Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Introduction

During the last decade, the Internet has become increasingly popular and now forms an important part of our daily life [1]. In the Netherlands, the Internet is even more popular than traditional media like television, radio, and newspapers [2]. Furthermore, the impact of the Internet and other technological developments on health care is expected to increase [3,4]. Patients are using search engines like Google and Bing to find health related information. In Google, five percent of all searches are health related [5]. Patients can express their feelings on weblogs and online forums [3], and patients and professionals can use the Internet to improve communication and the sharing of information on websites such as Curetogether [6] and the Dutch website, Artsennet [7] for medical professionals. The use of Internet or Web technology in health care is called eHealth [1,8].

In 2004 the term “Web 2.0” was introduced. O’Reilly defined Web 2.0 as “a set of economic, social, and technology trends that collectively form the basis for the next generation of the Internet, a more mature, distinctive medium characterized by user participation, openness, and network effects” [9]. Although there are different definitions, most have several aspects in common. Hansen defined Web 2.0 as “a term which refers to improved communication and collaboration between people via social networking” [10]. According to both definitions, the main difference between Web 1.0 (the first generation of the Internet) and Web 2.0 is interaction [11]. Web 1.0 was mostly unidirectional, whereas Web 2.0 allows the user to add information or content to the Web, thus creating interaction. This is why the amount of “user-generated content” has increased enormously [12]. Practical examples of user-generated content are online communities where users can participate and share content. Examples are YouTube, Flickr, Facebook, and microblogging such as Twitter. Twitter, for example, improves communication and the sharing of information among health care professionals [13].

According to some critics, Web 2.0 is not a new generation of the Internet because it is still based on old technologies such as HTML, the predominant markup language. Therefore, the term Web 2.0 simply describes renewal or evolution of these older technologies or of the Internet itself [14,15]. Nonetheless, the term Web 2.0 seems to be widely used and accepted. The search engine Google recently found over 85,000,000 results for the search string “Web 2.0 or Web2.0.”

When Web 2.0 technologies are applied in health care, the term Health 2.0 may be used. [16,17]. Other authors use the term Medicine 2.0, which combines medicine and Web 2.0 [18]. There are many examples of Health 2.0/Medicine 2.0, such as the websites Patientslikeme [19] and Hello Health [20]. Recently, the Dutch minister of health awarded a grant to the website MijnZorgNet, which offers 23 virtual networks in which patients and their caregivers communicate. The networks are organized around specific patient categories. Successful examples that preceded the project are a digital in vitro fertilization (IVF) outpatient clinic [21,22] for couples receiving IVF treatment, and the website Parkinson Net [23] for people suffering from Parkinson’s disease. Both initiatives were started to enhance collaborative health care. Expected beneficial aspects of these projects were improved quality and efficiency of care [24]. Another concept that appears in the Health 2.0/Medicine 2.0 literature is “patient empowerment 2.0.” This has been described as “the active participation of the citizen in his or her health and care pathway with the use of information and communication technologies” [25]. It is assumed that Health 2.0/Medicine 2.0 leads to empowerment of the patient, as patients have easier access to health-related information and thereby have better understanding of choices that can be made.

According to Hughes [16], no relevant differences exist between Health 2.0 and Medicine 2.0. Eysenbach [18] agreed but stated, “If anything, Medicine 2.0 is the broader concept and umbrella term which includes consumer-directed ‘medicine’ or Health 2.0.” More and also more specific definitions of Health 2.0 and Medicine 2.0 exist [16,17]. However, these definitions seem to have evolved together with the increased use of the definitions and the different parties involved in Health 2.0 and Medicine 2.0. Ricciardi stated, “Everyone is trying to grasp what Health 2.0 exactly is” [26]. Does Health 2.0 refer to patients or to professionals or both? Does it focus on health care in general, or does it address specific aspects of health care like preventive or curative care, acute or chronic illness? Several authors concluded that there is no authoritative definition of the term yet, and Health 2.0 definitions and translations in practice remain murky and fragmented [27,28].

A clear definition is important for the development of new Health 2.0 or Medicine 2.0 initiatives and also for the comparability of new developments in research. Therefore, the aim of this study was to identify definitions of Health 2.0/Medicine 2.0 and to gain insight into recurrent topics associated with these labels.

Methods

We performed a systematic literature study to find unique definitions of Health 2.0/Medicine 2.0 and identify and recurrent topics discussed in conjunction with these terms.

Results

We scanned a total of 1937 articles, 533 found in scientific databases and 1404 in the gray literature (Tables 1 and 2). We selected 287 articles, 25 peer reviewed articles, and 262 non-scientific articles for further analysis. After selection and removing duplicates, we distinguished 46 unique definitions of Health 2.0 or Medicine 2.0 in 44 articles (Table 3). The length of the definitions varied from 7 to 105 words. We found 42 definitions describing Health 2.0 [3,15-18,25-27,36-69] and two definitions describing Medicine 2.0 [70,71]. Of the 44 articles included, 8 included definitions of both Health 2.0 and Medicine 2.0 [16-18,40,50,52,55,65]. From these 46 definitions, we identified 7 main recurrent topics: patients, Web 2.0/technology, professionals, social networking, change of health care, collaboration, and health information/content (Table 4). In the following paragraphs we describe these recurrent topics from these definitions in more depth.

Discussion

This literature search resulted in 46 unique definitions in 44 articles of Health 2.0/Medicine 2.0 in scientific databases and gray literature on the Internet. We distinguished seven recurrent topics: Web 2.0/technology, patients, professionals, social networking, health information/content, collaboration, and change of health care.

This study showed that the use of the terminology differed among the definitions mentioned in literature. The term Health 2.0 was included in 42 definitions, 10 definitions mentioned Medicine 2.0, and 6 definitions described Health 2.0 and Medicine 2.0 as equal. There were 36 definitions that only mentioned the term Health 2.0, and only 4 definitions that described Medicine 2.0. Although some authors indicated that little or no differences existed between the two terms [16,18,27,55], others saw differences, for example that Medicine 2.0 is focused on the relation between professionals and patients whereas Health 2.0 is focused on health care in general [17,52,65]. As most definitions described Health 2.0, this term may be more widely used and accepted than Medicine 2.0.

Overall, we found that the term Web 2.0 was mentioned often: 33 authors used the term directly in the definition, which suggests that they accepted this concept. However, others state that Web 2.0 does not exist at all [72]. Authors’ interpretations of the meaning of Web 2.0 influenced their definitions of Health 2.0/Medicine 2.0 profoundly. We generally distinguished two meanings of Web 2.0. The first meaning is that Web 2.0 is a set or “mashing” (ie, a combination) of technological developments [51,58]. The second meaning is that Web 2.0 is a new generation of the Internet where interaction is important, with more user-generated content that empowers people. In this interpretation, technology, or the mashing of different technologies, is only a tool, and Web 2.0 is more than technology. These meanings result in different definitions of Health 2.0/Medicine 2.0. A number of definitions referred to the technological developments embedded in health care, whereas other definitions stated that Health 2.0/Medicine 2.0 is a new generation of health care. We believe Web 2.0 is a facilitator for Health 2.0/Medicine 2.0, but not a necessity. Indeed, patients can still access health related information without Web 2.0; for example, a patient can go to a library and become well-informed without Web 2.0 technology. However, this would be far more difficult than becoming well-informed through the use of Web 2.0 technology. Second, the topic of stakeholders reflects who the main players are in the field of Health 2.0/Medicine 2.0. The two main stakeholders we distinguished were patients or consumers, mentioned in 35 definitions, and professionals or caregivers, mentioned in 26 definitions. Interestingly, other stakeholders such as payers of health care, scientists, students, and entrepreneurs were mentioned less frequently, whereas the government was only mentioned once. This is particularly interesting as the government has great influence on health care and changes in health care. Apparently the government is not yet an active party in the development of Health 2.0/Medicine 2.0.

Also interesting was that most definitions focused on the relation between patients and professionals. With Health 2.0/Medicine 2.0, patients and professionals were seen to collaborate, with patients transforming their role in health care using social networks and access to health information. Moreover, other relationships might also change; for example, the appearance of online communities could change the relationship between health professionals and specific groups of patients. This has been termed collaborative health care [18].

Finally, it is expected that Health 2.0/Medicine 2.0 will lead to change of health care. Expectations concerning the speed of this change ranged from a “gradual shift” [27], an “ever changing” [66] or “continuous interactive process” [49] to “revolution” [55]. However, we advise caution in assuming that a revolution has taken place [27]. It may be that communication, information exchange, and patients’ contribution to his or her care has improved or accelerated, but according to Engelen [8], no fundamental changes in health care have yet occurred.

Authors of a Health 2.0/Medicine 2.0 definition generally seemed to approach the definition from their own perspective. For example, patients or patient federations saw patients as the main stakeholder and focused on empowerment of the patient. That is, definitions may be influenced by different stakeholders’ agendas. Therefore, it is important for future Health 2.0/Medicine 2.0 researchers to incorporate all stakeholders and thereby include all possible views and perspectives.