Welcome to the N2Y2 Remote Conference Health chat. Below you'll find the transcript for the chat that took place Tuesday, May 29, 4-5 pm PDT. Guest expert Enoch Choi of the Palo Alto Medical Foundation joined us to discuss how online tools can help organizations acheive their health-related goals. Joe Solomon of stuckinbed.org moderated the discussion.

Due to some technical problems with the chat client, the entire transcript was not preserved. However, you'll find most of it below.

enochchoi: Here are questions I was asked to answer for this session:
enochchoi: What is the biggest challenge for organizations seeking to address health issues using online tools?
joe_stuckinbed.org: I would definitely like to hear some of your ideas that stem from that question...
enochchoi: Non profits seeking to connect with those affected by particular illness or symptoms face significant competition for the attention of these individuals since there is a significant
enochchoi: investment in search engine optimization by leading consumer health websites to gain leading status in search engine result rankings. Since nonprofits
enochchoi: cannot outspend these commercial ventures in obtaining top search rankings, they must provide superior quality health information to gain higher ranking, and can
enochchoi: successfully do so by providing a greater depth of information in language that's friendlier to a lay audience. They can also do so sucessfully by developing a
enochchoi: community of users that comment, add and refine the content, showing the timeliness of particular pages by their ongoing updates.
enochchoi: next question:
enochchoi: Where do you see overlap between your work and the work of other health campaigns/organizations working online (including but not limited to the projects that were submitted to Net2)?
enochchoi: I find my work at MedHelp.org as complementary, since I'm seeking out cooperation with trustworthy nonprofits to come host forums (question & answer) and weblogs at
enochchoi: the 4th most popular health website, MedHelp.org. By hosting at MedHelp.org other nonprofits can leverage the millions of patients that already come every week, and
enochchoi: increase their organization's attention and prominence.
enochchoi: next question:
enochchoi: What experience have you had collaborating with other organizations, and what conditions make for constructive collaboration?
enochchoi: MedHelp.org has developed significant partnerships with leading health institutions over the last 14 years due to our trustworthiness, high quality of information and value we

[transcript broken]

our partners not only garner significant referral traffic to their websites, but their physicians
enochchoi: that participate increase their own practice's visits due to the patients that decide to self refer to seek care from these doctors they grow to trust by reading their answers.
enochchoi: Constructive collaboration is made by furthering the goals of both our partners as well as growing our own web traffic. Here is a few of our most prominent partners:
enochchoi: - Cleveland Clinic - Partners Healthcare : Harvard Brigham & Women's Hospital, Beth-Israel Deaconess Medical Center - Cornell University Weill Medical School
enochchoi: - National Jewish Medical and Research Center - American Academy of Ophthalmology - JDRF Juvenile Diabetes Research Foundation International - University of South Florida
enochchoi: next quesion:
enochchoi: What kinds of expertise or resources would help advance your work right now?
enochchoi: I'm recruiting doctors and medical writers to answer q&a's and to blog, and the company is hiring: VP Products, Interaction Designer, Director of Sales, and Office Manager. Anyone interested can reach me at enoch.choi AT medhelp D0T org
enochchoi: That's all that was asked of me to prepare for this coming hour
enochchoi: I'd love to hear from you all what you're interested in chatting about.
enochchoi: If anyone wants to introduce themselves, feel free to do so. A little about me:
joe_stuckinbed.org: Well those were some very informative answers ... does anyone have any comments on what was just written by Dr. Choi?
Aaron: wow, I for one am still digesting those
enochchoi: Full time family doc, 4 year old blogger, serial entrepreneur, took Medicalogic (online EMR) public in 1999, continue to do EMR consulting now, newest startup i'm involved in is MedHelp.org as you can tell from my answers above
enochchoi: Joe, Aaron, care to introduce yourselves?
joe_stuckinbed.org: My name's Joe Solomon and I'll be moderating this chat session for NetSquared. I'm the creative director of stuckinbed.org - a nonprofit social network for those who feel "stuck" in life ...
enochchoi: Welcome, Joe!
Aaron: I'm Aaron, I work for Social Signal, where I help to build and maintain online communities for mission-driven organizations.
Aaron: I help with the NetSquared website.
enochchoi: Joe, Aaron, Sarah, and other guest lurkers... what would you guys like to talk about this year?
Aaron: Enoch, I see that there's a question from one of the guests who couldn't be here during this time: guest232927: I'm not able to be online between 4-5 but would love to hear a discussion on forums and/or tools for sharing innovative ideas on implementing programs in developing countries. In particular, scaling up HIV care.
enochchoi: Last year the most popular topics were tagging, Google Co-op Health Topic, blogging, online journals (PLoS), social media in general and user generated content
enochchoi: Welcome, Dave!
joe_stuckinbed.org: That makes sense ... especially considering that the number of contributors that are not doctors greatly outweighs those that are...
enochchoi: Yes, the millions that come to the top health sites every week are all patients, and share their stories in the hopes that they'll help "someone like me"
enochchoi: they find mostly user generated content in forums and blogs, that may not often apply
Dave: Is it possible that a collection of patient's wisdom could be just as helpful as a professionals advice...
enochchoi: I think as more and more content is generated, it will become increasingly helpful
enochchoi: because it can match their own condition and stage of illiness
enochchoi: and offer treatment options that the searcher may not have been exposed to in their locale
Dave: that patients can (through wikis, blogs, etc) start to treat themselves because they have access to information and experiences that never before have been available?
enochchoi: Treatment options vary considerably with geographic locale, and the training of local docs
joe_stuckinbed.org5: I like the dialogue thats happening now ...
enochchoi: Patients in the USA may not be able to treat themselves, since they need a doc's prescription or referral for tests/treatments, but they can come prepared to ask
joe_stuckinbed.org5: There's definitely much to explore in the future of medical collective wisdom and how that will affect treatment plans
enochchoi: Thanks, Joe!
joe_stuckinbed.org5: Yes ... I agree ...
enochchoi: Patients worldwide have more options since in many places they can purchase their own medication without prescription
enochchoi: Or choose treatments & tests without a doctor's referral
enochchoi: Or decide that from reading a doctor's forum answers online that they'll travel to the USA to get their treatment from an american doctor. (if they can afford to)
joe_stuckinbed.org5: ch our own health and the health of our communities oe_stuckinbed.org5: yikes - my question got cut off ....
enochchoi: Meebo doesn't like it if you write too much text
enochchoi: that's why i had to cut and paste my answers above in short phrases
Dave: On online communities, patients have a chance to play doctor too... I wonder what kinds of results they have
joe_stuckinbed.org5: It's also fascinating to explore the future of how we in the US might receive our health care
enochchoi: Dave, I think trustworthy patients share their stories, and play doctor that way.
joe_stuckinbed.org5: Thanks for the meebo tip - hopefully I'
joe_stuckinbed.org5: ll get the hang of it
enochchoi: Their own stories are very compelling -- " eople like me" want to read and learn from them
Dave: I see... sort of prevents newly diagnosed patients from reinventing the wheel
enochchoi: Readers of these patients can try and tell how trustworthy a user is on a blog or forum from reading the aggregate, the whole of all the comments submitted by a patient
enochchoi: Kind of like considering the academic background of a doctor, you want to see the background and a history of the person you're considering taking the advice from
enochchoi: Dave, It helps newly diagnosed patients enormously
Dave: yes, I would imagine
joe_stuckinbed.org5: Right - and their could be rating/ranking systems based on how useful others found a contributor's advice/information
enochchoi: They're at a tipping point -- ravenous for advice
enochchoi: Yes, at many community sites, you'll find a series of stars after a blog post or forum entry where a user can vote to say how useful they found it
joe_stuckinbed.org5: I would dip some of our discussion into some of the NetSquared projects that are (for the most part) under development right now...
enochchoi: I think people vote on how readable and personable the writing is
enochchoi: I'm hoping that as more doctors participate, that the quality and depth of online health information improves
enochchoi: Rather than the voting simply on how accessible the content is
Dave: Now, do doctors have to supervise the content (to some extent), or is it possible for patients to supervise themselves?
enochchoi: Joe, which NetSquared project?
Dave: In other words, how likely would it be that misinformation spreads as the result of false ideas that spread
joe_stuckinbed.org5: I'm a bag fan of the star system ...and yes, you're right Dr. Choi, that writing style could possible overshadow the accuracy and usefullness of content
enochchoi: Dave, there are so few doctors participating online, that patients supervise themselves
joe_stuckinbed.org5: thesecondroad has some similarities to what we're discussing
enochchoi: Joe, care to elaborate on thesecondroad?
joe_stuckinbed.org5: so does a non-netsquared project, the social network for doctors, sermo

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(Enoch Choi reconstructed the following comment from memory as best he could)
enochchoi:what I remembered saying: Sermo may run out of steam as it finds its 500+ residents (doctors in training) lose their interest in trying to win an iPod or cash, which they have the opportunity to do as they write forum entries and recruit more doctors to participate. The AMA promotional partnership is interesting, as the AMA believes this venue to be important to get feedback from new doctors. Since Sermo is a private doctor-only community, I believe interest will be slower in growing than public communities where physicians can participate for the promotion of their practice, increasing clinic visits.
enochchoi: i'd love to see that extend to youtube and google video
enochchoi: I think the stories are even more compelling by video
enochchoi: tagging can help folks find relevant content " eople like me"
joe_stuckinbed.org5: How do you see a site like sermo perhaps working with a site like thesecondroad
enochchoi: Sermo is designed to be a private site
enochchoi: Gated only to allow MD's to participate
enochchoi: To ensure that Sermo's selling content that's actually from docs
joe_stuckinbed.org5: the promise of sermo, though, doesnt have to be private
enochchoi: I think that thesecondroad may attract doctors' and therapists' participation eventually
Aaron: my girlfriend works as an STI nurse here in vancouver. her organization has had some great success creating a nursing presence on 'escort review' and dating sites.
joe_stuckinbed.org5: perhaps, to then approach that question from a different angle (which i think is worth exploring) - is how do you see a transparent open social network of doctors being cajoled into websites that could really use their input...
enochchoi: if it gains critical mass enough to rank highly in search rankings, or gets in depth enough that searchers find " epole like me" along the long tail by the matching of the depth of content they're searching for.
enochchoi: Doctors are unfortunately very busy
Aaron: it's true. do you see organizations giving funding to drs or nurses to get online and meet people where they are?
joe_stuckinbed.org5: aaron, could you explore that a little bit further ... how those nurses were given perhaps incentives to contribute and what exactly they were contributing too ... it sounds fascinating!
joe_stuckinbed.org5: you're absolutely right ... they are a busy breed
joe_stuckinbed.org5: that's a great question!
enochchoi: translate "very busy" for many as: privacy concerned (online participation risks misinterpretation and malpractice lawsuits),

[transcript broken]

enochchoi: The way to get docs to come is to incent them according to their interests
joe_stuckinbed.org5: Lets explore how we could create those incentives, have accountablility, yet also protect those doctors from debilitating lawsuit practices ... because the benefits are HUGE!
enochchoi: Either: more referrals (more real-life visits), better research (participate in clinical trials or answer research questionaires), or recognition (not just ego-boosting, but real on-line brand building e.g. advertising)
enochchoi: Yes, they are HUGE!
joe_stuckinbed.org5: or at least the potential of those benefits is huge
enochchoi: Yes, the potential is huge!
joe_stuckinbed.org5: We're definitely on the same page
Aaron: do you know of dr. andrew weil?
Aaron: whatever you may think of his approach, he seems to have crafted a workable online practice
enochchoi: More doctors would blog or answer forum entries if it was easier to be clearly understood that:
enochchoi: there are inherent limitations in online writing that can't possibly come close to taking into account all of the non-verbal cues and detailed history taking we make in a clinical office visit
joe_stuckinbed.org5: Are there any developing websites in the health field that you think hold great promise for revolutionizing (or greatly assisting) healthcare as we know it? [This question is open to all ... c'mon folks, we'd love to get some of your opinions ...]
enochchoi: Solve that, and you'll start to come close to helping a lot of doctors come online, since they'll worry less about malpractice
enochchoi: Dr Weil has an online patients education site
enochchoi: not an online practice
enochchoi: I don't believe he practices in clinic anymore
joe_stuckinbed.org5: Hmmm..... interesting ... I think the future of videconferencing will go a long way in solving that
enochchoi: Joe, yes, I think that helps.
joe_stuckinbed.org5: Yet I wonder about other ways to alleviate the malpractive threat
enochchoi: But docs won't participate until they can be more easliy archived for others to benefit from them, and automatically tagged (perhaps the community can help with the latter)
joe_stuckinbed.org5: Videoconferencing would make for an excellent asset for treatin a specific patient online, but offering advice to a widespread audience, exploring that is a somewhat different beast, perhaps?
joe_stuckinbed.org5: That teamwork approach is very important...
enochchoi: Joe, to alleviate the malpractice threat, doctors will look to a 3rd party to host blogs and forums for them, a neutral "switzerland" that can be the firewall since they'll be sued first since they've got bigger deeper pockets
enochchoi: Joe, treating a specific patient online is not allowed
joe_stuckinbed.org5: not yet
joe_stuckinbed.org5: although its worth exploring the possibilities now to perhaps prepare for a more wired future
enochchoi: It's the general patient education that a doctor could provide without praciting medicine online, that helps fill out the long tail -- this very detailed information will be found by searchers looking for a "person like me"
enochchoi: In an online visit, the patient fills out a detailed questionnaire
joe_stuckinbed.org5: That's wild !... I find, perhaps like many here, that I am constantly catching up with the future.
enochchoi: and I consider whether or not i have enough information to prescribe or otherwise orders or referrals
enochchoi: if i don't have enough info, i ask them for more.
enochchoi: if it needs to be seen right away, i ask them to come in to the urgent care
enochchoi: it helps many patients because it's more convenient than coming in or waiting interminably for a voice mail to be responded to
Aaron: have you incorporated video into this portal? do you think it is/would be helpful?
joe_stuckinbed.org5: Thats seems like a fairly malleable approach to an effective virtual doctors visit - with the potential for a real visit when deemed necessary
enochchoi: Requests for eVisits appear in my EMR inbox, just like any other messge from my nurses, and i respond right away
enochchoi: Video is tricky since we don't host it
joe_stuckinbed.org5: Dr. Choi, how do you see the future of these online visits perhaps being able to help those in developing countries
enochchoi: For the HIPPA requirements, anything parto of the medical record must be stored for 7 years
joe_stuckinbed.org5: Perhapps a private medtube will exisit in the future
enochchoi: Youtube's backups don't cut it
enochchoi: for longevity or privace
enochchoi: privacy
enochchoi: Joe, those in developing countries are already flocking to health websites
enochchoi: They don't have the resources locally so they look online
joe_stuckinbed.org5: so it would have to be a video service centered on the hippa laws - any entrepeneurs interested?
joe_stuckinbed.org5: I imagine they are.
enochchoi: Those with the economic resources, fly to the doctors they want to get care from
enochchoi: That's one significant reason more and more doctors will participate online, to get a piece of this referral traffic
joe_stuckinbed.org5: Do you see a model that could come into existence wherein there could be a digital doctorswithoutborders
joe_stuckinbed.org5: Yes, that
enochchoi: Many patients feel -- "who needs the doctors anyways" -- but I think doctor's experience and expertise is very pertinent and helpful
joe_stuckinbed.org5: A nonprofit model wherein doctors could perhaps volunteer for prestige through a portal that gives specific personalized advice to individuals who can't afford it - that would be AMAZING!
enochchoi: Yes, I think the prestige factor is important
joe_stuckinbed.org5: yes, collectivewisdom i imagine isquite enough in most cases - we've certainly come a long way
enochchoi: That's why you'll find them at sites with significant traffic already
joe_stuckinbed.org5: I think so too, in the same that veteran journalists still have their place and importance ina field of milllions of bloggers
enochchoi: I think it's unlikely to happen at any but the largest existing health sites
Aaron: great analogy, joe
enochchoi: Joe, collectivewisdom? you mean organizedwisdom
joe_stuckinbed.org5: Don't you think traffic may become less important as the long tail gets longer
enochchoi: Doctors are risk-adverse
joe_stuckinbed.org5: Thanks, aaron
enochchoi: They want to participate in someplace that has history
enochchoi: Won't go away tomorrow
enochchoi: Hasn't been sued
joe_stuckinbed.org5: Yes, although I was referring to the idea, not the specific website
enochchoi: Joe, yes, wherever the stories of " atients like me" are written, with the level of depth to be found far down the long tail, yes wherever they're written they'll be found
joe_stuckinbed.org5: you're absolutely right ... web20 is an explosion and new users with a lot to invest want to get involved with something with a proven track record
enochchoi: That said, I don't see them written on personal doctor's blogs, for the malpractice risk fears
joe_stuckinbed.org5: but a new website can prove itself rather quickly with the proper partnerships - creating room for innovative ideas to take off and help the world ona grand scale
joe_stuckinbed.org5: i see your point ... it seems like that malpractice hump is the major obstacle to unlocking the potential of the personalized wisdom of the md community
enochchoi: Yes, but innovation is less attractive to established doctors -- they want low risk o the end of our hour
joe_stuckinbed.org5: True, true ... although as the md community gets infused with more tech savvy and willing residents and full fledged mds, we could see a radical shift
joe_stuckinbed.org5: Good point !
enochchoi: I wanted to se if Aaron & Sarah could introduce themselves so we get their identities out there
enochchoi: And any other guests, like agenthandy
joe_stuckinbed.org5: We are indeed ... It's been a very lively discussion and I thank you for taking the time to engage with the netsquared remote conference
Aaron: Thanks a lot., Enoch.
joe_stuckinbed.org5: Yes...
enochchoi: You're welcome! It's been a blast. If you can believe it, i'm just waking up here in Singappre
enochchoi: Singapore
Aaron: whoa!
enochchoi: You're welcome, Aaron!
enochchoi: This year was a better discussion
enochchoi: less concurrent threads
enochchoi: Will be back in Palo Alto monday if anyone wants to meetup in meatspace
enochchoi: Eg. Launch: Silicon Valley 2007
joe_stuckinbed.org5: That's fantastic, and relevant to the boundaries of geography coming down in the virtual world
enochchoi: anyone going there?
Aaron: Not me, sadly. I'm in Vancouver for the forseeable future.
joe_stuckinbed.org5: Perhaps some of the guests are and they'
joe_stuckinbed.org5: ll introduce themselves to you in due time
enochchoi: I love these chats, they're like an unconference without the physical necessity of meeting
Aaron: totally!
enochchoi: Hope to see some of you soon!
joe_stuckinbed.org5: Yes, sooner than later!

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