EHE Interview: Jeremy Bonfini
- 18 January 2010
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Jeremy Bonfini |
“Health 2.0 is as disruptive to healthcare as social networking is to putting letters in the post-box,” says Jeremy Bonfini. And he appears to be right.
In the UK alone, NHS Choices provides a digital advice, symptom checking and hospital comparison service to millions of users, and there is talk of external suppliers such as Google and Microsoft giving patients access to their health records online.
In the US, WebMD provides the largest patient portal to more than 20m patients looking for information every month, and President Barack Obama has promised electronic medical records for all within five years, to cut costs and improve quality.
Bonfini, the vice president of the Healthcare Information and Management Systems Society (HIMSS), says Health 2.0 is about allowing people to take greater responsibility for their health as more people live longer and with more chronic conditions.
“Given demographic waves of chronic disease, hospitals and countries have no other choice but to deploy health information technology, because the legacy infrastructure cannot sustain a tripling of elderly patients over the next 20-30 years,” he adds.
Health 2.0 will be a hot topic at this year’s eHealth Week, which will combine the World of Health IT (WoHIT) conference and exhibition with the high level ministerial e-Health Conference, and take place in Barcelona from 15-18 March.
Contributors will look at the benefits and challenges of using social networking in a healthcare environment, asking questions such as whether Web 2.0 phenomena such as Twitter and Facebook could replace physical patient-doctor relationships.
For almost six years after the term Web 2.0 was coined by textbook publisher O’Reilly, people still remain sceptical. Visible progression within the healthcare industry has only just started to gather real pace.
Ready for the revolution
Getting patients to engage in compliance and to take care of themselves is one of the biggest battles. According to Bonfini, around 90% of those with chronic diseases do not comply fully with their drug and lifestyle regimes, because people do not want to be constantly reminded of their condition.
Health 2 .0 technologies provide constant feedback, but also allow people to choose where and when to make use of the technology. However, Health 2.0 also needs GP and clinician participation for it to be successful; and healthcare is a field that’s very slow to change.
Bonfini says: “Although the idea of patients connecting to other patients is great, that is not enough. Getting patients to connect with GPs is the important missing component that would propel Health 2.0 forward.”
For this to happen, he says GPs and clinicians need to feel that exchanged information in a safe, controlled, reliable format.” Issues around liability and, to a lesser extent data protection, will also need to be addressed.
“Even the most progressive GPs will say that this is not for critical needs,” he points out. “If you have a critical need, then go to the emergency department and don’t wait for my reply. There are definitely some concerns that if you get GPs plugged in that they may see some liability to have that patient interaction.
“In terms of data protection hacker wants your bank details not your health information, that’s not to say it’s not important but those concerns will always be there when on the internet.”
An unhealthy exclusion
On top of these concerns, there is also a niggling concern that we could be missing the point completely with Health 2.0, and that it could end up excluding the people who need the technology the most.
In its most advanced forms Health 2.0 applies to the most computer savvy patients. However, the people who are likely to need health services the most are the elderly and the poor, who presently are the least likely to have access to IT in the home and the skills to use it.
On the other hand, Bonfini argues: “There are solutions to make sure that Health 2.0 can aid the people that need it most. For example, you can get suppliers to provide the most simplified user interface to improve compliance.
“Also, people seem to think that there is a reliance on high speed broadband band but there’s not. Most people have a TV, which may not give you the whole 2.0 networking experience but it still helps.”
In a session called ‘How hospitals and healthcare organisations can address Web 2.0,’ at eHealth week, these issues will be discussed.
The rise of the machine
From Bonfini’s point of view, the best way for Health 2.0 to progress is for GPs who have regular patients to start using it to manage their patients’ health.
“I also think it will work best in healthcare systems that are not fee for service, because the question of ‘how do I get paid for this, why should I be spending time on the computer and not being reimbursed or paid for it when I could be seeing patients’, is less relevant,” he adds.
But Bonfini says that despite the progress Health 2.0 is gradually making, it is not yet safe to refer to patients as consumers, and it may never be appropriate to do so.
“The word consumer assumes a variety of things, including that the patient has as much information about the care their care as a TV they are going to buy,” he says. “When you are a consumer, you have financial responsibility for a transaction, even in countries like the US. I think that consumer is a little premature but it’s a signal of the new reality of the more informed patients.”
Leading the way
Bonfini says that we should be looking to regions including Andalucía, Lothian in Scotland and the Netherlands for the building blocks of Health 2.0.
“There are areas of Europe that are leading the way, but we’re also starting to see a lot of the players in the internet space, the non traditional healthcare players, playing an even bigger role across the world,” he argues.
“This has the potential to be more disruptive role than many of the other healthcare portals that we are familiar with and could potentially change the way healthcare is perceived and delivered forever.”
