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About 2 years ago in the summer of 2006, there were perhaps 3-4 sites where one could rate and review physicians. As the summer of 2008 approaches, there are over 30 such sites. All of these sites are competing for the same eyeballs, hoping these eyeballs might also submit a review for a physician or three. Needless to say, there is no single dominant player -- not one has crossed over a million ratings. And given the current state of these web sites, no viable player from amongst these appears likely to emerge.

This is because I believe the fundamental structure of these sites is flawed. So if all such sites are flawed, what then should the structure of a Health 2.0 site be? A good place to start would to gain an understanding of the structure of successful Web 2.0 portals. Within this context, I believe it is worthwhile to read this article from Fast Company as a starting point.

A short explanation of the key points of this article, and then how it applies to creating a Health 2.0 portal follows.

Of note is the concept of a double viral expansion loop. We too want to create a site where:

1. members invite other members (first order network effect), and
2. members can start their own groups, blogs, etc., so that their members start inviting other members in turn (second order network effect).

The first order network effect is something that has been known to computer scientists and economists for decades. It's a variation of what is sometimes called Metcalfe's Law: The value of a network increases as the square of its members or nodes.

The second order network effect has also been known: it's called the Power Law Curve.

There are different levels of viral. SEO and viral marketing alone are unlikely to get a Health 2.0 rating and review site where we want to go. An example of a simple viral loop was Hotmail when first launched: each email sent from a Hotmail account had a hook for the recipient to also create a Hotmail account. Next is a viral network: classic Web 2.0 examples include FaceBook and MySpace. Finally, Ning is the only current example of a double viral expansion loop. Arguably, Yahoo, Google, FaceBook and MySpace are only partially there.

The double viral expansion loop means that some members in a given social inter-network spawn their own new networks. The potential for a Health 2.0 portal is wide open because nothing yet exists that is purposefully targeted at Health Care. As every gentle reader knows, health care will only continue to grow in importance and as a percentage of the economy due to spiraling costs and a graying population.

Another important point in the FC article is how entire economies are spawned when viral networks are stacked on top of each other. Effectively, this is what Geoffery Moore talked about 15 years ago when introducing the notion of "Whole Product Solution" in Crossing the Chasm. Smart companies and start-ups figure out the entire value chain of their segment of economic interest (sometimes called a market :-), choose a node or three to focus on themselves, and then fill the holes by partnering.

Health 2.0 is perhaps 12-24 months behind Web 2.0. One opportunity lies in creating the infrastructure for a double viral loop or social inter-network, engineered to be so from day one. .

The list of characteristics below can be refined. From the viewpoint of creating a Health 2.0 portal with a structure likely to be successful, Double Viral Expansion Loop objectives include:

• Building the ecosystem in which Care Seekers, Care Givers and Care Providers can create not just their own content, but also their own mini-worlds or mini-social networks.
• Extend the ecosystem so other user groups or roles can create their own health related social networks.
• Less is more: one does not know what will fly, so one provides the minimum capabilities which can be easily combined to do new things (that's what Ning and FaceBook pioneered for social networks). Let users potentially help discover what will fly.
• Map out each node in the Health Care value chain, and provide functionality via partnering to offer value to as many health care participants as possible, except for nodes served directly by CareSeek.
• There is no currently known silver bullet. And one cannot explore each possibility in detail. By providing an open architecture, we let serendipity play a role in finding the silver bullet. See this article On the Origins of Strategy to see why it is important for a start-up to experiment with as many strategies as possible at the lowest cost possible.

The above are high-level principles which need to be distilled into specific actions and capabilities on the Health 2.0 portal. Some that come to mind include:

• A place where patients can gather to find relevant information: physicians, dentists, chiropractors, hospitals, nursing homes.
• A place where nurses can gather to chat, blog, connect with other fellow nurses.
• A place where physicians can gather to chat, blog, connect with other follow physicians, perhaps to debate a new medication or procedure, or even just seek advice.
• A place where hospitals or nursing homes can communicate with existing patients and market to potential patients.
• I am not aware of a single online Health destination even attempting to unite the above Healthcare constituents in a possible dialog on one uniform platform. The power of Ning is cross-over. Conceptually, it is like registering at eBay or Amazon once, and being able to purchase from any number of competing vendors for the same product. What is interesting is that Amazon can recommend a related product from a different vendor. Similarly, the Health 2.0 portal can recommend a patient either alternative treatments / medicine / ..., based on what the portal knows of the patient's past behavior.
• A place where the above constituents can create new networks of their own (second order network effects start here):
  • One of the major benefits of Ning is that once registered for a single network, one doesn't have to re-register -- one can become a member of other existing networks, or with the same user id, start one's own new network. This enables cross-over effects, and serendipitous discovery of other networks of interest (sometime called browsing).
  • Let users starting a new network choose from a variety of applications (as in FaceBook). Out of the box, one can provide several of value. For example, a physician wanting to communicate with his/her patients can quickly (I mean within 15 minutes) configure a slew of applications such as blogging, private messaging, calendaring, and such.
  • Because this hypothetical Health 2.0 platform has open APIs defined, other vendors / partners can create other more specialized applications to play within that ecosystem (this is taking a page out of FaceBook and Salesforce.com's playbook -- each of which enable different kinds of apps). Our goal would be to enable Social eCommerce for Health Care.
  • The more support or backend hooks the platform provides to grease commerce, the quicker is the potential route to revenues. I do not yet know what these ought to be -- perhaps I shall explore them in a future note.

As the above Health 2.0 platform is put together, it is now sufficiently differentiated from all players in the online HealthCare and Health 2.0 space today.

With respect to marketing, revenues and execution, the following points seem self-evident to me:

• Building out such plumbing is akin to laying the rail network or other utility networks. There is no short term revenue, but they become cash cows downstream.
• Health 2.0 is virgin territory. The platform itself will become very valuable within a short time, even if the membership drives fall flat.
• As per the Geoffery Moore point above, the shortest path to revenue is to offer specific commercial value to users by being a part of this network ecosystem via partnering. Because one cannot predict in advance what this commercial value will be, one creates an open platform.
• This approach can be very risky -- not for the faint of heart. The rewards, however, are utterly out of proportion when the risks are managed appropriately.
• Healthcare social networking is not like other online networking:
  • MySpace is where one goes to spend discretionary time; FaceBook is the same but they're increasingly trying to integrate commerce into their platform.
  • Patients or their Care Givers go online under somewhat morbid circumstances. Succor and perceived value need to be obvious and immediate.
  • Physicians go online primarily to use it as a tool to achieve specific goals.

Because online behavior of different constituents in Health Care is different, this Health 2.0 portal needs to take this into account, and build that difference into the platform.

In the next installment, I intend to focus on the other great quest of Health Care, namely, the Electronic Medical Record, which also goes by myriad other aliases. Specifically, I will discuss how this can be incorporated in a non-obtrusive and easy-to-use way in this Health 2.0 platform.

Cheers,
Sunit.