HEALTH 2.0 IN PRACTICE: A REVIEW OF GERMAN HEALTH CARE WEB PORTALS Roland Görlitz FZI Forschungszentrum Informatik, Karlsruhe, Germany
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Benjamin Seip FZI Forschungszentrum Informatik, Karlsruhe, Germany
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Asarnusch Rashid FZI Forschungszentrum Informatik, Karlsruhe, Germany
[email protected]
Valentin Zacharias FZI Forschungszentrum Informatik, Karlsruhe, Germany
[email protected]
ABSTRACT Contemporary studies show that the usage of health-related web portals increases continuously. Additionally, the internet’s usage is in a transition towards more user participation by allowing more and more user generated content. In the area of health care this development is commonly called health 2.0; a development that leads more patients and doctors to actively participate and contribute on health portals their virtual communities. This results in numerous opportunities for health care providers to capitalize on online health communities. In order to aid the understanding of this emerging trend, this paper presents an extensive analysis of up-to-date German web portals that provide health-related content from a user perspective. They are classified as well as clustered according to their characteristics regarding usage of web 2.0 technologies and health care specialization. With this clustered overview of the current health care web portals this paper tries to clarify the term health 2.0. Additionally, general design options for health care portals are drawn from the analyzed web portals and state-of-the-art literature to aid in the development of new health care portals. KEYWORDS Health 2.0, Medicine 2.0, e-Health, health care, virtual community, review
1. INTRODUCTION With emerging new technologies and applications the use of the internet changed drastically in the course of the past decade giving rise to the term “Web 2.0” (O'Reilly, 2007). In the frame of web 2.0, many derivates have appeared, for example music 2.0, enterprise 2.0, science 2.0, health 2.0 and medicine 2.0. The latter two are found to be denoted very similar and both terms are generally attributed to eHealth, which already popped up in the context of telemedicine in the year 2000 (Hughes et al., 2008, Mitchell, 2000). It is used inconsistently and unfortunately there is no clear definition, but due to the strong influence of the internet, its conception is gradually shifting to health care practices based upon usage of telecommunication and internet. Nevertheless, eHealth, in contrast to medicine 2.0 and health 2.0, does not imply collaboratively generating
and utilizing content. In particular, health 2.0 is characterized by an interactive information sharing and usercentered design. Nevertheless, it is not defined what extent of user-centered design health 2.0 generally implies. According to contemporary studies, the use of health-related web portals increases continuously. Due to advancing health 2.0, the user generated content (UCG) is becoming more and more important (Kummervold et al., 2008). This offers numerous chances, because the doctor is an expert in identifying a disease, but the patient is an expert in experiencing it. In this context there are many publications that discuss the influence of the internet on medical practice in general and on individual consumers focusing on information quality, trust and acceptance. Furthermore, there are studies that focus on social interaction and benefits of crowd sourcing in health care. However, there are no publications that review and analyze health-related web portals’ utilization of web 2.0 technologies and virtual communities, thus the importance of user generated content in their business model. This paper presents a broad review of German health-related web portals. The range of incorporated social media is analyzed from a user perspective and they are clustered according to their degree of specialization in health care and potential interaction between users. Due to this two-dimensional characterization, the websites are clustered according to their purpose, offered services and means of participation, which facilitates the comparability among the portals. Individual portals are then analyzed with a focus on the utilization of web 2.0 components and virtual communities. Then a set of design options that allows describing the web portal’s business model according to a framework for virtual communities described by Leimeister et al. (Leimeister and Krcmar, 2004). Thus, by reviewing contemporary healthrelated websites, design options for virtual community business models in health care are identified.
2. HEALTH CARE AND THE WEB 2.0 In the last decade the internet started to be perceived as an important source of information and naturally it also became a source for patients seeking health information (Wilkins, 1999, Baker et al., 2003, Diaz et al., 2002). Since health information are vital, many publications assess the quality of health information on the internet (Impicciatore et al., 1997, Eysenbach, 2002, Baker et al., 2003, Wilkins, 1999), assess the trustworthiness of experts performing these quality assessments (Craigie et al., 2002) and evaluate its effect on transforming the traditional system of medical primary care (Murray et al., 2003, Cross, 2008). However, with the upcoming of web 2.0 technologies, the research focus has switched to the effects of the collaborative components of health care websites, which utilize the collective wisdom of the crowd. For example, Eysenberg discusses the influence of social networks as well as the willingness for patients to collaborate regarding health related subjects online in his article about medicine 2.0 (Eysenbach, 2008). Because of an increasing number of people that use social networks regularly, an increasing number of people use social networks to find answers to health-related problems. Nevertheless, there was no evidence found that the influence of virtual communities and online peer to peer interaction did have a significant impact on the patient’s convalesce (Eysenbach et al., 2004, Griffiths et al., 2009). Furthermore, in interrelation to the common lack of willingness to pay for content that is available online, people are not willing to pay for health related content either (Adler, 2006).
3. METHODOLOGY The methodology of health portal analysis is two-fold and has a qualitative as well as a quantitative approach. The first part consists of a quantitative search for German health-care-related portals, their classification and subsequent clustering. In the second part, a set of business-oriented design options for community-centered health care portals is identified through qualitatively analyzing particular portals more closely and state-of-the-art literature.
3.1 Searching, Classifying and Clustering of Health Portals The search process for the German health-related web portals incorporates three procedures: a web search using Google, Bing and Yahoo with the German key words depicted in Table 1 in which the first 20 search results are considered excluding pages that do not target an audience seeking health-related information, products and services; interviews with healthcare researchers as well as domain experts; and examining relevant links on the retrieved websites that are identified with the first two procedures. Table 1. Translated German key terms used for the web search Age Care Care relatives Care support
Community Disease Doctor Geriatrics
Health Health Care Health insurance Helping the elderly
Living in old age Medicine Nursing home Nursing service
Patient Self-help group Physician Seniors Relatives Wellness Retirement home
After the search process, the identified health-related web portals have to be classified in order to compare their characteristics as well as cluster similar portals together. Consequently, the portals are classified along two dimensions, which assess their accentuation of health care and user participation. Precisely these two dimensions were chosen, because they grasp the core of health 2.0: health care and user participation. The results of the classification are plotted in a chart in which the x-axis denotes the “degree of web 2.0,” which represents the user involvement in generating the offered content and the y-axis denotes the websites’ “degree of specialization” in health care. The degree of user involvement ranges from 1, indicating no user involvement at all, to 5, in which the user provides all the content. The second dimension, the degree of health care specialization also ranges from 1 to 5, whereas 1 is a rather universal portal that among others also addresses health care issues (e.g.Wikipedia) and 5 implies a very specialized website focusing on one aspect of a disease. All the found web portals are classified according to the two introduced dimensions by two persons independently. If the two analysts classify one particular website differently, it is assessed again and its characteristics are determined together. After searching and classifying the German web portals with health-related content, they are exploratively clustered subject to their position in the chart that indicates the individually classified specialization in health care and degree of user involvement.
3.2 Identifying Design Options for Health Portals In the second part of the analysis design options for virtual community business models are determined exploratively. They are grouped according to a framework describing virtual community that was introduced by Leimeister et al. (Leimeister and Krcmar, 2004). Leimeister defines four separate models that need to be considered when designing a virtual community, thus the design questions are grouped according to the partial models for strategy, products and services, actors and revenue. An initial set of design questions is specified iteratively through analyzing representative web portals that have been identified in the first part.
4. RESULTS 4.1 Results of the Health Care Web Portal Classification The search yielded 246 German web portals with health care related content. The specific URL and the corresponding degrees of specialization in health care and web 2.0 of each web portal are depicted in Table 2.
Table 2. The 246 web portals and the classified values for their degree of web 2.0 and degree of specialization in health care denominated X and Y, respectively Web Portal
X
Y
Web Portal
X
Y
Web Portal
X
Y
www.achse-online.de www.ahano.de www.aktiv-in-jedem-alter.de www.aktiv-mit-ms.de www.patienten-verband.de www.alzheimerblog.de www.alzheimerforum.de www.alzheimerinfo.de www.amazon.de www.pflegedienst.org angehoerigenberatung.de www.aok.de www.aok-gesundheitsnavi.de www.apotheke.de www.apotheke-am-marktbielefeld.apodigital.de www.apotheken-umschau.de www.down-syndrom.org www.arzt-atlas.de www.arzt-auskunft.de www.arztverzeichnis.at www.awo-pflege-sh.de www.barmer.de www.beauty24.de www.beruf-und-familie.de www.besano.de
1 3 1 2,5 1 5 2 2 2 1 1 2,5 3 1
4,5 2 2 5 3 4,5 4,5 4,5 1 4 1 2,5 3 2,5
gesundheitsinformation.de www.gesundheits-laden.de www.gesundheitslexikon.de www.gesundleben-apotheken.de www.getwellness.ch www.g-netz.de www.goldjahre.de www.gutefrage.net www.pflegehilfe.biz www.helphive.com www.hilfe-und-pflege.de www.hilfe.de www.hilferuf.de www.hilfswerk.at
1 1,5 1 2,5 1,5 1 2,5 5 1 5 1 2,5 2,5 1
3 3 3 2,5 2 3 2 1 4 1 4 1,5 1 1,5
www.pflege.org www.pflegeagentur24.de www.pflegebedarf24.de www.pflegebeduerftig.de www.pflegeberatung24.de www.pflegeboard.de www.pflegedienst.de www.pflege-erfahrung.de www.pflegehilfe.de www.pflegenetz.at www.pflegenetzwerk.com www.pflegen-online.de www.pflegestufe.info www.pflegeverantwortung.de
1 1 1 1 4,5 4 1 4 1 1,5 1 1,5 1 2,5
4 4 4 4 4 3 4 4 4 4 3 4 4,5 4
1
2,5
www.illumistream.com
1
2
www.pflegewiki.de
5
4
2,5 1 1,5 1,5 1 1 1 1,5 1 2,5
2,5 4,5 3 3 3 4 2,5 2 1 3
4 1 1 4 2 1 1 1 1 1
3 3 3 2 3 1 2,5 3 3 3
www.thema-altenpflege.de www.planetsenior.de www.platinnetz.de www.pro-senior-direkt.de www.qualimedic.de www.qype.de www.rehacafe.de www.richtig-beantragen.de www.wellness-gesund.info www.selbsthilfe-online.de
2,5 3,5 4 1 2,5 2 2,5 1 1 1
4 2 2 2 3 1 2,5 1 2 2,5
www.betanet.de
1
3,5
www.betreut.de www.bloghaus-ms.de www.brambor.com www.bremer-pflegedienst.de www.arzt.de www.patienten-beraten.de www.careshop.de www.caritas.de pflegende-angehoerige.or.at www.copd-aktuell.de www.dak.de www.altersportal.de www.gerontologie-forum.de www.das-pflegeportal.de www.ernaehrung.de www.pflegen-zuhause.net www.demenz-support.de www.familienatlas.de www.deutsche-alzheimer.de www.hirntumorhilfe.de/ www.krebsgesellschaft.de www.krebshilfe.de www.dmsg.de www.gliomnetzwerk.de www.deutsches-krankenhausverzeichnis.de www.krebsinformation.de www.medizin-forum.de www.diakonie.de www.diaet.com www.dmsg.de www.doccheck.de docinsider.de www.docmed.tv www.gesundheitslexikon.com www.doktor.ch www.doktor.de doktorlar24.de www.drk.de www.ebay.de
4,5 1,5 1 1 1 1 2 1 2,5 1 1 1 4,5 1 1 2,5 1 2,5 2,5 1 1 1 2,5 1
1 5 4 4 3 3 4 1,5 4 5 2,5 2 4 4 2 4 4,5 1 4,5 4,5 4 4 5 5
www.imedo.de www.info-aerzte.de www.medizin-2000.de www.iquarius.de www.jameda.de www.karlsruhe.de/fb4.de www.kkh-allianz.de www.klinik-krankenhaus.de www.krankenhaus.de www.krankenhaus.net www.krebsforum-fuerangehoerige.de www.pflege-gt.de www.pflege.portal-lb.de www.landesseniorenrat-bw.de www.last-minute-wellness.com www.leben-mit-ms.de www.lebenshilfe.de www.lifeline.de www.special-pflege.de www.lust-auf-abnehmen.de www.mcgesund.de www.medfuehrer.de www.medhost.de www.mediclife.de www.medikompass.de http://www.medinfo.de/ www.medizin.de www.medizinfo.de www.medknowledge.de http://www.medisuch.de/ www.mein-pflegeportal.de www.meine-gesundheit.de www.menschen-pflegen.de www.menshealth.de www.mobidat.net
4,5
4
www.selbsthilfe-tirol.at
1
2
1 1 1 1 2,5 1 2,5 2 2,5 2 2,5 1 1,5 2 1 1 1,5 3,5 1 2 1 1 2,5 1
4 4 1 2 5 3,5 3 4 2 2 3 3 2 3 3 3 3 3 3 4 2 4 2 2,5
www.lungenemphysem-copd.de www.pflegende-angehoerige-sz.de www.selbsthilfegruppe.at www.pflegehilfe24.com www.senior-balance.de www.senioren-seelsorge.de www.senioreninfo.de www.senioren-online.net www.senioren-ratgeber.de community.seniorentreff.de www.s-wie-senioren.de www.zuhause-altern.de www.senioren-fragen.de www.senioren-hilfe.org www.seniorenland.com www.seniorennet.de www.seniorenportal.de www.seniorweb.ch www.familie-siegen.de www.spiegel.de www.sprechzimmer.ch www.stiftung-gesundheit.de www.netz-fuer-pflegende.de www.thema-pflege.de
2 1 2,5 1 1 2,5 1 4 2,5 4 1 1 1 1,5 1,5 1 4 3 1 2,5 1 1 1 1,5
5 4 5 4 2 3,5 2 2 2 2 2 4 4 2 2 2 2 2 1,5 1 3 3 4 4
1
3
www.mobile-pflegehilfe.de
1
4
www.tk-online.de
1
2,5
1 4,5 1 2,5 2,5 2,5 4 1
4 3 1,5 2 5 3 3 3
www.mobilepflege.net ms.ms-angehoerige.de www.ms-gateway.de www.ms-infozentrum.de www.ms-lexikon.de www.ms-life.de www.ms-world.de my-cure.de
2 2,5 2,5 1 1 2,5 4 4,5
4 4,5 5 5 5 5 5 4,5
treffpunkt-pflegende-angehoerige.de unabhaengige-patientenberatung.de www.unterstuetzungskasse.de www.vz-bawue.de www.vitalitat.de www.vitalusmedical.de www.vitanet.de www.vivantes.de
1 1 1 1 4 1 1 1
4 3 2,5 1 2 3 3 3
2
3
www.my-hammer.de
5
1
www.weisse-liste.de
1
3
2 1 2,5 1 5
3 2 3 1,5 1
www.nakos.de www.netdoktor.de www.pflegebegleiter.de www.nai.de www.neuroonkologie.de
1 1,5 2,5 1 1
2 3 4 2,5 5
www.wellness.de www.wellnessfinder.com www.wellness-heaven.net www.wellness-united.de www.wellness.at
1 1 1 1 1,5
2 2 2 2 2
Web Portal
X
Y
Web Portal
X
Y
Web Portal
X
Y
www.elternimnetz.de www.eltern.de elternpflege-forum.de www.seelsorge-im-alter.de www.exchange-me.de www.feierabend.de www.fitforfun.de www.forum-demenz.net www.forum-fuer-senioren.de www.forumgesundheitspolitik.de www.geroweb.de gesundheit-regional.de gesundheitsprechstunde.ch www.gesundheit-lifestyle.de www.gesundheit.ch www.gesundheit.de www.gesundheit-aktuell.de
1 2,5 4,5 1,5 5 2,5 1,5 1 4
1 1 4 2 1 2 2 4,5 2
www.lpfa-nrw.de www.onmeda.de www.optikur.de www.otto.de www.paradisi.de www.patient-zu-patient.de www.patienteninitiative.de www.patienten.com www.patienten-erfahrungen.de
1 2,5 2,5 1,5 2,5 4,5 1 1 4,5
4 3 2 1 2 3 3 3 3
www.wellness.info www.w-h-d.de www.wellness-lebensart.de www.das-wellness-lexikon.de www.wellness-shop.de www.wellness.ch www.wikipedia.de www.wir-pflegen.net www.wissen.de
1 1 1 1 1 2 5 2,5 1
2 2 2 2 2 2 1 4 1
1
3
patienten-information.de
1
3
www.wohlfahrtswerk.de
1
4
1 2,5 1 1 1 2,5 1
4 2 3 2 2 2 2
www.patientenleitlinien.de www.patienten-scout.de www.patientenverfuegung.de www.patient-informiert-sich.de www.pflege-nachbarschaft.de www.pflege.de www.pflege.net
1 1 1 1 2 1,5 1,5
3 3 3,5 3 4 4 4
www.wohnen-im-alter.de www.wohnforumplus.de www.pflegeheim.de groups.yahoo.de www.yourfirstmedicus.de www.zukunftsforum-demenz.de
1,5 1 1 4,5 2,5 1
3,5 3,5 4 1 3 4,5
In Figure 1 the distribution of the 246 individually assessed web portals is visualized. While determining each portal’s characteristic degree of health care specialization as well as the utilization of web 2.0 technologies, it became evident that from a user perspective the offered services and social network components are difficult to compare. Therefore, the identified web portals are clustered according to their individual characteristics into 23 exploratively identified clusters, which is illustrated in Figure 2. Since every web portal can be appointed to a definite cluster, a complete analysis of each individual web portal can be avoided by thoroughly analyzing representatives of the clusters. Furthermore, the cumbersome individual differentiation can be replaced by a sophisticated delineation of the identified clusters’ characterization. Figure 1. The distribution of the 246 classified German health care web portals
The 23 identified clusters can be separated into two major groups, whose division is illustrated by the horizontal line in Figure 2. The 7 clusters below this line contain e-shops, information portals or wikis that only partly deal with health care, but are rather general. The clusters above the line have at least the key issue health care. These higher 16 Clusters are roughly divided into 4 categories on each of the two dimensions. There are pure information websites or e-shops that do not grant users permission to add content at all. Another group consists of web portals that offer content, which is generated by the operator, but can be commented by users directly or through an affiliated forum, in which users can freely post content. If the web portal is completely user-centered and its main focus is the user generated input in a forum, it is in a community cluster, and if the portal only consists of freely generated user content, it is in a wiki cluster. The rough division in the health care specialization dimension yields the following four groups: focus on wellness or senior citizens, which have a high proportion of health care subjects; focus is generally health care, medicine or physician; focus on one health care aspect or disease groups, e.g. care giving or cancer; focus on certain health care issues or particular disease, e.g. dementia or multiple sclerosis. Figure 2. The identified 23 clusters of the German health care portals
There are numerous examples for information portals that do not allow any user content: for example www.ernaehrung.de or www.altersportal.de in the wellness and senior cluster; www.arztverzeichnis.de for a physician search engine; www.patienten-verband.de for health information; www.pflegebedarf24.de is an health-related e-shop; www.pflegedienst.de for care information; and www.copd-aktuell.de for information on the particular disease COPD. Except for e-shops the business models of most of these information portals are based on providing health-care-related information while being cross-financed or financed through banner ads. The afore mentioned clusters also exist with some user involvement in the form of possible comments or associated forums. Because of stronger user integration, most of the portals in this group of clusters incorporate different ways of generating revenue in their business model. Apart from banner ads they also have more tailored sources of revenue. For example www.doccheck.de is a portal for physicians and medical employees offering an e-shop, a forum, videos and medical information. There are also additional services,
which are subject to fees like access to medical literature, further education, software and videos. Furthermore, third parties offer supplementary services like CRM-systems. Thus, the portal has a wide array of revenue sources, ranging from simple sale and premium accounts to individual services. Even though in the United States there are several business models that are based on virtual communities and their user-generated content, for example www.patientslikeme.com, www.23andme.com, www.wegohealth.com and www.medpedia.com, German community-centered health care portals are rather scarce. Their number even decreases with increasing specialization in health care. There are only two portals that have an innovative business model: www.betreut.de/pflege and www.ms-gateway.de. They are in the clusters care community and patient community, respectively. The care community portal Betreut is an intermediary for family services. People can offer their service, e.g. taking care of the children, on the portal and others can search for it. The service seeking person has to pay a fee to establish the contact and can then rate the received service. Additionally, the portal operator sells licenses to companies for using the platform commercially. This care community portal combines online and offline contacts while assessing the quality of the services through user feedback. The patient community MS-Gateway is a portal sponsored by BayerHealthCare and only deals with the disease multiple sclerosis. It offers various information, studies and literature on multiple sclerosis and allows the users to exchange details of their personal health record and to enter a personal health therapy sponsored by Bayer. The portal is supposedly financially supported by Bayer, but its business model might be self-sustaining due to the offered personal health therapy.
4.2 Determining Design Option In addition to the health portal review, a catalogue of 70 design options for virtual community portals in health care was created. The initial options were iteratively refined by determining their value for exemplary websites out of the 16 more closely considered clusters. The final set of design options that have an enormous influence on the business model for health care virtual communities is divided into the four categories strategy, products and services, actors and revenue. The main aspects covered by the design options are - strategic questions, such as the legal form of the portal, its language and regional or national orientation, the used technology and the decision between commercial or non commercial; - questions concerning the products and services, i.e. what is offered, how much user generated content is allowed, is the portal specialized in a certain healthcare domain, how to ensure credibility and what is the actual added value for the future customers; - involved participants and their communication, i.e. is communication between users allowed, are offline contacts between users desirable, how much are users involved in the community as well as the portal und do I want to incorporate third party content; - possible revenue, such as connections between the offered services and products, transaction dependent as well as transaction independent sources of revenue and the question of whether the user or third party members have to pay.
5. CONCLUSION One striking aspect distilled from the conducted review of German health care web portals is that most of the found portals are predominantly “web 1.0,” for which the operator provides and controls all the information that is published. In contrast to the possibilities user generated content offers, only a fraction of the investigated portals tries to live on these potentials by applying health 2.0. Furthermore, there are many different concepts of user generated content, ranging from simply rating the professionally created content up to creating all the content available on a website. Particularly, portals that deal with specialized health care or diseases, for example multiple sclerosis or regional care giving support groups, try to employ the most usercentered designs and interactive information sharing. Thus, a common definition of health 2.0 cannot be derived. This review’s design options for developing health care community portals offer support for the creation of a new health care web portal. However, the portals have only been analyzed from the user’s point of view. Certain options cannot be defined exactly, because data either from the operator or from other reliable
sources is necessary. Therefore, an interesting future approach would be to interview the stakeholders of particular health care web portals. Despite its drawbacks the accumulated and reviewed health care portals as well as the created design options are a unique snapshot of contemporary German health care portals and a valuable instrument, respectively. In a further step either specific health care portals that incorporate user generated content need to be investigated further by obtaining data from the operators or a newly designed web portal will be prototyped and evaluated.
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