitored devices, another trending topic in "telehealth". Online consultations - and getting insurance companies to pay for them - have also been a subject of great concern to the American Medial Association, which has been lobbying for more modern billing practices for online consults since 2004.

Doctations has also expressed the goal of making physicians' offices entirely paperless by moving source data (such as reports, faxes, and mail) and business processes online. The company has partnered with Sure Scripts and Quest Diagnostics to send prescription requests and order lab results. The company has also partnered with science and health publisher Elsevier to give patients access to important research materials and decision support alerts.

These are just a few noteworthy features we found while browsing around the Doctations website. The service appears to be full-featured for all aspects of a medical practice, from staffing and billing to patient-focused task management. The service is available on a subscription basis for healthcare providers.

Check out this CNBC interview with Doctations founder and neurosurgeon Dr. Louis Cornacchia:

Although many users would love the opportunity to have quicker, simpler, less expensive healthcare as well as greater access to their physicians, others still probably have concerns about the security of putting their most personal information online. On which side of the fence do you find yourself? And for our readers who are also medical doctors, would it make sense to implement such software in your own practice? What are the objections?

Let us know your thoughts in the comments. We're going to switch on the webcam and see if we can get a doctor to look at this troubling mole.

Assistive and Health-Related Technology: Created by Aramys Miranda, Hernan Pelassini and Dan Raju, iSign is a simple iPhone application created to help those with hearing challenges communicate via their iPhone. The group leverages the device's touch screen and employs modified American sign language to produce voice outputs. In this way, members can use the device to communicate to those with little or no knowledge of sign language. This application won the Hackathon award for "Best Accessibility Application". Meanwhile, Chief Medical Officer gives patients iPhone access to their Google Health files. Created over the weekend by Bess Ho, Myk Klemme, Jen McCabe and Chip Vanek, the application will allow users to gather their medical records and prescriptions in one place. This is particularly useful for medical emergencies. The group plans to release the application as an open source project upon completion.

Mobile Music Production: Nettwerk recording artist BT's Sonifi is by far one of the most sophisticated iPhone music applications available. The product is a cross between Indaba's flash-based audio sequencer and Yamaha's touch instrument, the Tenori-On. While the Tenori-On retails at $1000, the Sonifi iPhone application is available in the App Store for $4.99 and allows users to mix via the touch interface on the iPod touch or iPhone. Some of the unique features of this product include a touch interface with 4 channel arrangement mapping, reactive visuals, a collaborative group mixing mode and "Stutter Edit" - a feature that allows users to shake their device for audio feedback. In the past, electronic artists have experimented with a modified NIntendo Wii remote for an accelerometer-prompted dj experience, Sonifi is the first gesture-based iPhone mixer.

The new alliance wants to guide governments, NGOs, and mobile firms on how mobile technology can be used to help save lives.

Already, mobile technology is providing and augmenting healthcare initiatives throughout the world. In a recent study released by the UN and Vodafone titled, "mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World," over 50 of these types of initiatives throughout 26 countries were discussed. The biggest adopters of mobile technology were India with 11 projects and South Africa and Uganda with 6 each.

• Sending mobile phone owners updates on diseases via SMS.
• Letting health workers in Uganda log data on mobile devices from the field.
• In South Africa, the SIMpill is a sensor-equipped pill bottle with a SIM card that informs doctors whether patients are taking their tuberculosis medicine.
• In Uganda, a multiple-choice quiz about HIV/AIDS was sent to 15,000 subscribers inviting them to answer questions and seek tests. Those who completed the quiz were given free airtime minutes. At the end of the quiz, a final SMS encouraged participants to go for voluntary testing. The number of people who did so increased from 1000 to 1400 over a 6-week period.
• In the Amazonas state of Brazil, health workers filled in surveys on their phones about the incidences of mosquito-borne dengue fever.
• In Mexico, a medical hotline called MedicallHome lets patients send medical questions via SMS.

The Power of Mobile Technology

But beyond just the altruistic aspects of mobile healthcare, the UN report also demonstrated to mobile operators how programs such as these could provide value to the industry. That, said UN/Vodafone Foundation Partnership head Claire Thwaites, was a crucial step since the industry, like many others today, stands at the edge of a downturn.

Because mobile technology is relatively cheap and easy to spread, it can connect the rural areas that desperately need healthcare with the large populations of doctors who live in the urban centers. For example, "in India," said Dan Warren, director of technology for the GSM Association, the umbrella organization that hosts the MWC, "there are 1m people that die each year purely because they can't get access to basic healthcare. The converse angle to that is that 80% of doctors live in cities, not serving the broader rural communities where 800 million people live."

Some Drawbacks

Using mobile technology is not a panacea for the world's health issues, though. Says Forrester analyst Elizabeth Boehm, one of the biggest issues with mobile healthcare is that "the people who are most in need of healthcare are usually more aged, so they don't use the mobile or they're not comfortable with it." This limits the use of mobile phones in public health information campaigns.

However, as the technology continues to spread throughout the world, it's easy to see how, over the course of time, phones could become a "doctor in your pocket" for the less fortunate citizens of our world.

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.

Web Trends

RWW Live: Health 2.0

We have been tracking the so-called 'health 2.0' trend for some time now. We've covered the top health web apps, the trends to watch in health 2.0, and the latest industry stats. And we published a Health 2.0 update this week (see below). So in this week's episode of RWW Live, the ReadWriteWeb authors get together with a number of industry experts to discuss how the Web is changing health care.

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Health 2.0 Through the Eyes of a Diabetic - One Year Later

ReadWriteWeb founder/editor Richard MacManus: One year ago, I discovered that I had contracted Type 1 Diabetes. I was 36 at that point and it's relatively rare for someone of my age to suddenly get Type 1 Diabetes - indeed they used to call this form of diabetes "juvenile diabetes", because it mostly occurs in children. So it was quite a shock to discover that I had it! Immediately I looked to the Web to find out all I could about this condition. I discovered a thriving community of 'health 2.0' apps and social networks, which I then wrote about in this blog.

As it's now a year later, I thought it'd be good to review health 2.0. What has changed in web-based health services over the past year? And indeed what web tools do I use to help me manage diabetes?

Nine Recommendation Tools We Wish We Had

...And The Best Substitutes We've Come Up With So Far

There's so much content online every day that it's totally overwhelming. That's where good recommendation technologies and media outlets come in handy. As a blog that seeks to share the most interesting web technology and trends with readers, automated help with the discovery process is of great interest to us. In this post, we discuss some tools we wish we had and the closest makeshift substitutes we've been able to come up with. Maybe you'll find some of them useful or have even better recommendations to offer us and other readers.

2009 Tips for Big Web Companies

2009 is approaching quickly, and the consensus is that it's going to be a really tough year. The US financial crisis is triggering a global recession. Yet, a crisis is also a time full of hope. It is a time to re-think, re-tool, and get ready for the next upswing.

For big Internet companies, 2009 is going to be a very bad year for sure. Advertising profits are going to plunge, and consumers will spend less money overall, particularly on the web. There is little that can be done to change that. But what big companies can do is invest in innovation and killer moves that will bear fruit in the years to follow. Here is what we think would be cool for various big web companies to do in 2009.

SEE MORE WEB TRENDS COVERAGE IN OUR TRENDS CATEGORY

A Word from Our Sponsors

We'd like to thank ReadWriteWeb's sponsors, without whom we couldn't bring you all these stories every week!

• Mindmeister is an online mind mapping tool.
• Pro Opinion allows you to get paid to take surveys.
• WildApricot is Membership Management Software.
• Crowd Science gives you detailed visitor demographics.
• Glue enables you to connect with friends while browsing.
• Strands provides real-time recommendations of products.
• Direct Media Exchange is a solution for managing ad networks.
• Rackspace provides dedicated server hosting.
• VisualCV lets you stand out from the crowd when job-hunting.
• Quintura is a visual-based search engine.
• Eurekster is a custom social search portal.
• MediaTemple provides hosting for RWW.
• SixApart provides our publishing software MT4.

RWW Jobwire

Who's Getting Hired in Tech? Last Week's Jobwire Graphs

We all know the economy is in shambles and there are massive layoffs across most industries, including technology - but there are still new hires happening in tech and new media! Who's getting hired? That's what we're tracking at our blog Jobwire - the stories of lucky people with exciting new jobs.

Who's getting those jobs? What kinds of positions are being filled and in what sectors? Check out our first set of charts below from last week's aggregate activity on Jobwire to find out the answer to those questions.

SUBSCRIBE TO READWRITEWEB'S JOBWIRE FOR THE LATEST NEWS ON JOB HIRES IN TECH

Web Products

Google SearchWiki is Not a Wiki

Late last week Google unveiled the first major change to its search interface since the introduction of multi-media ("Universal") results into the search results page. They called it Google SearchWiki.

It's a big deal, it's awkward, it's frightening, it's brave, it's already both loved and hated - but it's not a wiki. As Ward Cunningham, the man who invented wikis, told us in our initial coverage of SearchWiki, "Collectively editing thoughts is what leads to the unique wiki behavior..." Days into the experiment it's clear that this feature is more like a forum, and it's not a particularly well architected one at that.

Your Favorite Mobile Web Apps & Sites

One year ago we ran a contest asking you to tell us your favorite Mobile Web apps. From the resulting comments there were 5 Mobile Web apps that clearly stood out, with multiple mentions: Gmail Java app for mobile phone, Google Maps for Mobile, Opera Mini, Fring, Shozu.

Well, a lot has changed in the Mobile Web application world since then. The Apple App Store launched in July '08, prompting a wave of new third party iPhone apps. And we've seen innovation from Apple's mobile phone competitors: Google's Android (which has multiple app stores), Nokia, and Blackberry, and others. So what are your favorite Mobile Web apps and sites circa November 2008? The ReadWriteWeb authors listed their faves, plus we polled our friends in Twitter (subscribe to our Twitter account @rww).

Firefox China Edition: Everything a Local Browser Should Be

Did you know that the way you surf the internet may be influenced by your culture? In the U.S. and Europe, web surfers are leaning forward, one hand on the mouse and the other on the keyboard, typing and mousing equally. In China, however, the process is much different. Web surfers there tend to lean back from the monitor while keeping one hand on the mouse, the other hand dangling. The keyboard is used much less frequently as much of the navigation is done with clicks instead.

YouTube: More to Love

As the prices of professional quality video equipment continue to drop and the number of people with high-speed internet connections continues to increase, online video sites have been scrambling to keep up with their users' desires to deliver higher quality content to their viewers.

YouTube is no different. This week, they announced the latest enhancement to the YouTube platform - a widescreen video format across the site - which they hope will provide users with "a cleaner, more powerful viewing experience."

SEE MORE WEB PRODUCTS COVERAGE IN OUR PRODUCTS CATEGORY

RWW Enterprise Channel

Is SaaS Cheaper Than Licensed Software?

Most people quickly answer this question in the affirmative. We certainly do. However, there are people out there who aren't sure. They look at the monthly cost of a SaaS application and compare it to the equivalent licensed product over an extended period of time. Given enough time, you will eventually hit a point when the SaaS product appears to be more expensive. In this post we looked at it from the perspective of the total cost of ownership (TCO).

Email us if you're interested in writing for ReadWriteWeb's Enterprise Channel.

SEE MORE ENTERPRISE COVERAGE IN OUR ENTERPRISE CHANNEL

That's a wrap for another week! Enjoy your weekend everyone.

There are privacy agreements to check as part of the sign-up process, and also the site has a straight forward but comprehensive privacy and security section that promises not to allow "any third party access to your personal health information."

When it comes to getting a lab test done via MyMedLab, there is a fairly long list of lab tests that you can request through the site - although some of them aren't available online and require you to call a phone number (e.g. DNA tests). MyMedLab has partnered with reference laboratories in the U.S. and their services are available at nearly 2000 Patient Service Centers (PSC). Users are given a secure area of the site for their "Personal Health Record (PHR)", essentially their account history at MyMedLab.

Pros and Cons

A recent Wall St Journal article outlined some of the potential concerns about MyMedLab. While not needing a doctor's prescription will save consumers time and money, it's important to note that MyMedLab tests won't necessarily be covered by a consumer's health insurance. Also the money savings of not seeing a doctor may be offset by the cost of using MyMedLab - WSJ reported that a blood test on MyMedLab.com costs $45.

Also WSJ raised concerns about the ability of consumers to interpret their lab test results. MyMedLab says that results are interpreted by one of the company's doctors and put in the user's PHR. While MyMedLab encourages its users to share their test results with their own doctors, it isn't a requirement. David Clymer, CEO of MyMedLab, commented on ReadWriteWeb earlier this week that "once you know your numbers you can begin to make informed decisions, formulate a plan, and track your progress over time." Ultimately, as John Sharp of the eHealth blog wryly noted, this argument against MyMedLab and similar consumer-focused health services may be "one of the last hold outs of paternalistic medicine". We at ReadWriteWeb like the fact that MyMedLab is consumer-centered, although I personally would want to run my lab tests by my doctor or specialist.

Favorite Health 2.0 Apps of the RWW Live Panelists

Here were the choices of each of the RWW Live guests this week, along with Sean the host. Let us know your own favorite in the comments, and we will take a note to explore some of them in upcoming posts.

• Sramana Mitra: Maria Health (currently in stealth mode)
• Steven Krein, OrganizedWisdom: 23andMe (online genetics)
• Abe Lederman, Deep Web Technologies: PatientsLikeMe (patient community)
• Robert Shelton, Private Access: Sermo (physicians collaboration site)
• Malcolm Costello, Kryptiq: no one choice, but likes "sites that encourage sites to take personal responsibility for their healthcare"
• Scott Shreeve, MD: ChangeHealthcare (will become "the Mint.com of healthcare")
• Sean: Yelp (not health 2.0 per se, but it helped him find a yoga studio while traveling)

You can tune into the show, and interact with us via the chat, by clicking here. You can also use the Calliflower Facebook app to tune in and participate.

• Scott Shreeve, MD, from Crossover Healthcare. Dr. Shreeve is a board certified Emergency Medicine physician and was a co-founder of Medsphere Systems Corporation, the first open source electronic health record for the healthcare enterprise.
• Abe Lederman, President and CEO of Deep Web Technologies. He has helped design several major search engines in health notably science.gov and worldwidescience.org and the new search engine Mednar.
• Robert Shelton, Co-Founder, Chairman & CEO of Private Access, a suite of web-based applications that "solve the significant privacy hurdle that the medical community faces when attempting to recruit subjects for clinical trials and share confidential records in pursuit of faster diagnoses and better treatments for diseases and chronic illnesses."
• Sramana Mitra, author of the book Entrepreneur Journeys, who in her Forbes column has been calling for Internet entrepreneurs to tackle the health care industry.
• Malcolm Costello, SVP Marketing and Strategic Relations at Kryptiq, a provider of connectivity solutions for healthcare - for information sharing among healthcare professionals, their colleagues, and patients.
• Steven Krein, CEO and CO-founder of OrganizedWisdom, a human-powered, doctor-guided search service for health.

RWW Live is hosted as always by Sean Ammirati, with Marshall Kirkpatrick and Richard MacManus from ReadWriteWeb on the call.

Before the show starts, we're interested in what questions you have for the panelists. Please leave a comment on this post and one of the RWW crew on the call (Sean, Marshall and Richard) will do our best to ask your question.

We will post the audio from the show at the end, but we hope you join us LIVE on Calliflower or Facebook.

UPDATE: the show is now finished, here is the audio:

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As it's now a year later, I thought it'd be good to review health 2.0 - as I did with Semantic Apps last week. What has changed in web-based health services over the past year? And indeed what web tools do I use to help me manage diabetes?

Consumer Web Apps

Probably the biggest change over the past year in health 2.0 has been the number - and quality - of health web apps that have become available.

Currently I use a couple of iPhone apps on a daily basis to help me manage diabetes: Diametic, for inputting glucose readings and insulin shots, and Weight Tracker to track my daily weight.

Connecting to Health Professionals

What we're all really wanting in healthcare web apps is the ability to connect with health systems and manage our health online. We're certainly not there yet - for example there's no way for me (in New Zealand) to connect online to my doctor or diabetes specialist, or to blood testing labs and chemists.

But there is progress being made, particularly in the US. In March at the Health 2.0 Conference, Bill Allman from HealthCentral.com noted some services that help consumers find, evaluate, and make an appointment with a doctor or health provider - e.g. Healthcare.com, Xoova.com, Healthgrades.com, Vitals.com, and Carol.com. All of those services offer variations on the theme of enabling users to research local health resources, get reviews of them, and even book an appointment online.

Then there are apps such as MyMedLab - which enables consumers to order and pay for many routine lab tests online, then go to their local lab to get their blood drawn and have their results sent to them electronically.

There are also solutions for connecting consumers with professionals. For example Kryptiq is a provider of connectivity solutions for healthcare, for information sharing among healthcare professionals, their colleagues, and patients.

So connecting to healthcare professionals is happening, slowly but surely. How about medical diagnosis via the Internet then? Still a long way off, but companies such as IBM are experimenting in this arena.

Medical Records

There is a lot of competition now in the area of online health records. Google Health and Microsoft's Healthvault are essentially doing the same thing - both are platforms, neither tries to be a healthcare provider or conduit between healthcare professionals and patients, and both have search as their business model.

In August we profiled one of the startups going for the professional market - Practice Fusion is aimed at professionals (doctors), calling itself a 'Google Apps For Doctors'. miVitals is another startup which we've profiled that is trying to find a niche as an online records service.

We've also seen the rise of so-called "wellness management" services - Daily Strength and Aliveworld are two examples.

Portals

Meanwhile in the health portal space, Everyday Health (which merged with Revolution Health in October) has been the big mover this past year. A couple of weeks ago, Medical Marketing and Media reported that Waterfront Media's Everyday Health had surpassed WebMD to lead the online consumer health space. According to comScore's Media Metrix data, released in mid-November, Everyday Health had 25.7 million unique visitors in October, compared with 19.6 million for WebMD.

Other leaders in the space according to comScore are: AOL Health (10.4 million); About.com Health (9.1 million); MSN Health (8.8 million); Yahoo! Health (8.6 million); NIH.gov (8.1 million); Walgreen Co. (6.4 million); and UnitedHealth Group (5.1 million).

Search and Information

If I may return to diabetes: there is still a great deal that isn't understood about Type 1 diabetes, for example there is no cure (although there are a number of experimental treatments) and the medical community still doesn't know the exact cause of it. Fortunately, the Web is a great place to search for and explore information about diabetes - or any other health condition. Of course you must be careful about which sources you trust, but that almost goes without saying on the Web.

Some of the best information websites and search engines for health:

• Patients Like Me: this one is getting a lot of interest in the industry; it allows you to drill down and see people with your condition, on your drugs and see what did or did not work for them.
• DoublecheckMD: uses natural language recognition to allow consumers to search medical texts and match symptoms with the drugs they’re on.
• Vitals.com: a one-stop shop for information about physicians; uses reported empirical data, patient reviews, and an algorithm extracted from physician reviews.
• Organized Wisdom: "the Wikipedia of healthcare".
• American Well: a "virtual visit" service, profiled recently in The New York Times.
• Kosmix: a kind of search-portal for many different verticals - one of which is diabetes.
• Healia: a health search engine that gives you filtering options.
• Healthline: a health information portal.
• CognitionSearch: semantic web health search.

There are many others, too many to list in one post!

Community

There are a number 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 are somewhere in between, like MedHelp. Two of the ones that have caught my eye in the past year are Sermo - a social network for physicians - and Carol.com, which is creating a market for consumers with health plans to buy discreet bundles of medical services.

With the number of U.S. adults who are Health 2.0 consumers now said to be over 60 million, there is obviously a big market for social networks. I have been a member of a great diabetes social network, Tu Diabetes, since last November. I haven't logged in as much as I should've, but when I have it's been a source of inspiration and support. In last year's post I mentioned a bunch of Facebook groups - but I must admit that I haven't used any of them.

Blogs

Of course, there are lots of niche bloggers covering all kinds of health issues. For diabetes, a few of my favorites are Amy Tenderich's DiabetesMine, Lemonade Life, Ask Manny Hernandez (the founder of Tu Diabetes), and SixUntilMe. Do also check out some of the more general health 2.0 blogs - Indu Subaiya and Matthew Holt's The Health 2.0 Blog and Bertalan Meskó's ScienceRoll are two of my all-time favorite blogs.

If you want a much wider selection of health 2.0 blogs to subscribe to, you simply can't go past RNCentral.com's excellent list of Top 50 Health 2.0 Blogs. Or if you want a search engine based around those blogs and more, then our own Marshall Kirkpatrick has created one of his famous 'magic searches' for health 2.0: Top Health 2.0 and Medicine Blogs.

My Own Health 2.0 Usage

To be honest, I don't think I've used the Web as much as I could've in managing my diabetes. Partly that's because many of the most innovative apps are not available to people who live outside the US - e.g. I wouldn't get much benefit from using Google Health, as it only connects to healthcare systems in the US (and only parts of the US, at that).

Also, it took me a few months to adjust to having diabetes and by that stage I was set in certain offline habits - such as entering my glucose readings into the paper notebook I was supplied with by my diabetes nurse. It was only when my paper notebook ran out that I was prompted to use a web app instead!

There is a more psychological reason too: over the past year I've felt that I was spending enough time offline doing diabetes management (injecting myself with insulin twice a day, exercising, eating good foods, etc). So I think that, subconsciously perhaps, I resisted spending online time on diabetes management too. I wanted to just get on with my job and life, without letting diabetes get in the way of what I did before I got it.

However, those are excuses. I recently started to use the Web to monitor my diabetes (the iPhone apps mentioned above). And I hope I can make better use of Tu Diabetes and other online health management apps more over the next year. Perhaps that will be a New Years resolution!

What Are Your Favorite Health 2.0 Sites?

As always in posts like these, I have only listed a tiny fraction of the websites, blogs, social networks and web apps that are available in the health 2.0 field. I invite you to list those that are missing in the comments below. And don't forget to tune into RWW Live later today, on the topic of 'health 2.0'. It starts at 3.30pm PST Monday (6.30pm EST).

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.

"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?

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

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