Health 2.0

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"Health 2.0" is a term introduced in the mid-2000s, as the subset of health care technologies mirroring the wider Web 2.0 movement. It has been defined variously as including social media, user-generated content, and cloud-based and mobile technologies. Some Health 2.0 proponents see these technologies as empowering patients to have greater control over their own health care and diminishing medical paternalism. Critics of the technologies have expressed concerns about possible misinformation and violations of patient privacy.

Health care Prevention of disease and promotion of wellbeing

Health care, health-care, or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Web 2.0 World Wide Web sites that use technology beyond the static pages of earlier Web sites

Web 2.0 refers to websites that emphasizes user-generated content, ease of use, participatory culture and interoperability for end users.

Medical paternalism is a set of attitudes and practices in medicine in which a physician determines that a patient's wishes or choices should not be honored. These practices were current through the early to mid 20th century, and were characterised by a paternalistic attitude, surrogate decision-making and a lack of respect for patient autonomy. It is almost exclusively undertaken with the intention of benefiting the patient, although this is not always the case. In the past, paternalism was considered an absolute medical necessity, as there was little to no public understanding of medical procedures and practices. However, in recent years, paternalism has become limited and blind faith in doctors' decisions has come to be frowned upon.



Health 2.0 built on the possibilities for changing health care, which started with the introduction of eHealth in the mid-1990s following the emergence of the World Wide Web. In the mid-2000s, following the widespread adoption both of the Internet and of easy to use tools for communication, social networking, and self-publishing, there was spate of media attention to and increasing interest from patients, clinicians, and medical librarians in using these tools for health care and medical purposes. [1] [2]

eHealth is a relatively recent healthcare practice supported by electronic processes and communication, dating back to at least 1999. Usage of the term varies. A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health.

World Wide Web System of interlinked hypertext documents accessed over the Internet

The World Wide Web (WWW), commonly known as the Web, is an information system where documents and other web resources are identified by Uniform Resource Locators, which may be interlinked by hypertext, and are accessible over the Internet. The resources of the WWW may be accessed by users by a software application called a web browser.

Social network Theoretical concept in sociology

A social network is a social structure made up of a set of social actors, sets of dyadic ties, and other social interactions between actors. The social network perspective provides a set of methods for analyzing the structure of whole social entities as well as a variety of theories explaining the patterns observed in these structures. The study of these structures uses social network analysis to identify local and global patterns, locate influential entities, and examine network dynamics.

Early examples of Health 2.0 were the use of a specific set of Web tools (blogs, email list-servs, online communities, podcasts, search, tagging, Twitter, videos, wikis, and more) by actors in health care including doctors, patients, and scientists, using principles of open source and user-generated content, and the power of networks and social networks in order to personalize health care, to collaborate, and to promote health education. [3] Possible explanations why health care has generated its own "2.0" term are the availability and proliferation of Health 2.0 applications across health care in general, and the potential for improving public health in particular. [4]

Podcast Type of digital media

A podcast is an episodic series of digital audio or video files which a user can download to listen. Alternatively, the word "podcast" may refer to the individual component of such a series or to an individual media file.

Twitter Global micro-blogging Internet service

Twitter is an American online microblogging and social networking service on which users post and interact with messages known as "tweets". Tweets were originally restricted to 140 characters, but on November 7, 2017, this limit was doubled to 280 for all languages except Chinese, Japanese, and Korean. Registered users can post, like, and retweet tweets, but unregistered users can only read them. Users access Twitter through its website interface, through Short Message Service (SMS) or its mobile-device application software ("app"). Twitter, Inc. is based in San Francisco, California, and has more than 25 offices around the world.

The open-source model is a decentralized software development model that encourages open collaboration. A main principle of open-source software development is peer production, with products such as source code, blueprints, and documentation freely available to the public. The open-source movement in software began as a response to the limitations of proprietary code. The model is used for projects such as in open-source appropriate technology, and open-source drug discovery.

Current use

While the "2.0" moniker was originally associated with concepts like collaboration, openness, participation, and social networking, [5] in recent years the term "Health 2.0" has evolved to mean the role of Saas and cloud-based technologies, and their associated applications on multiple devices. Health 2.0 describes the integration of these into much of general clinical and administrative workflow in health care. As of 2014, approximately 3,000 companies were offering products and services matching this definition, with venture capital funding in the sector exceeding $2.3 billion in 2013. [6]

Software as a service is a software licensing and delivery model in which software is licensed on a subscription basis and is centrally hosted. It is sometimes referred to as "on-demand software", and was formerly referred to as "software plus services" by Microsoft. SaaS is typically accessed by users using a thin client, e.g. via a web browser. SaaS has become a common delivery model for many business applications, including office software, messaging software, payroll processing software, DBMS software, management software, CAD software, development software, gamification, virtualization, accounting, collaboration, customer relationship management (CRM), Management Information Systems (MIS), enterprise resource planning (ERP), invoicing, human resource management (HRM), talent acquisition, learning management systems, content management (CM), Geographic Information Systems (GIS), and service desk management. SaaS has been incorporated into the strategy of nearly all leading enterprise software companies.

Cloud computing form of Internet-based computing that provides shared computer processing resources and data to computers and other devices on demand

Cloud computing is the on-demand availability of computer system resources, especially data storage and computing power, without direct active management by the user. The term is generally used to describe data centers available to many users over the Internet. Large clouds, predominant today, often have functions distributed over multiple locations from central servers. If the connection to the user is relatively close, it may be designated an edge server.

Venture capital start-up investment

Venture capital (VC) is a type of private equity, a form of financing that is provided by firms or funds to small, early-stage, emerging firms that are deemed to have high growth potential, or which have demonstrated high growth. Venture capital firms or funds invest in these early-stage companies in exchange for equity, or an ownership stake, in the companies they invest in. Venture capitalists take on the risk of financing risky start-ups in the hopes that some of the firms they support will become successful. Because startups face high uncertainty, VC investments do have high rates of failure. The start-ups are usually based on an innovative technology or business model and they are usually from the high technology industries, such as information technology (IT), clean technology or biotechnology.


The "traditional" definition of "Health 2.0" focused on technology as an enabler for care collaboration: "The use of social software t-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health." [7]

In 2011, Indu Subaiya redefined Health 2.0 [8] as the use in health care of new cloud, Saas, mobile, and device technologies that are:

Indu Subaiya is an American entrepreneur and consultant in healthcare and technology. She is the Co-Founder, Co-Chairman, and CEO of Health 2.0, a company that promotes, showcases, and catalyzes new technologies.

  1. Adaptable technologies which easily allow other tools and applications to link and integrate with them, primarily through use of accessible APIs
  2. Focused on the user experience, bringing in the principles of user-centered design
  3. Data driven, in that they both create data and present data to the user in order to help improve decision making

This wider definition allows recognition of what is or what isn't a Health 2.0 technology. Typically, enterprise-based, customized client-server systems are not, while more open, cloud based systems fit the definition. However, this line was blurring by 2011-2 as more enterprise vendors started to introduce cloud-based systems and native applications for new devices like smartphones and tablets.

In addition, Health 2.0 has several competing terms, each with its own followers—if not exact definitions—including Connected Health, Digital Health, Medicine 2.0, and mHealth. All of these support a goal of wider change to the health care system, using technology-enabled system reform—usually changing the relationship between patient and professional.:

  1. Personalized search that looks into the long tail but cares about the user experience
  2. Communities that capture the accumulated knowledge of patients, caregivers, and clinicians, and explains it to the world
  3. Intelligent tools for content delivery—and transactions
  4. Better integration of data with content

Wider health system definitions

In the late 2000s, several commentators used Health 2.0 as a moniker for a wider concept of system reform, seeking a participatory process between patient and clinician: "New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care". [9]

Health 2.0 defines the combination of health data and health information with (patient) experience, through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway. [10]

Health 2.0 is participatory healthcare. Enabled by information, software, and communities that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself. [11]

Definitions of Medicine 2.0 appear to be very similar but typically include more scientific and research aspects—Medicine 2.0: "Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups. [12] [13] Published in JMIR Tom Van de Belt, Lucien Engelen et al. systematic review found 46 (!) unique definitions of health 2.0 [14]


A model of Health 2.0 Swan Health 2.0 model.jpg
A model of Health 2.0

Health 2.0 refers to the use of a diverse set of technologies including Connected Health, electronic medical records, mHealth, telemedicine, and the use of the Internet by patients themselves such as through blogs, Internet forums, online communities, patient to physician communication systems, and other more advanced systems. [15] [16] A key concept is that patients themselves should have greater insight and control into information generated about them. Additionally Health 2.0 relies on the use of modern cloud and mobile-based technologies.

Much of the potential for change from Health 2.0 is facilitated by combining technology driven trends such as Personal Health Records with social networking —"[which] may lead to a powerful new generation of health applications, where people share parts of their electronic health records with other consumers and 'crowdsource' the collective wisdom of other patients and professionals." [5] Traditional models of medicine had patient records (held on paper or a proprietary computer system) that could only be accessed by a physician or other medical professional. Physicians acted as gatekeepers to this information, telling patients test results when and if they deemed it necessary. Such a model operates relatively well in situations such as acute care, where information about specific blood results would be of little use to a lay person, or in general practice where results were generally benign. However, in the case of complex chronic diseases, psychiatric disorders, or diseases of unknown etiology patients were at risk of being left without well-coordinated care because data about them was stored in a variety of disparate places and in some cases might contain the opinions of healthcare professionals which were not to be shared with the patient. Increasingly, medical ethics deems such actions to be medical paternalism, and they are discouraged in modern medicine. [17] [18]

A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2.0 setting: a patient goes to see their primary care physician with a presenting complaint, having first ensured their own medical record was up to date via the Internet. The treating physician might make a diagnosis or send for tests, the results of which could be transmitted directly to the patient's electronic medical record. If a second appointment is needed, the patient will have had time to research what the results might mean for them, what diagnoses may be likely, and may have communicated with other patients who have had a similar set of results in the past. On a second visit a referral might be made to a specialist. The patient might have the opportunity to search for the views of other patients on the best specialist to go to, and in combination with their primary care physician decides who to see. The specialist gives a diagnosis along with a prognosis and potential options for treatment. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a joint decision with their healthcare provider. They can also choose to submit more data about themselves, such as through a personalized genomics service to identify any risk factors that might improve or worsen their prognosis. As treatment commences, the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them, and they can stay up to date on research opportunities and clinical trials for their condition. They also have the social support of communicating with other patients diagnosed with the same condition throughout the world.

Level of use of Web 2.0 in health care

Partly due to weak definitions, the novelty of the endeavor and its nature as an entrepreneurial (rather than academic) movement, little empirical evidence exists to explain how much Web 2.0 is being used in general. While it has been estimated that nearly one-third of the 100 million Americans who have looked for health information online say that they or people they know have been significantly helped by what they found, [19] this study considers only the broader use of the Internet for health management.

A study examining physician practices has suggested that a segment of 245,000 physicians in the U.S are using Web 2.0 for their practice, indicating that use is beyond the stage of the early adopter with regard to physicians and Web 2.0. [20]

Types of Web 2.0 technology in health care

Web 2.0 is commonly associated with technologies such as podcasts, RSS feeds, social bookmarking, weblogs (health blogs), wikis, and other forms of many-to-many publishing; social software; and web application programming interfaces (APIs). [21]

The following are examples of uses that have been documented in academic literature.

PurposeDescriptionCase example in academic literatureUsers
Staying informedUsed to stay informed of latest developments in a particular fieldPodcasts, RSS, and search tools [2] All (medical professionals and public)
Medical educationUse for professional development for doctors, and public health promotion for by public health professionals and the general publicHow podcasts can be used on the move to increase total available educational time [22] or the many applications of these tools to public health [23] All (medical professionals and public)
Collaboration and practiceWeb 2.0 tools use in daily practice for medical professionals to find information and make decisionsGoogle searches revealed the correct diagnosis in 15 out of 26 cases (58%, 95% confidence interval 38% to 77%) in a 2005 study [24] Doctors, nurses
Managing a particular diseasePatients who use search tools to find out information about a particular conditionShown that patients have different patterns of usage depending on if they are newly diagnosed or managing a severe long-term illness. Long-term patients are more likely to connect to a community in Health 2.0 [25] Public
Sharing data for researchCompleting patient-reported outcomes and aggregating the data for personal and scientific researchDisease specific communities for patients with rare conditions aggregate data on treatments, symptoms, and outcomes to improve their decision making ability and carry out scientific research such as observational trials [26] All (medical professionals and public)

Criticism of the use of Web 2.0 in health care

Hughes et al. (2009) argue there are four major tensions represented in the literature on Health/Medicine 2.0. These concern: [3]

  1. the lack of clear definitions
  2. issues around the loss of control over information that doctors perceive
  3. safety and the dangers of inaccurate information
  4. issues of ownership and privacy

Several criticisms have been raised about the use of Web 2.0 in health care. Firstly, Google has limitations as a diagnostic tool for Medical Doctors (MDs), as it may be effective only for conditions with unique symptoms and signs that can easily be used as search term. [24] Studies of its accuracy have returned varying results, and this remains in dispute. [27] Secondly, long-held concerns exist about the effects of patients obtaining information online, such as the idea that patients may delay seeking medical advice [28] or accidentally reveal private medical data. [29] [30] Finally, concerns exist about the quality of user-generated content leading to misinformation, [31] [32] such as perpetuating the discredited claim that the MMR vaccine may cause autism. [33] In contrast, a 2004 study of a British epilepsy online support group suggested that only 6% of information was factually wrong. [34] In a 2007 Pew Research Center survey of Americans, only 3% reported that online advice had caused them serious harm, while nearly one-third reported that they or their acquaintances had been helped by online health advice. [34]

See also

Related Research Articles

Health On the Net Foundation

Health On the Net Foundation (HON) is a Geneva, Switzerland-based not-for-profit organization which promotes a code of conduct for websites providing health information and offers certificates to those in compliance.

Electronic health record a program used to document a patients medical history on a computer

An electronic health record (EHR) is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.

Medical education education related to the practice of being a medical practitioner

Medical education is education related to the practice of being a medical practitioner; either the initial training to become a physician, or additional training thereafter.

Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.

Infomed is the Cuban health portal and the network of people and institutions that share the purpose of facilitating the access to the health information in Cuba.

An e-patient is a health consumer who participates fully in his/her medical care, primarily by gathering information about medical conditions that impact them and their families, using the Internet and other digital tools. The term encompasses those who seek guidance for their own ailments and the friends and family members who go online on their behalf. E-patients report two effects of their health research: "better health information and services, and different, but not always better, relationships with their doctors."

Gunther Eysenbach Canadian medical researcher

Gunther Eysenbach is a researcher on healthcare, especially health policy, eHealth, and consumer health informatics.

The Journal of Medical Internet Research is a peer-reviewed open-access medical journal established in 1999 covering eHealth and "healthcare in the Internet age". The editor-in-chief is Gunther Eysenbach. The publisher is JMIR Publications.

mHealth mobile health application

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and PDAs, and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care as well as training and collaboration of health workers.

Patient participation is a trend that arose in answer to perceived physician paternalism. However, only rarely can unchecked physician paternalism be justified, and unlimited patient autonomy would presumably be equally abhorrent.

Health 3.0 is a health-related extension of the concept of Web 3.0 whereby the users' interface with the data and information available on the web is personalized to optimize their experience. This is based on the concept of the Semantic Web, wherein websites' data is accessible for sorting in order to tailor the presentation of information based on user preferences. Health 3.0 will use such data access to enable individuals to better retrieve and contribute to personalized health-related information within networked electronic health records, and social networking resources.

The online encyclopedia Wikipedia has, since the late 2000s, served as a popular source for health information for both laypersons and, in many cases, health care practitioners. Health-related articles on Wikipedia are popularly accessed as results from search engines, which frequently deliver links to Wikipedia articles. Independent assessments have been made of the number and demographics of people who seek health information on Wikipedia, the scope of health information on Wikipedia, and the quality of the information on Wikipedia.

Digital health is the convergence of digital technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicines more personalized and precise. The discipline involves the use of information and communication technologies to help address the health problems and challenges faced by people under treatment. These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, wearable devices, and clinic or remote monitoring sensors. Generally, digital health is concerned about the development of interconnected health systems to improve the use of computational technologies, smart devices, computational analysis techniques, and communication media to aid healthcare professionals and their clients manage illnesses and health risks, as well as promote health and wellbeing.

Health information on the Internet any use of Internet to publish or share health information

Health information on the Internet refers to all communication related to health done on the Internet.

Infodemiology is a term coined by Canadian researcher Gunther Eysenbach. Eysenbach defines "infodemiology" as a "new research discipline and methodology [which deals with] the study of the determinants and distribution of health information [on the Internet]", with the ultimate goal to improve public health

Health Web Science (HWS) is a sub-discipline of Web Science that examines the interplay between health sciences, health and well-being, and the Web. It assumes that each domain influences the others. HWS thus complements and overlaps with Medicine 2.0. Research has uncovered emergent properties that arise as individuals interact with each other, with healthcare providers and with the Web itself.

Within the field of digital health, digital medicine is a category of pharmaceuticals which combines a prescription medication with an ingestible sensor component. Digital medicines are designed to communicate to mobile and/or web-based applications that a patient has taken a specific dose of medication at a certain time. Because of the ingestible sensor component and association with prescription pharmaceuticals, products in this category require regulatory oversight and clinical validation.

Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and behavioral information pertinent to health and wellness. A plurality of health data are collected and used when individuals interact with health care systems. This data, collected by health care providers, typically includes a record of services received, conditions of those services, and clinical outcomes or information concerning those services. Historically, most health data have been sourced from this framework. The advent of eHealth and advances in health information technology, however, have expanded the collection and use of health data—but have also engendered new security, privacy, and ethical concerns. The increasing collection and use of health data by patients is a major component of digital health.


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