College of American Pathologists
Printable Version







July 2007

Raymond D. Aller, MD
Hal Weiner

How Health 2.0 paradigm can transform business as usual

Those who make health care their No. 1 priority, whether as a professional or a consumer, may have much to gain from Health 2.0.

The term, boiled down to its most basic definition, refers to the evolution of technologies and the medical industry itself to create the next generation of health care for consumers, providers, and payers alike. The term is a take on Web 2.0, which refers to the evolution of the Internet from a tool used essentially for information gathering to one used for collaboration and social interaction.

Health 2.0 is a response to the challenges that have arisen within the health care industry, says Scott Shreeve, MD, a health care consultant who has written extensively about the concept on his Web log, or blog (, and spoken about the topic at various national conferences. “People are recognizing that the current way we deliver health care has multiple different problems and significant challenges that range from access to affordability to safety and quality,” says Dr. Shreeve.

In essence, Dr. Shreeve explains, health care is shifting from an industry where competition has been driven largely by price to one where value, or health care outcomes divided by the price to achieve those outcomes, is becoming the critical driver of reform. “It’s a value-based versus just a price-based framework,” he says. “People are no longer willing to pay an increasing amount of good money for bad care.”

Technology is critical to the transition to the Health 2.0 paradigm. New technologies and tools are allowing consumers to access outcomes and pricing information before making health care decisions. This information, in turn, is empowering consumers with knowledge that they’re using to make more informed choices about their health care.

One of the main elements of Health 2.0 is the electronic health record. As patients bear more of the cost of their health care, health care is becoming more consumer-centric. In other words, consumers are increasingly relying on their personal health information to make decisions about their health care. The EHR/EMR serves as a convenient repository for such information, as it can be shared across encounters, physicians, and facilities. Consumers can keep their own personal health records, or PHRs, and then transfer relevant data to the clinical EHR/EMR at the hospital or doctor’s office.

“The health record is a foundational element in all of this,” says Dr. Shreeve. “Once the record is in electronic format, it serves as an aggregation tool of all health information related to the patient.”

Health 2.0 is also dependent on the concept of transparency—or giving patients access to price and quality care information so they can better judge value.

The concepts behind Health 2.0 are embodied in the business models of a number of companies that are providing patients with new health care information services. Companies such as Revolution Health, WebMD, and Healthwise offer medical information to consumers to educate them about their health care. Others, such as Vimo, provide comparative health data on pricing and quality outcomes that allow consumers to make more informed decisions about their health care needs. Still others offer genetic and other laboratory testing services directly to patients. DNA Direct, for example, offers genetic testing and consultation services to consumers, while MyMedLab allows consumers to order their own lab tests at a price that is significantly lower than if the tests were ordered through the doctor’s office.

“I think MyMedLab is a representative Health 2.0 company,” says Dr. Shreeve, who has done consulting work for the company. With MyMedLab, consumers can order general wellness and screening laboratory tests online and have the results sent directly to them. “The information,” adds Dr. Shreeve, “is stored in the MyMedLab PHR, which is designed to interoperate with other PHRs, such as those provided by CapMed, MedCommons, and Tolven Health.”

“All along the cycle of care, there are opportunities for new companies, new providers, to aggregate data, analyze the information, and add value through advisory services that help the consumer make informed health care choices,” he says.

Dr. Shreeve, who is a board-certified emergency medicine physician, has long been interested in the convergence of medicine, business, and technology. During his residency, he completed a rotation at a venture capital firm, where he learned how entrepreneurs obtain funding and how products and services evolve from that process. “I wanted to be on the leading edge of these new technologies that were emerging and being developed so that I could help other physicians use those technologies effectively,” he says.

With his brother, Dr. Shreeve co-founded Medsphere Systems Corp., Aliso Viejo, Calif., in 2002, which he describes as the first company to offer an open-source EHR for the hospital market. After leaving the company last fall, he began experimenting with Health 2.0 technology, products, and services. He recently founded CrossOver Healthcare, a consulting practice with a client list that includes Health 2.0-style companies.

Dr. Shreeve says the term Health 2.0 is becoming more widely used, and he expects that trend to continue. Health 2.0 should not be considered just a buzzword for new technology, he adds, but descriptive of an entire movement within the health care industry.

Bruce Friedman, MD, who has written about Health 2.0 on his blog,, believes Health 2.0 is revolutionizing health care and will have direct implications for the laboratory. Reference laboratories will become busier as more consumers choose to order their own lab tests, he predicts. The straightforward results of, say, a cholesterol reading are easy for consumers to self-monitor, he adds.

In the future, he continues, the results from direct-access testing will be transferred from the lab’s computer to the URL, or Internet address, of a patient’s personal health record. “All of these things tie together in terms of letting people shop smarter, letting them have access to their own health record,” says Dr. Friedman, who is active emeritus professor of pathology at the University of Michigan Medical School, Ann Arbor.

Dr. Friedman believes that within the next 10 or 20 years, the routine annual physical will be replaced with a trip to the lab rather than the doctor’s office. Patients will get tested using hundreds of biomarkers to detect disease at the presymptomatic stage. This will result in more work for labs and initially higher costs for insurance companies, he says, as more diseases will be detected. However, he adds, in the long run costs will most likely decrease because it’s less expensive to treat a disease at an early stage than at a highly developed stage.

“But the labs will be sitting pretty because the attention is going to shift from medical imaging, in my opinion, and from office visits to essentially these large panels of biomarkers,” he says. “So all of these changes are huge.”

IRS allows nonprofit hospitals to donate EHR software to doctors

A May 11 Internal Revenue Service memo indicates nonprofit hospitals can give their staff physicians electronic health record, or EHR, software and the necessary technical support without violating federal anti-kickback and physician self-referral laws.

The IRS states in the memo that it won’t treat the benefits a hospital gives its staff physicians as “impermissible private benefit or inurement in violation” of Internal Revenue Code if the benefits fall under health information technology items and services that are permissible under Department of Health and Human Services regulations. The hospital must have health IT subsidy arrangements with its staff physicians for the provision of health IT items and services at a discount. These arrangements require the hospital and participating physicians to comply with HHS’s EHR regulations on an ongoing basis.

The memo notes that some hospitals claim their staff physicians need “a financial incentive to acquire and implement EHR software that would allow physicians to connect to the hospitals’ EHR systems.”

Wyndgate gets FDA clearance for blood center management system

The FDA has granted Wyndgate Technologies, a division of Global Med Technologies, 510(k) clearance for Donor Doc.

Donor Doc is the first of Wyndgate’s new ElDorado suite of integrated blood management solutions. The product is part of the company’s next-generation software, which creates a bridge between Wyndgate’s SafeTrace blood center management systems and its donor and transfusion software innovations, which are nearing completion.

ElDorado Donor Doc is an electronic health history questionnaire and physical exam tracking system that assists blood centers in screening donors by capturing medical and physical examination information. The system allows donors to self-administer questionnaires at an individual’s pace, choosing text or audio presentation of questions in the donor’s preferred language, as well as graphics to clarify content.

Donor Doc may be implemented on standard and touch-screen computers. It identifies donor responses where additional staff investigation is necessary and helps prevent blood centers from releasing products from unsuitable donors.

SNOMED CT functionality now on Multilex Drug Data File

First DataBank Europe, a clinical decision support specialist, has released SNOMED CT-based sensitivity checking within its drug knowledge base, the Multilex Drug Data File, or Multilex DDF.

Drug sensitivities and allergies recorded using DM+D (Dictionary of Medicines + Devices) products and SNOMED CT (SNOMED Clinical Terms) substance codes can now be used to drive a sensitivity check within the Multilex DDF. The sensitivity check determines whether a medication is related by base ingredient, ingredient group, or cross-reactor group to a recorded patient sensitivity or allergy.

FDBE is also releasing a subset of SNOMED CT codes that can be presented in a pick list to support the recording of patient medication sensitivities and allergies. The codes will help FDBE customers implement this functionality more effectively in order to become SNOMED CT compliant.

Health care IT gurus fix on the future at spring conferences

The future is now—face it, or better yet, embrace it. So, more or less, said speakers at this year’s Lab InfoTech Summit and American Pathology Foundation spring conference, both held in Las Vegas. Armed with an arsenal of insights, experts delved into the future of health care information technology and related areas. Here’s a glimpse of what they shared.

Lab InfoTech Summit

Kenneth E. Blick, PhD, professor of pathology, University of Oklahoma Health Sciences Center, Oklahoma City, demonstrated how lab automation can improve patient safety and dramatically improve turnaround times. Dr. Blick was able to significantly improve his laboratory’s ability to meet turnaround time targets through Lean analysis and by implementing total laboratory automation in chemistry and hematology. This reduced stat testing in his lab from more than 50 percent of all orders to less than five percent. Through use of expert rules and by implementing a continuous flow automation line, the lab reduced its staffing by five full-time-equivalent employees and the facility closed its stat lab in the emergency department. The automation system was implemented on a per test cost basis, so the laboratory did not have to incur large initial capital expenses.

Bruce Friedman, MD, active emeritus professor of pathology, University of Michigan Medical School, Ann Arbor, advocated the premise that pathology and radiology should be merged into a unified medical specialty called diagnostic medicine. Dr. Friedman stated that substantial overlap between the mission of the two specialties—diagnosis of disease through images and analysis of biomarkers—already exists. A merger would serve to reinforce and provide greater impetus to a trend that is already occurring. Pathologists and radiologists would benefit from the merging of laboratory and radiology information systems and picture archiving communication systems databases. The integrated reports of pathologists and radiologists working collaboratively would achieve higher levels of quality, which is already occurring in the medical imaging, molecular imaging, and molecular diagnostics arenas.

APF 2007 Spring Conference

Health care systems consultant Dennis Winsten, founder of Dennis Winsten and Associates, Tucson, Ariz., shared his vision of the next generation of pathology systems, which would better integrate anatomic pathology and clinical pathology, enhanced imaging, and telepathology. Winsten offered the intriguing concept of a histology work area manager that would be a middleware solution to support histology processes and procedures and interface to instruments and imaging systems. The work area manager would focus on improving the efficiency and quality of histological processing, recording, and billing.

John Gilbertson, MD, associate professor of pathology and director of pathology informatics, Case Western Reserve University, Cleveland, suggested that new DICOM-based standards be used to integrate pathology images into the electronic health record. Dr. Gilbertson showed how one could implement automated, high-speed, high-resolution whole slide imaging systems through a virtual microscope and pathologist workstations. A new DICOM (digital imaging and communications in medicine) working group, WG-26, is developing and promulgating the related standards. If such standards were adopted by all vendors, says Dr. Gilbertson, it would provide a means for whole slide image exchange worldwide. (Additional information about the DICOM standards is available at

Ronald Weinstein, MD, professor and head of the Department of Pathology, University of Arizona Health Sciences Centers, Tucson, demonstrated how new technologies, such as the array microscope, which provides ultra-rapid whole slide capture, coupled with remote telepathology could provide a cost-effective method to improve patient care. It may not be long, says Dr. Weinstein, until decentralized virtual group practices, in which a distributed network of pathology subspecialists resides in many different physical locations, is fully implemented.

—Hal Weiner

Siemens and Partners HealthCare collaborate on SOA platform

Siemens Medical Solutions USA and Partners HealthCare have finalized an agreement to jointly further develop innovative service-oriented architecture infrastructure in health care information technology.

The diagnostics company Siemens and Partners HealthCare will leverage their respective areas of expertise to jointly develop clinical services within the Soarian SOA platform. Partners is a Boston-based integrated health system founded by Brigham and Women’s Hospital and Massachusetts General Hospital.

Siemens has been developing a SOA health care application—a robust, flexible architectural design strategy that is being deployed across its Soarian line. Soarian was designed with a workflow orientation and manages not just transactions and data, but also the process of health care and the interactions between members of the care team. SOA allows users to extend, reuse, and access software components that implement a business task or process.

Iatric Systems and eWebHealth enter into technology integration venture

EWebHealth, the technology division of ChartOne, has signed a partnership agreement with the Meditech integration company Iatric Systems. Under terms of the agreement, eWebHealth’s electronic medical record workflow technology will be integrated into hospitals’ Meditech systems, eliminating the need for manual processes, such as data entry, printing, faxing, and scanning medical records.

The eWebHealth technology suite digitizes paper records and integrates electronic information from software used throughout the hospital. Health information is stored in one comprehensive medical record repository, from which it can be directed to the point of impact. Iatric Systems’ technology serves as an interface between the eWebHealth medical record repository and Meditech hospital information systems.

BioAnalytics Group launches system to help researchers manage data

The BioAnalytics Group has launched BioPathwise DM, a system designed to make it easier for biomedical researchers to capture, secure, share, and publish data from any laboratory instrument in any format, including images, spreadsheets, and documents.

The system saves raw data in association with the summary information that makes it meaningful. It is a lightweight application that can be downloaded and set up for small groups by a lab head or principal investigator with basic computer skills. For larger organizations, BioAnalytics provides guidance on server configuration and network installation.

The system allows labs to make information available in a secure environment that is accessible on the Web from any location. Groups of researchers can easily document, store, and share data along with reports, records, copies of peer—reviewed articles, or other relevant information.


The health care management company Universal Health Services, King of Prussia, Pa., has purchased MediSolution’s automated TD-Synergy laboratory information system and Virtuo business intelligence solution for a system-wide implementation of its acute care hospitals. The solution will be centrally hosted at UHS’s corporate headquarters and used by 25 sites across the company’s network.

Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at