Wednesday, February 07, 2007

Healthcare Blogging and Web 2.0

Today and tomorrow I am attending the American Health Lawyer Association's Hospitals and Health Systems Law Institute in Las Vegas where I am speaking on Healthcare Blogging and Web 2.0. The session is designed to introduce health lawyers to the world of health care bloggers, RSS, web 2.0, health 2.0 and the impact on the health care industry.

While planning my presentation I decided to post the outline of my materials so the attendees and others could access the information after the conference. By posting the information it will allow a wider audience to read, provide feedback and comment on the materials.

Healthcare Blogging and Web 2.0: Understanding the Basics and Explore the Impact on the Healthcare Industry

Note: The handout for this session contains live links to online resources that are only accessible through the electronic version of the session materials. You can access these links by using the electronic copy of the materials contained on the Health Lawyers program material CD or by accessing a copy of the materials that will be posted on the Health Care Law Blog after the conference at the post link, Healthcare Blogging and Web 2.0.

· Blogging - What is it?

· A blog or "web log" is a user generated website where entries are made in journal style and displayed in a reverse chronological order. A typical blog contains text, images and links to other blogs, web pages and websites. The first blogs were started as online journals where people kept a running account of their personal lives. As the tools for blogging became more sophisticated and more people joined in on the blogging phenomenon there was creative growth in the ways and type of content that was delivered or written. Different topic areas or genre of blogs were created -- politics, technology, travel, fashion, legal and health care. News and political blogs were the first group of blogs to become popular and reach the mainstream public. Since 2001, blogs have had an increasing impact and role in breaking, shaping and spinning news stories.

· The modern blog evolved from users who went online in the 1990s to participate in digital communities. The history of blogs goes back to usenets, bulletin board systems and email listserves. The origin of blogs goes back to 1994 with Justin Hall being recognized as one of the first bloggers. The December 2004 New York Times Magazine referred to him as "the founding father of personal blogging." On December 17, 1997, Jorn Barger was credited with coining the term "weblog" to describe the process of "logging the web" as he surfed the Internet. The shorter form of "blog" was created by Peter Merholz, who broke the word weblog into the phrase "we blog" in the sidebar of his blog called Blogging gained momentum in the late 1990s with the launching of hosted blog tools that allowed for the mass creation of thousands of new blogs -- including Open Diary, LiveJournal and Blogger. This set the stage for the phenomenal growth in blogs and other social networking technology tools that has been expanding since 2001.

· Technorati defines a blog as a regularly updated journal published on the web. Some blogs are written to reach a small audience and others vie for readership equal with national newspapers. Blogs are powerful because they allow millions of people to easily (and quickly) publish and share content and ideas, and allow millions more to read, respond and interact with the content. They allow writer and reader to have an open interactive conversation by sharing comments and links.

· Blogs are really just an extension of websites but allow individuals (especially non-technical persons) to manually update the content rather than requiring a webmaster who knows HTML. Blogs can be hosted on their own dedicated hosting server or can be run using remote blog software such as WordPress, Blogger, Typepad, Windows Live Spaces, LiveJournal, Vox and others. The Online Journalism Review has a good blog software comparison chart of some of the more popular blogging software.

· Blog technology capitalizes on and is suited for the desire and need of individuals to share information on narrowly focused topic areas or areas of interest. People like and need to collaborate. The success of the AHLA listserves is a perfect example of the need for and benefits from a digital community focused on specialty areas. It allows me, an attorney practicing in Charleston, West Virginia, to share experiences, seek guidance and information and collaborate with other health lawyers from around the country. My participation in the AHLA listserves and in the health and law blogging community has developed into what I refer to as my "virtual law firm." Blogs and Web 2.0 social networking initiatives are only expanding on what can be done, shared and learned in these virtual collaborative communities.

· Blogging and Web 2.0 are the vehicles allowing the transformation of the traditional concept of the World Wide Web, where a majority of the information is static or periodically updated, into what is fast becoming a living breathing Live Web. As evidence of the "live-ness" of the web, Technorati indicates that bloggers update their blogs regularly to the tune of 1.6 million posts per day or over 18 updates a second. Below are additional statistics showing the incredible growth of blogs and user created content over the last couple of years. Steve Rubel recently indicated at the first Healthcare Blogging Summit that he thinks that blog post volume has peaked. However, the full evidence is not in yet and I can’t believe that the volume of blogging won’t continue to rise based on my experience on knowing how many people are still just beginning to learn about the value of blogging. The current trends will be closely watched in 2007 to see whether or not the flattening out of blog post volume over the last quarter of 2006 is actually a trend.

· Blogging Terms: Like any hobby or specialty area blogging has developed its own specialized vocabulary -- posting, tagging, blawg, carnival, blogroll, Instalanche, link or permalink, commenting, trackback, splogs, vlog, etc.

· Technorati is recognized as one of the authorities on what is happening on the "Live Web". Currently Technorati is tracking 63.2 million blogs (January 6, 2007). Technorati founder Dave Sifry often looks at the state of the blogosphere on the Technorati Blog and Sifry's Alerts. In Sifry's October 2006 State of the Blogosphere, Technorati was tracking 57 million blogs. The post indicates that 100,000 blogs are created every day, and the blogosphere (total blogs tracked) has been doubling every 5-7 months. The post also compares blogs to mainstream media and charts the global breakdown of language of blogs (English 39%, Japanese 33%, Chinese 10%). For more information see State of the Blogosphere April 2006 which contains links for a historical perspective on blogs.

· Additional Statistics and Examples:

· In 2004, the Pew Internet & American Life Project found that 44% Internet users were creating content for the online world. The November 2005 Pew Internet Report, "Teen Content Creators and Consumers," found that 57% of teens now create content for the Internet. The trends indicate that the younger generations will want to create and control content, including health information, which will influence all of us. I speculate that this group will demand from the health care industry the ability to create, manipulate and easily access their own health information online.

· One statistic that blogged about earlier this year (courtesy of Denise Howell) was that "Among 21 year olds, 61% of web content was created by someone they know." This statistic shows that the public is not only creating content but using and relying on content by those who they personally know. Along these same lines, Steve Rubel of Edelman who spoke at the Healthcare Blogging Summit commented that research has shown that 68% of the public agreed that the people we trust are "a person like me." Indicating that people tend to trust those "like themselves" more than larger organizations. The statistics are not really surprising and the results mirror what is mostly human nature. If we need help with a critical issue or problem -- we seek the help of a person like us who we know.

· Riding the Waves of Web 2.0, another Pew Internet Project article, highlights the online activities that demonstrate Web 2.0 characteristics. One example discussed in detail is the growing use and traffic to Wikipedia, the online encyclopedia whose content is shaped by the wisdom and, at times, the stupidity, of its users and has an amazing growth rate as compared to the downward growth of its corporate cousin, Encarta. Think for a minute – when was the last time you used the electronic encyclopedia that resides on your hard drive as part of the software bundle that came with your computers? My suspicion – not much, if at all. Your response is probably similar to the amount you pull off the shelf a hard bound volume of Encyclopedia Britannica.

· Blogs: A Guide to Health Care Bloggers

· Following are some representative health care related blogs. While this is not an exhaustive list of health care blogs, it serves to demonstrate the breadth and scope of the types of health care blogs that are available online. Most bloggers include on their blog a “blogroll” that lists other bloggers that they find interesting or regularly follow. An excellent way to explore other blogs of interest is by accessing the links of the other blogs referenced in the blogroll.

· Searching for blog posts can be done though dedicated search engines that are designed to track and search blog related materials. Most known in this area is Technorati, which is dedicated to indexing, organizing and making blogs and other user generated content available through search. Google has also developed its own blog search, Google Blog Search. Google Blog Search contains content published through Blogger, Google's blog publishing technology, and other blogs that publish a site feed (either RSS or Atom).

· Health Law Blogs

o Garlo Ward, P.C. Blog - Focused on legal issues for long term care, retirement, home health care, assisted living providers, physicians and other health care providers.

o HIPAA Blog - A discussion of medical privacy buried in political arcana.

o Holland and Hart's Health Care Law Blog - Focused on health care issues affecting the Rocky Mountain West and the states in which we practice which include Montanan, Idaho, Wyoming, Utah, Colorado and New Mexico.

o HealthBlawg - David Harlow's health care law blog.

o Physician Law - Current news, updated and useful tips relating to legal issues affecting physicians and non-institutional providers in their personal and professional lives.

o Health Care Law Blog - Thoughts and comments on the health care industry, privacy, security, technology and other odds and ends.

o Tennessee Med Mal Blog – A firm sponsored blog focusing on medical malpractice.

· Hospital CEO/Administration Blogs

o Nick's Blog - Nick Jacob, President of Windber Medical Center and the Windber Research Institute, Winber, PA. Recognized as the first hospital CEO blogger. More on Nick and Windber via YouTube, including Why are Hospitals the Way They Are?

o Running a Hospital - Paul Levy, President and CEO of Beth Israel Deaconess Medical Center, Boston, MA.

o Hospital Impact - Collaborative blog on hospital related topics.

o The Candid CIO - Will Weider, CIO of Ministry Health Care and Affinity Health System.

· Physician/PA/Nurse/Med Student Blogs

o Kevin, M.D. - A practicing primary care physician tells it like it is.

o A Chance to Cut is a Chance to Cure - A perspective on medical and other issues from a general surgeon.

o GruntDoc - Ramblings of an Emergency Physician in Texas.

o Tundra Medicine Dreams - Bush medicine, dog mushing and tundra life from a physician assistant in Southwest Alaska.

o - Notes on Medicine, Science & Technology from a Nephrologist in New York City.

o Emergiblog - The Life and Times of an ER Nurse.

o The Examining Room of Dr. Charles - A young family physician's attempt to say something pithy.

o blogborygmi - Nick Genes, founder of Grand Rounds - a digest of developments in the life of an emergency medicine resident.

o Dose of Reality: Med Students' Blog - University of Michigan Medical School sponsored student blogs. The blog project allows 12 current University of Michigan medical students to share their thoughts and feelings about being in medical school. The blogs feature students from each level of the program. The project also involves audio blogs via podcasts. The online edition of the AMA's American Medical News covered this unique blog experiment in an April 2006 article, Med Schools Web Site Adds Student Blogs.

o Graham Walker's Over My Dead Body is an example of the next generation of physicians bloggers. Mr. Walker was featured in USNews in a feature on Blogging Their Way Through Academe. His recent post, Meet The GMR, An EMR That Doesn't Suck, highlighting his development of a user focused web 2.0 based EMR (or as he refers to GMR) and is an example of the bottom up approach that bloggers and Web 2.0 aficionados are taking to change institutions and traditional business methods and models.

· Other Health Care Blogs

o MSSPNexusBlog - Rita Schwab, CPCS, CPMSM - focusing on issues for medical staff service professionals.

o The Health Care IT Guy - Shahid Shah, CEO of Netspective - focusing on health care information technology issues.

o The Health Care Blog - Matthew Holt - focusing on health care policy. Blog byline: "Everything you always wanted to know about the Health Care System. But were afraid to ask."

o Healthcare Vox - Fard Johnmar - focusing on healthcare communications and marketing news.

o Health Business Blog - David E. Williams of MedPharma Partners - focusing on business issues in health care.

· Patient and Health Topic Blogs

o Patient Blogs which allow them to share their experiences with others. The blogs are sponsored by High Point Regional Health System in North Carolina.

o Diabetes Mine - A gold mine of straight talk and encouragement for people living with diabetes.

o Mighty Max Update - Mother of child with CHARGE Syndrome blogs about his diagnosis, surgeries, development and spirit to get well.

· Legal Blogs:

o Legal blogs are often referred to as "blawgs," a term coined by one of the early law bloggers, Denise Howell of Bag and Baggage. A blawg is a blog whose content is devoted in to legal topics, opinions or issues.

o Legal Blawg resources:

§ Blawg: A blawg directory and source for legal blogs and podcasts. Blawg was started in December 2002 by Bill Gratsch.

§ MyHq Blawgs: A blogroll listing an extensive list of the available law related blogs.

§ Justia's Blawg Search: A legal blog directory and search tool which also ranks the popularity of legal blogs. The site also provides good basic information for lawyers exploring the idea of starting a legal blog.

§ 3L Epiphany Taxonomy of Legal Blogs: A law blog list and law blog information organized by Ian Best a recent Ohio State law grad as a part of an independent study project on law blogs. In addition to his taxonomy of legal blogs he has compiled some interesting information about the citation of blogs in legal decisions (including the first time the U.S. Supreme Court opinion cited to a blog) and interviews with judges on the current impact blogs are having on the judiciary.

o Blog Carnivals:

§ Grand Rounds - The weekly rotating carnival of the best of the medical blogosphere.

§ Health Wonk Review - A biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog. For participants, it's a way to network and share ideas, and for those readers who don't live in this space every day, it's a way to sample some of the latest thinking and the "best of the best."

§ Pediatric Grand Rounds - A bi-weekly collection of the best posts pertaining to the health of children.

§ Radiology Grand Rounds – A carnival focused on radiology and medical imaging for physicians, patients, nurses, medical students, radiographers and imaging technicians.

§ Patient Consumer Parade (no longer active) – A carnival of patient-consumer posts.

§ Change of Shift - A place for nurses and other members of the health care team, including students and patients to send their nurse related stories and ideas.

§ Blawg Review – A weekly roundup of legal issues by law bloggers.

· Web 2.0: What is it?

· Web 2.0 is a perceived or proposed second generation of Internet based services -- such as social networking sites, wikis, folksonomies, podcasts, RSS feeds and other person to person communication tools that emphasize online collaboration and sharing among users. The 2.0 moniker hints at the idea of an improved or new version of the "World Wide Web." Web 2.0 is also a social phenomenon centered around generating and distributing content that is characterized by open communication, decentralization of authority, freedom to share and reuse and a market of conversation.

· The phrase was coined in 2004 by Tim O'Reilly of O'Reilly Media in his opening talk at the first Web 2.0 Conference. O'Reilly summarized the key principles of Web 2.0 applications as:

o the web as a platform

o data as the driving force

o network effects created by an architecture of participation

o innovation in assembly of systems and sites composed by pulling together features from distributed, independent developers (a kind of "open source" development)

o lightweight business models enabled by content and service syndication

o the end of the software adoption cycle ("the perpetual beta")

o software above the level of a single device, leveraging the power of The Long Tail.

o easy to pick up by early adopters

· Paul Graham's Web 2.0 post from November 2005 provides the historical perspective and origin of the term, Web 2.0. Graham's blog post provides a useful definition as we explore and try to understand the Web 2.0 phenomenon. Graham's suggests a two part definition of Web 2.0 -- web-based applications and democracy. He indicates that the first vision of Web 2.0 was centered around "using the web as a platform" or utilizing web-based applications. This description was used in the promotion of the first Web 2.0 conference in June 2004: "While the first wave of the Web was closely tied to the browser, the second wave extends applications across the web and enables a new generation of services and business opportunities." According to Paul Graham, the definition of Web 2.0 came to mean something else -- democracy -- by the second Web 2.0 Conference. Graham described this as the ability of amateurs to surpass professionals. He cited Wikipedia as an example. He also described the democratic power of Web 2.0 to displace traditional media outlets dictating and "deciding what counts as news." Digg (user powered news and content) and (collaborative bookmarking and tagging) are examples cited. The third point Graham makes in his definition of Web 2.0 in an attempt to distinguish it from the initial Internet bubble has to with how you and I are treated as "users." Generally, his idea focuses on not mistreating the user and allowing the user more control.

· Why is Web 2.0 possible? Ajax. No not the stuff under your sink. Ajax is shorthand for Asynchronous JavaScript or XML and is responsible for allowing the creation of interactive web applications. In simple terms -- Ajax lets web pages feel alive and responsive by exchanging small amounts of data behind the scenes so that the entire web page doesn't have to be reloaded each time the user requests new information. Ajax is what makes web-based applications look and act like desktop applications. Ajax has been the fuel allowing a paradigm shift -- desktop applications to web-based applications. Example, Microsoft Word and Excel vs. Google Docs & Spreadsheets.

· Jesse James Garrett of Adaptive Path was the first to use the term Ajax in public. For a more detailed description of how Ajax works read Garrett's, Ajax: A New Approach to Web Applications. The article describes classic web application as working like this: "Most user actions in the interface trigger an HTTP request back to a web server. The server does some processing — retrieving data, crunching numbers, talking to various legacy systems — and then returns an HTML page to the client. It’s a model adapted from the Web’s original use as a hypertext medium, but . . . what makes the Web good for hypertext doesn't necessarily make it good for software applications." The article goes on to describe the benefits of Ajax, "[a]n Ajax application eliminates the start-stop-start-stop nature of interaction on the Web by introducing an intermediary — an Ajax engine — between the user and the server. It seems like adding a layer to the application would make it less responsive, but the opposite is true. Instead of loading a web page, at the start of the session, the browser loads an Ajax engine — written in JavaScript and usually tucked away in a hidden frame. This engine is responsible for both rendering the interface the user sees and communicating with the server on the user’s behalf. The Ajax engine allows the user’s interaction with the application to happen asynchronously — independent of communication with the server. So the user is never staring at a blank browser window and an hourglass icon, waiting around for the server to do something."

· Google was one of the first companies to capitalize on and has invested heavily in Ajax development. Most of Google's products are Ajax based applications -- including, Gmail, Google Suggest and Google Maps. Google Suggest provides one of the clearest examples of Ajax. As you type in your search term the suggested terms automatically update as you type. Most new Web 2.0 applications include some Ajax based features and many traditional software and Internet companies have now moved toward implementing Ajax based applications.

· Recently, Time Magazine recognized the power of those who now create, control and collaborate with content online and the incredible influence that it is having around the world. In doing so, Time honored "you" and "me" as Time's Person of the Year. In describing Web 2.0, Time stated, "Web 2.0 harnesses the stupidity of crowds as well as its wisdom. Some of the comments on YouTube make you weep for the future of humanity . . . But what makes all this interesting. Web 2.0 is a massive social experiment, and like any experiment worth trying, it could fail. There's no road map for how an organism that's not a bacterium lives and works together on this planet in numbers in excess of 6 billion. But 2006 gave us some ideas. This is an opportunity to build a new kind of international understanding, not politician to politician, great man to great man, but citizen to citizen, person to person."

· For a perspective on Web 2.0 and what it may mean for lawyers and law practices, read Bruce McEwan's blog post, Web 2.0 In The Legal Blogosphere at Adam Smith, Esq. McEwan produces a chart showing the evolution from Web 1.0 to Web 2.0 and offers some comments on legal sites targeting micro-communities. McEwan suggests the theory that any new media/medium begins by imitating its closest analogous predecessor and then experiments and evolves. McEwan outlines that the web began imitating print and has evolved roughly as follows:

o Web 1.0

§ revolution = hyperlinks

§ static content ("brochure-ware")

§ activity = surfing

o Web 1.5

§ revolution = self-contained portals

§ dynamic content (Salon, Nerve, Slashdot)

§ activity = search

o Web 2.0

§ revolution = collaboration

§ user-generated content

§ activity = share

· RSS: What is it?

· RSS (Web Feed) is a term used to publish frequently updated digital content, such as blogs, news feeds, podcasts or videocasts. RSS stands for "Really Simple Syndication". Using a program called a "feed reader" or "news aggregator" a user subscribes to an RSS feed. Programs known as feed readers or aggregators can check a select list of RSS feeds on behalf of a user and display any updated articles or information found. Many websites and most blogs now have some form of RSS of Atom capability.

· Dave Winer, the father of RSS, describes RSS with a three-word answer: automated web surfing. It allows you to spend more time reading content rather than searching for content. I've often referred to it as "push technology" where you select the information you want and have it pushed to you rather than you having to constantly go to the information using bookmarks or favorites.

· Have you ever wondered what that little orange box is? A website has RSS capabilities and can be subscribed to if it has any of the following terms or icons: RSS, Atom, XML, Subscribe, a feed icon, XML or XML. In addition, many of the news aggregators have developed their own distinct icons or subscriptions buttons to notify a user of an available RSS feed. For example, MyYahoo, Feedburner, NewsGator and MyMSN have all created their own distinct subscription buttons.

· What do I need to get started? You will need to choose a "news reader" to subscribed to RSS feeds. There are two basic types: desktop software application and online readers. I prefer the online reader because I like to be able to access my feeds from multiple locations, including my Blackberry. I currently use Bloglines as my primary reader, although I have also been experimenting with the new Google Reader. I also use MyYahoo, which now has RSS capabilities built into the custom start up page allowing you to select any RSS enabled content. News reader functionality is now being integrated into the latest version of browsers, including Internet Explorer 7 and Firefox.

· If you have not incorporated RSS technology into your online research and monitoring process, you are missing out on an amazingly powerful resource. RSS allows you to monitor (in real time) any new web related content or news article about your most important client, updates on a particular area of law, new regulatory materials, new state/federal court decisions and the list goes on. If there is one thing you take away from this session it should be how to implement RSS technology into your everyday practice.

· The ABA published a good "how to" article on RSS called, RSS Resources You Can Use: Automatic Websurfing for Lawyers. The article written by Tom Mighell and Dennis Kennedy provides an overview of RSS and practical guidance on using RSS technology. Instead of referring to RSS as "really simple syndication" they use the Oprah Way, "I'm Ready for Some Stories!" The article also links to the RSS Tutorials for Law Librarians, three online video/audio online tutorials that walks you through the basics of RSS, using an aggregator and advanced RSS techniques.

· Still not convinced of the value of RSS? Check out Robert Ambrogi's article What RSS Can Do For Lawyers, Steve Matthews' article Top Ten Uses for RSS in Law Firms, Tim Yang's Things You Can Do with RSS and How To Explain RSS the Oprah Way.

o Examples of legal and law related RSS feeds you can use:

§ State Legislative RSS Feeds via

§ U.S. Supreme Court RSS Feeds for "Daily Decisions" and "Recent Decisions" via Cornell's Legal Information Institute

§ U.S. Government RSS Library, including the following White House RSS feeds, Federal Court RSS feed (7th Circuit), FDA Recalls RSS Feed, Health Care and Medicare/Medicaid related RSS feeds, U.S. Copyright Office RSS Feeds and others.

§ RSS in Government, a blog providing news about how RSS is being used by international, federal, state and local government including a variety of RSS links (see right hand column of links)

§ Google search using the terms hospital and RSS provide some sample hospital RSS feeds

· Health Care Blogging and Web 2.0 Health 2.0 Trends:

· Health care blogging is still in its infancy and we will continue to see more individuals and businesses take up blogging on a variety of health care topic areas. Physicians were the early blogging adopters, writing about their experiences and sharing observations on the health care system. An April 28, 2003, article from AMA American Medical News, Welcome to the Blogosphere: A brave new world of web dialogue, provides insight into some of the early physician bloggers. This core group of health care bloggers has now grown in diversity as shown by the blogs mentioned above. Discussing health care is popular -- whether its a patient recommending advice to another patient, a physician offering preventative care tips or a health policy expert offering solutions to the national debate over health care. This popularity creates a perfect environment for blogging and Web 2.0 Health 2.0 type companies. As a result, the number and diversity of health care focused blogs will grow and entrepreneurial type ventures will be explored. Over the next couple of years health care blogging and Web 2.0 Health 2.0 will mature. It is likely we will see more coordinated efforts to utilize blogging as a media and public relations communication tool. There will be a growing number of corporate coordinated and collaborative (multi-author) blogs.

· There is a growing community of health care bloggers which was recognized by the first Healthcare Blogging Summit held on December 11, 2006, in Washington, D.C. The conference brought together a diverse group of bloggers, public relations representatives, physicians, policy expert, media consultants, health care opinion leaders and others interested in the health care blogging trends. Additional conference events are planned for 2007.

· In July 2006, an online survey of health care bloggers, "Taking The Pulse Of The Healthcare Blogosphere: A global online survey of healthcare bloggers," (free download) was conducted by Envision Solutions and The Medical Blog Network (now The results of the survey were released as a part of the Healthcare Blogging Summit in December 2006. Fard Johnmar of Envision Solutions summarized the poll results in this December 11, 2006 blog post. Following is an overview of key statistics and findings from the survey:

o Bloggers devoting at least 30% of blog posts to health care related topics were eligible to take the survey. 214 healthcare bloggers took at least a portion of the poll, which was fielded between July 31 and September 29, 2006.

o 76% percent of survey respondents are from the United States. Between 3% and 5% hail from Canada, the United Kingdom, Australia and the Netherlands. The survey population was evenly split between men (54%) and women (46%). The age distribution was older than expected -- Age category: 18-25 (9.3%); 26-29 (9.9%); 30-39 (35.5%); 40-49 (20.3%); 50-59 (22.1%) and 60 or above (2.9%).

o Nearly 40% of bloggers report that the most important reason they decided to start their blog was to "share their opinions" or "educate others." 12.4% of bloggers responded to "market myself." 8.5% of bloggers responded to "advocate for cause." 8.5% of bloggers responded to "cope with medical condition." 2.3% of bloggers responded to "employed to write."

o A combined 72% of those taking the survey said that their primary audience is either healthcare providers, the general public or patients. 6.5% said that their primary audience was "healthcare executives" and 1.2% said their primary audience was "journalists."

o In response to a question about primary topics they blog about, 60.9% of respondents write about their personal experiences. 55.7% blog about health news, 54.6% blog about health business, 51% blog about health policy, 44.8% about medical treatment, 47.1% about disease information and 23.6% about health law.

o 38.7% of those surveyed hide their identity to protect their privacy. Of this group, the reason they hid their identity: 85.5% to protect myself, 42.1% to protect patient privacy and 36.8% to enable me to freely comment about my job/employer.

o 93% of those responding have been blogging about health care less than three years. Of this group, 52% have been blogging about health care less than one year.

o 47% of those taking the survey spend between one and two hours maintaining their blogs daily. However, nearly as many (43%) devote less than one hour a day to their blog.

o The survey also included interesting statistics on trust and credibility the survey participants gave to other blogs. The results indicated that 77% of respondents have either a low or moderate level of trust in their blogging colleagues.

· The Healthcare Blogosphere survey speculates on ways that blogs have the potential to improve health care, including speeding the adoption of best practices, aiding the critique and analysis of clinical trials, fostering the exchange of information about treating new illnesses and educating patients on preventative health care issues.

· A January 10, 2007 iHealthBeat article, Consumers Read, Post Info on Health Blogs, reported that about 8.9 million U.S. adults reported reading health related blogs online. The study, conducted by Manhattan Research, also found that 9.9 million consumers regularly post health information online. The study results were based on a telephone survey of 4,000 U.S. adults conducted between September and November 2006.

· The HealthTrain: The Open Healthcare Manifesto (full Report Version 0.1) released by The Medical Blog Network (now was discussed at the Healthcare Blogging Summit and provides some interesting material on the future impact open published health media might have on the health care industry. The Manifesto presents the idea that the "new wave of open publishing technology now enables any individual, with or without professional training, to communicate with global audiences to share health related information and opinions." The Manifesto recognizes the change occurring from "traditional command and control" forms of communication. The goals of the Manifesto are to develop a shared vision of how open media can have a positive impact on health care. There is diversity/opposing views on health care issues, including health care policy, politics, finance, liability, scope of practice and moral values among others. The principal of the Manifesto is not to take sides but to focus on a shared understanding that an open exchange of information and opinion can create positive change. The principles of the Manifesto are organized around the following key concepts: openness, empowerment, conversation, empathy, trust, critical thinking, guidance, control, credentials, transparency, privacy, anonymity, scientific validity, conflict of interest, sponsorship, promotion, controversy and civility and respect.

· Examples of Health 2.0 focused companies:

o Organized Wisdom was launched in beta in August 2006. Organized Wisdom is a health focused, social networking site that enables consumers, physicians, health care professionals and health organizations to collaborate on health topics. The mission of the company is to make it easier for people everywhere to get access to better health wisdom. The company has developed what they call "WisdomWizard" application that allows people to easily share their knowledge and recommendations on any health-related experiences with diseases, conditions, medications or health procedures. The goal of the company is that the result will be human indexes of user-generated health content that will help people make better health decisions. The Health Wisdom Blog has more information about Organized Wisdom.

o Launched in September 2006, Sermo is an online community, created by physicians for physicians. It is a medium for physicians to aggregate observations from daily practice then -- rapidly and in large numbers -- challenge or corroborate each other's opinions, accelerating the discovery of emerging trends and new insights on medications, devices, and treatments. Through Sermo, physicians exchange knowledge with each other the minute it is learned, and gain insights from colleagues as they happen instead of waiting to read about them in conventional media sources. Sermo harnesses the power of collective wisdom and enables physicians to discuss new clinical findings, report unusual events, and work together to impact patient care.

o Revolution Health, launched in preview in December 2006 and scheduled for a mid January 2007 public launch. Revolution Health is the brainchild of founder, Steve Case, co-founder and former CEO of America Online. Revolution Health's website says that its objective is to give consumers more choice and control over their health care. The health portal allow the user to do a variety of things: create your own personal health portfolio, learn about health topics, rating doctors and hospitals, complete online health risk assessment surveys, join community groups on health specific topics, read and comment on health related stories, create your own health care blog and utilize (free trial) a health expense manager. The health content is divided in sections on Healthy Living and Conditions & Treatments. The content is from resources such as: The Mayo Clinic, Harvard University and The Cleveland Clinic. It allows users to rate the content they think is best and even submit your own resources from around the web. The Personal Health Portfolio feature allows you to save information about your conditions and treatments for future reference, store basic contact information for all your doctors and health care providers and automatically generate a form to take with you to your next office visit. The Tracking feature allows you to track a variety of areas: blood pressure, blood glucose, health weight/BMI, weight loss/gain, pregnancy weight gain, exercise routine, etc. There will also be a membership section which includes other services such as: personal health counselor, claims advocate and health expense manager. Revolution Health may have the best chance of success in the Health 2.0 space if it focuses on what it does well and can gain critical mass and participation by consumers. This type of consumer "revolution" will likely force change in traditional models of health care delivery and payment.

o Tony Chen at Hospital Impact provides commentary and comparison of what Revolution Health offer versus what U.S. Preventative Medicine offers. Chen provides a link to U.S. Preventative Medicine's letter to the American public announcing its efforts and reasons for focusing on preventative medicine. Based on information from U.S. Preventative Medicine's website, the company wants to create a "comprehensive prevention ecosystem" and believes "that proactive, preventive health management is a necessary and imminent revolution in medical care. Economic necessity and medical evidence are driving the transformation of health care from a legacy of treatment to a culture of prevention." The mission of the company is, "to provide consistent services and methodologies, strong brand recognition, and a turnkey business model that will make the "prevention experience" a winning proposition for health care providers and consumers." Chen indicates that U.S. Preventative Medicine may be Revolution Health's biggest competitor in the preventative medicine space. I'm in agreement with Chen's closing comment that someone is going to figure a way to monetize prevention and make billions. Maybe it will be the next company listed below . . .

o Google Health (aka Google Scrapbook). At this stage Google has not made any formal announcement of its strategic plans toward the health care industry. However, it is evident that Google is actively developing ideas in the health care space. Adam Bosworth, VP at Google, provides some insight in a November 2006 post, Health Care Information Matters, on the Google Blog. His post looks at the use of Google Co-op in the health arena along with discussing Google's ideas on the ability of patients to have easy access to their medical information. Also, Bosworth was the keynote speaker at a national conference sponsored by The Markle Foundation on December 7, 2006. His keynote address was titled, Connecting Americans to Their Health Care: Empowered Consumers, Personal Health Records and Emerging Technologies, which looked at putting patients in charge of their health information and creating a "Health URL". Bosworth envisions the Health URL as follows, "every ill person needs a “health URL,” an online meeting place where their caregivers — with express permission from the ill person — can come together, pass on notes to each other, review each other’s notes, look at the medical data, and suggest courses of action. This isn’t rocket science. It is online web applications 101." For an interesting response read, Where Google Veep Adam Bosworth is Wrong. For more details on what Google Scrapbook might include read, The Upcoming Google Scrapbook.

· The Health Care Blog does some health care forecasting for 2007, including a discussion of Health 2.0. The author, Matthew Holt, indicates that he thinks Health 2.0 is not all "hype" and that by the end of 2007 there will be a larger category of health care consumers starting to use the new web-based health care software tools. I agree with his prediction and believe that these tools will start the process of fundamentally changing the way that patient/consumers interact with insurers and providers. The key to success will depend on which companies tap into the real needs of health care consumers, successfully execute a business model to entice health care consumers who are looking for a solution to the ever growing health care problems (including health coverage and cost) in our country and ultimately gain the confidence of those patients/consumers.

· Additional Health 2.0 Resources and Creative Uses of Technology:

· Health 2.0 Wiki is a new health 2.0 focused wiki. This resource was created in late 2006 and the users and public authors will continue to add content and resources. What's a wiki? A website that allows visitors to add, remove, edit and change content. It is a very effective tool for mass collaborative authoring (example: Wikipedia). Imagine the possibilities of using this type of technology in a variety of ways in the health care and legal industry? For example, physicians or patients collaborating around conditions, treatments or drugs or health lawyers collaborating around health law topics or regulations.

· Ask Dr. Wiki is a medical wiki devoted to creating a free source of medical information allowing individual to store handouts, pearl book, teaching EKGs, X-ray Images, and Coronary Angiograms and Venograms online so they can have access to them from anywhere at anytime.

· YouTube Health Films: A GPs' surgery in mid Wales has launched a series of health education films on YouTube. Advice about flu vaccination and cervical screening are two of the topics covered by Builth and Llanwrtyd Medical Practice in Powys.

· The Clinical Cases and Images Blog in Echocardiograms and Cases on YouTube provides another example of the use of YouTube as an educational device.

· YouTube and Whistleblowers. This August 2006, Washington Post article, On YouTube, Charges of Security Flaws, highlights what might be in store for those prosecuting or defending health care whistleblower cases. The article highlights the YouTube video clip (and video updates) by a Lockheed Martin engineer who had complained to no avail to his boss, the government and his congressman about security flaws in a fleet of refurbished Coast Guard patrol boats. What about hospital whistleblowers?

· Legal Implications of Blogging:

· The Electronic Frontier Foundation's Legal Guide for Bloggers provides a good basic resource for understanding the legal implications of blogging. The guide covers intellectual property rights, defamation, freedom of speech, Section 230, privacy, bloggers rights as journalists and labor law. There are FAQ sections on each topic area. Like any new technology development we are still in a learning phase of understanding the legal impact and the court's interpretation regarding bloggers and blogging.

· Workplace issues involving the rights and restrictions on employee blogs has received the most attention from labor lawyers. Employment law blogging issues take on added complexity when dealing with health care employee bloggers due to the added privacy and confidentiality overlay. For example, we will see employment litigation involving the release of protected health information via an employee blog. Further, to date no guidance or interpretation has been issued on whether HIPAA places any specific requirements on a health care employer to limit or restrict employee blogs.

· Following are a number of corporate blogging resources and sample blogging policies that provide some insight into those employers who have chosen to allow some amount of employee blogging.

o Your Guide to Corporate Blogging provides in a June 2005 post, Policies compared: Today's corporation blogging policies, that looks at the core principles in most blogging policies by comparing eight well known blogging policies. The result is four simple rules: (1) you are personally responsible; (2) abide by existing rules; (3) keep secrets; and (4) be nice. The post also goes into some common rules (that appear in at least half of the policies examined) and also looks at unusual rules contained in some of the policies.

o A post, Sample Corporate Blogging Policies, by Kevin O'Keefe of Real Lawyers Have Blogs (citing Yourden Report) highlights links to blogging policies at some major corporations, including:

§ IBM’s Blogging Policy and Guidelines

§ Sun Microsystems’ Blogging Policy

§ Yahoo Employee Blog Guidelines

§ Groove’s Blogging Guidelines (discussion by Ray Ozzie's discussion from 2002)

o Other examples of corporate blogging policies from the NewPR Wiki and other blogs:

§ Exony Blogging Policy, James Snape, November 4, 2004

§ Corporate Blogging Policy, March 7, 2005

§ Weblogs At Harvard Law - Terms of Use

§ Blogging policies and guidelines, Niall Cook, Marketing Technology, May 19, 2005

o A podcast on corporate blogging with Denise Howell, Steve Rubel, George Lenard and Jeff Seul at IT Conversation.

o Practical advice from Random Acts of Reality written by Tom Reynolds (a London, England EMT) called How To Blog And Not Lose Your Job.

o The Thomas Nelson Publisher's Blogging Guidelines (revised) and commentary by Thomas Nelson's CEO, Michael Hyatt.

o Plaxo's Public Internet Communication Policy, and much reader commentary.

o Robert Scoble's Corporate Weblog Manifesto and Scoble's update.

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Anonymous said...

I can't believe it. A healthcare lawyer that knows what RSS is. I'm so glad that technology is finally hitting the legal and healthcare fields.

Punja said...

Another company technically advancing our understanding of Health 2.0 is Jumper ( that provides a contributory knowledge base for doctors and researchers, not just patient’s blogging on the web. Like many new open-source software platforms it does not fit our traditional view of social networking. This type of tool could dramatically improve healthcare by fundamentally changing our approach to collaboration between clinicians and researchers.

podiatry emr said...
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