"Social Healthcare" and "Social HIT"

I considered a title of “Socialized Healthcare” as a play on words, just to get some attention. But I’m not talking about socialized medicine and government takeover of healthcare (I won’t touch politics with a 10 foot pole in this blog). Rather, I’m thinking about the implications of social networking and interactive communities. This is a big theme of the Health 2.0 community, of which I’ve attended an innovative and fascinating conference. “Patient engagement” – a key priority in the incentives for Meaningful Use (MU) – isn’t just about patients accessing their electronic health records, but also about interaction among a community of patients, caregivers, care providers, and others. People already “socialize” (talk about) their health quite a lot already, in some cases using IT (e.g., the Internet)!

A little-known fact about the Direct Project is that there was a “bake-off” among four exchange protocols: SMTP (e-mail transport***) chosen by consensus as the primary protocol, SOAP (web services as used by IHE) chosen as an option to bridge to many existing EHRs, REST (web services based on Internet HTTP protocol), and XMPP (the protocol used in Facebook). While XMPP wasn’t chosen, its consideration was intriguing. The state of existing technology adoption in healthcare IT, and the fitness to purpose were factors in reaching the decision, but there was recognition that new technologies could play a significant role in the future. So as healthcare itself becomes more interactive and collaborative, new enabling technologies will become more applicable.

***Caveat – I realize that Direct Project is not just “plain old e-mail” like most people are using, but e-mail is the easiest analogy to explain the Direct push pattern of information exchange.

The key question isn’t about protocols, but how persons and systems interact with each other. Generally speaking:

1. System-system interactions are called interoperability
2. Person-system interactions are called user interface
3. Person-person interactions (facilitated by IT) are sometimes called social networking

The first two have received much attention in discussions about MU. The last has not. Even though there are proposed Stage 2 or 3 Meaningful Use requirements such as uploading patient-sourced data, that’s one-way, not really interactive. Secure patient-provider messaging may be the closest MU requirement in the Person-person category.

While e-mail-style of interaction can appear semi-interactive (i.e., long threads), it’s less interactive than chat/instant messaging or Facebook. It matches those use cases that drove it (e.g., pushing referrals, discharge summaries, results, and immunization updates among known recipients). Facebook, in contrast, has push, pull, and publish/subscribe patterns all rolled together. I haven’t seen many use cases that imply more interactivity (though a few were mentioned in the XMPP link above), so I’d be interested if anyone could point out some.

I haven’t researched or pondered this subject enough to write in depth about it it yet, but foresee huge and possibly transformative potential there. My company’s CEO, John Glaser, said as much at the HIMSS HIT X.0 mini-conference. I look forward to learning more about the opportunities (use cases), technologies, and innovations in “Social Healthcare.”