Sunday, September 21, 2008

Farad Johnmar Discusses Health 2.0: Fad or Fundamental?

Fard Johnmar at HealthcareVOX nicely summarizes and explores some of the concerns I've been feeling as I've vacillated over attending the Health 2.0 Conference next month in San Francisco. I do think the fundamental concept is valuable, I'm concerned by the sound of hype inherent in the term: language does create its own reality. Nonetheless, I'm headed for San Francisco for the conference on my way to Chicago (I'm starting from Brooklyn, NY) for the annual ACEP Scientific Assembly.

I'd like to suggest that consistent with his theme, he could sharpen both his diagram of the four "clogged arteries" and his explanation of its content. First the diagram itself could benefit from the third dimension, I envision a cone the base covering the entire diagram and drawing to a point at a figure/avatar representing the user-consumer-patient-community of users.

I suggest this blanketing user-consumer-patient-community of users input not to hold this central aspect (We used to call it "patient-centered" and "family-centered" care.) outside or orthagonal to the concept embedded into the diagram, but rather to respect the underlying thoughts while refining the concept. For I see in all four of the "clogged arteries" components of purely professional endeavor and components of professional interaction with user-consumer-community of users.

Medical Decisions seems especially fraught. Perhaps that's just me, a physician-educator-executive, responding to the term in this context when my efforts over the past 30+ years in this realm are best crystallized by Jerome Groopman in How Doctors Think where the focus is really on how doctors make medical decisions. The user-consumer-patient-community of users certainly does as well, differently and at many different levels. Johnmar in conflating physician prescription practice with managing end-of-life care cost rather crosses many more boundaries than I can comfortably traverse within the core concept--at least so long as I'm devoting the attention I am to young physicians learning the practice of making medical decisions.

The implications of Molly Coye's (HealthTech) observation that hospital expenditures are shifting away from labor expenditures and towards capital, both facility and technological, seems fundamental to this transition time as well. I don't know if any hospital has asked its community if the user-consumer-patient-community of users would prefer a new MRI machine or a patient navigator program. Both is too glib an answer, which while not unrealistic today in many environments, may soon become so.

The exposure to these various constructs is provocative and mind-expanding. I'm looking forward to meeting some of the progenitors of the Health 2.0 concepts and the entrepreneurs who are seeking to bring it to fruition. There has to be a pony in there somewhere.



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