When I first came to “Health 2.0” and joined ranks with folks who were leading this charge, it was because I was so thoroughly discouraged by the realm of health information technology for physicians and hospitals and disappointed with both the vendors of electronic health record technology and most of their customers. I saw what was happening on the consumer and patient side of health IT as leapfrogging over the tired, staid, and expensive proprietary client-server apps that were about the only thing in that marketplace.

Health 2.0 was an extension of “Web 2.0,” which meant that it was starting from a point out ahead of the traditional health IT industry. Innovation was welcome, and entrepreneurs were given a pat on the back. It was participatory, in the sense that the patients’ rights and capabilities to engage in their own health and health care decisions was a given. And although at times I felt that because I am a physician I was unwelcome, I understood that social groups need boundaries and you have to earn your stripes if you come in from the “outside.” Hey, I even welcomed some of that suspicion, as it assured me that this was a new, vibrant, and independent place where people were put first, not professionals.

However, as I’ve recently written with Brian Klepper in “EHRs for a Small Planet,” there is a problem with Health 2.0, just as there is a problem with the way that we’ve approached EHR technology for doctors and hospitals. We’ve been seeking solutions from IT instead of from people.

We have not been concerned with what happens in our local communities. “Think globally, act locally” could be applied to the use of health IT by local groups as a way of reinvigorating our innate problem-solving abilities, helping one person at a time if necessary, but also building community resources for empowerment from the ground up.

What others are saying is partly true: “…[T]he kinds of solutions required for health care in the U.S. today have nothing to do with fancy IT or prioritization on search engines and everything to do with low-tech, unsexy approaches toward grass-roots public health.” This is only partly true, because even “low-tech, unsexy” and public health-oriented solutions to our health problems could benefit from the use of health IT if it’s affordable, easy-to-use, and based on the resources people already have available to them. Instead of asking, “What would be possible if everyone had the IT resources of Kaiser or Mayo or some expensive RHIO?” we should be asking, “What is possible given the IT resources already available in the community we live in?”

There is something wonderful about the crowd on the Internet, but there is also something real, practical, and just as wonderful about our actual neighbors. There is something very confused and troubling going on when physicians don’t know how many patients with hypertension there are in their practices, how many of those patients are being treated appropriately, at what cost, or by whom else in the health system. But there is just as much wrong when a city or town council doesn’t understand what the priority risks are for their community, the kinds of solutions that might address those risks, or the relationship between continuity of care among providers and the rates of disease and high-cost care that their citizens must face.

Due to my work, I travel on airplanes a lot. I’ve noticed that whenever there are soldiers on the plane, the pilot makes an announcement something like this: “Folks, we have a group of fighting men and women on our plane today, and we’re all very proud of the job that they do in defending our lives and liberties. Let’s show them how much we respect them by letting them get off the plane first and by giving them a big round of applause.”

This is fine; I clap too. But I fantasize an alternative that would go something like this. Pilot: “Ladies and gentlemen, we have a group of people on board who have lost 10 pounds of excess body weight in the last six months by eating right and exercising daily. We also have a few people on board who have successfully quit smoking cigarettes. Let’s show them how proud we are of their healthy lifestyle choices by letting them get off the plane first and by offering them a big round of applause.”

I clap loudly.

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