A year after the COVID-19 pandemic vaulted digital health into the headlines, we’re asking some big questions. Is there a better warning system for the next pandemic? Can we have consumerization of health care? Will new payment models work? What impact can we make on key issues such as health equity and vaccine confidence?

W2O’s annual Digital Health (this time, virtual) event was the place to go to for answers. As always, it took place alongside the J.P Morgan Health Care Conference and CES and featured some of the leading minds in health care and beyond.

Day One Keynote: Improving the Human Condition Through Data and Technology

The two-day summit began with an engaging discussion between former Bill & Melinda Gates Foundation CEO Dr. Sue Desmond-Hellmann and W2O’s Mike Huckman, Global Practice Leader, Executive Communications. The pair have known each other for many years, dating back to Huckman’s days as a CNBC reporter.

Dr. Desmond-Hellmann, an oncologist and longtime biotech leader, spoke about the need to make sure the tools used to make medicines even more precise are “fit for purpose” in public health. She also discussed the role of digital technology in helping those experiencing “long-haul” symptoms from COVID-19.

For more: Reunited and It Feels So Good: A Conversation with One of My Favorite Executives

Day Two Keynote: Why Do You Even Call It A “System?”

Mastercard Chief Marketing and Communications Officer Raja Rajamannar highlighted the potential for tech-oriented payment companies to disrupt what he called a “mind-befuddling” health care system. He asked, “Why do you even call it a system?”

Rajamannar called for tech-focused disruption in three key areas: billing, paperwork and the catch-all category of waste, fraud and abuse.

For more: Mastercard CMO’s Prescription to Fix the US Healthcare System

The Evolution and Transformation of Primary Care

What’s next for primary care was the focus of a discussion between Crossover Health Founder and CEO Dr. Scott Shreeve and health economist Jane Sarasohn-Kahn, an advisor to W2O.

Dr. Shreeve, a board-certified emergency medicine physician, said that when the pandemic hit last March, Crossover – whose clients are largely self-insured companies – embraced “pandemic primary care” almost immediately.

For more: Primary Care 2.0 – How Crossover Health is “Re-Bundling” Health Care

How Far Did the Pandemic Push Digital Health?

The pandemic not only accelerated the development and use of digital health, but also pushed the FDA to be even more flexible in its regulatory approach. That was one of many conclusions in a panel discussion moderated by Udit Nagar, a Vice President at health care investment banking group BTIG, and panelists Brian Harris, Co-founder and CEO of MedRhythms, Eddie Martucci, CEO and Co-founder of Akili, and Michael Evers, CEO of Woebot Health.

For more: The New Next and What Does 2021 Look Like for Digital Health

How Do You Find an Ideal Patient Population?

Ron Elwell, Co-founder of Swoop and – which were recently acquired by W2O – talked with W2O Chief Marketing Officer Aaron Strout about getting patients with undiagnosed conditions, especially rare diseases, connected more quickly to potential treatment paths. The discussion also focused on ensuring a more representative sample of patients in clinical trials.

For more: Moderated Chat: Uncovering Your Ideal Patient Population and Closing Remarks (video)

The New Normal: Digital Welcomed with Open Arms

Techonomy’s David Kilpatrick led a session about the “return to normalcy” after the pandemic. Kirkpatrick was joined by Denise Heaney, Senior Scientific Affairs Manager, Diagnostics Information Solutions at Roche Diagnostics, and Nick Vitalari, Chief Strategy Officer at Quantum Materials Corp.

Heaney pointed out that the pandemic “has opened up a lot of doors where digital will really be welcomed with open arms, because people have started to adopt, or at least consider, these types of virtual platforms that allow them to do a variety of virtual care.”

For more: Health Tech’s Role in Return to Normalcy

Can We Have Amazon-Like Experiences in Health Care?

Health systems are getting pushed into the digital age by changing patient demands that the pandemic accelerated. How those systems handle that was the focus of a discussion between Salesforce Executive Medical Director Dr. Geeta Nayyar, M.D., and HIMSS Senior Vice President of Enterprise Marketing and Communications Terri Sanders.

Investing in the patient-physician/provider relationship may be the best opportunity to satisfy those patient demands and improve patient outcomes, Dr. Nayyar said, and not just for large hospitals. “You have to bring value to that independent practitioner,” she said.

For more: Digital Health’s Push Into Consumerism

Public Health’s Early Warning System Is Digital

Last year, users of Kinsa’s connected thermometer provided early signs that COVID-19 was spreading. Public health officials were slow to accept the data, Kinsa CEO Inder Singh said in an eye-opening session with Techonomy’s Kilpatrick. “I’m sad it took a pandemic to bring to light how important our work on early warning of outbreaks is,” Sing said.

For more: Kinsa’s Thermometer Network: Crowdsourcing for Public Health

Critical Issue: Clinical Trial Diversity

The need to keep up the push for true diversity in clinical trials was the main subject of a panel moderated by Eric Roberts, Vice President of W2O’s Hū, with Peyton Howell, EVP and Chief Commercial Officer of Parexel, Sonali Duggal, Chief Commercial Officer of par8o, and Jackie Kent, EVP and Head of Product for Medidata.

Duggal sounded a note of optimism: “It’s more than just lip service. It’s actual people, it’s budgets, it’s time, it’s executive attention, and that is something that feels really new, and that it will last and stick beyond COVID.”

For more: Clinical Trial Diversity in Recruitment/Identification

Media Chat: Stories from the Frontlines

Wired magazine Co-founder Jane Metcalfe and ex-CNBC reporter Christina Farr, who moved from journalism to OMERS Ventures last year, had a wide-ranging chat on the event’s final day.

Farr discussed her jump into the VC world from media, saying she wanted to be “more of a source of help behind the scenes,” and Metcalfe talked about how her science-focused NEO.LIFE brings together “a community of people who should all be talking to each other.”

For more: Your Ultimate Guide to Hiring Doctors into Digital Health (scroll to bottom)

Learn more about W2O via our About or Healthcare pages.

We kicked off our 2nd annual Movers & Shapers event (last year known as Geekfest) on Saturday here during SXSW. This one featured several people I’m lucky to call friends. As Bob Pearson mentioned, we chose this list of speakers because many of them are shaping the future of business in this digital age.

Thanks to our clients, partners and sponsors and W2O employees who made today (and our other #SXW2O events) possible. Below are a few highlights from each of the speakers.

  • Javier Boix, Senior Director, StoryLab, AbbVie
    Javier discussed activating a storyline paradigm (see his pre-interview here). When he and the team thought about how to move AbbVie in the storytelling realm, they knew they had to approach things differently. That’s why they created StoryLab.  For AbbVie, StoryLab = Content Development + Media Relations + Digital + Measurement. Tune into the Movers & Shapers livestream at just over the 9 minute mark to see Javier’s session.

Jesse Knish Photography Jesse Knish Photography

  • Michael Jarjour, CEO, ODH, Inc
    Michael joined us to talk about how Data is Improving Mental Health. He sat down with our own Bob Pearson to discuss Michael’s passion, how we transform behavioral and health. Key challenges in behavioral health are resource constraints and highly fragmented data. Mentrics is a tool that combines ODH’s risk assessment data along with data of the complex care patients to find out which patients are most at risk.  From a data perspective, payers are the most important component. How does the risk stratification process work? Michael explained that the ODH team had worked on the solution for four years. It identifies the high-cost patient population to track cost drivers over a year. The goal is to help health care providers figure out which patients are at risk and provide insights into the kind of treatment that can best affect outcomes. It’s about identifying 1) which patients need the most help 2) what kind of help do they need? 3) How can we help? Tune into the Movers & Shapers livestream at about the 23 minute mark to see their discussion.

Jesse Knish Photography Jesse Knish Photography

  • Amber Naslund, SVP Marketing, Sysomos
    I’ve known Amber a long time. She’s someone I’ve always had a great deal of respect for. Now even more so after hearing her talk about embracing imperfection. Everyone talks about transparency and authenticity. Amber nails both. She lives and breathes social engagement and analytics. Much of her talk centered around Impostor Syndrome. It refers to “high-achieving individuals marked by an inability to internalize their accomplishments and a persistent fear of being exposed as “fraud.” In 2011, she was riding high when Radian6 was purchased by Salesforce, she had a successful book and was well-known for the social engagement work that she was a part of. During her next step is when she starting struggling those negative feelings of self-doubt. Especially as so many of her peers in the social space appeared to be at the top of their game. That period led her to do research on the topic. She quickly found in her interviews that Impostor’s Syndrome affects everyone… men, women, all ages, etc. Even extremely successful people like best-selling author Stephen King. Bottom line, Amber’s currently focused on making this topic as her next book. I hope she’s successful on that front and applaud her for having the courage to share with the folks here at our event.  You can check out Amber’s session at about the 39 minute mark of the Movers and Shapers livestream.
Jesse Knish Photography
  • Ray Kerins, SVP Head of Communications & Government Relations, Bayer
    Ray’s topic of discussion was the Criticality of Intellectual Property. Ray did something I wasn’t expecting. He made a talk about IP pretty lively and engaging. He started his session by acknowledging that most people’s eyes glaze over when they hear about patents and IP. He defined IP as the set of laws that protect individuals and companies who have created a unique product or thing. It’s important to all of us because it protects innovation. Ray cited one of the most difficult aspects of IP is the un-evenness of laws around the world. While those in the United States are decent, several countries outside the US have very weak laws, and in some cases, those laws can be difficult to enforce. Ray is a board member of the US Chamber of Commerce and he’s also a member of the Global Intellectual Property Center (GIPC). GIPC’s sole responsibility is to make sure the IP laws around the world help protect innovation created in America. According to Ray, IP creates job. He referenced several reports compiled by GIPC. One such report is the International IP Index, which ranks the world’s countries in terms of levle of IP protection. In other words, to track the places where counterfeiting is the biggest problem. Surprises? Venezuela is the country that currently ranks the highest on that list. India is #2. Another surprise? China currently ranks  17th on the list. Ray attributed China’s going down on the list (improving) to the Chinese government’s active efforts to strengthen their IP laws and enforcing those laws. You can check out Ray’s session just about the 50 minute mark of the Movers and Shapers livestream.
Jesse Knish Photography
  • Michele Skelding, SVP Global Technology and Innovation, Austin Chamber of Commerce
    Michele’s topic was The Next Big Thing? Disruptive Innovation in ATX. Michele has lived in Austin for the last 20 years and has worked in technology for most of that time. She joined the Austin Chamber of Commerce about three years ago with the goal of bringing her tech expertise to the city. Michele mentioned that the average age in Austin was 33. The city has a population of about 1.9 million people, of which 415,000 are students. What’s one of the most important things the city can do to keep those students here? Create jobs that they’ll want to stay here for. As a city, that means we have to be on target with our business benefits. Add it all up and Austin is expected to be one of the fastest growing cities until 2025. Michele ended with a plea for those of us in Austin to get engaged in terms of the future of the city. Along those lines, she mentioned recent headlines where Austin proposed city ordinances are creating barriers for companies like Uber and Lyft to operate in this city. One more thing: Thanks to Michele for making the introduction to Hugh Forrest and making that PreCommerce fireside chat possible. You can check out Ray’s session just about the 1 hour 27 minute mark of the Movers and Shapers livestream.

Jesse Knish Photography Jesse Knish Photography

  • Robert Scoble, Entrepreneur in Residence, UploadVR
    Robert is another person I’m fortunate to know pretty well. Robert’s book Naked Conversations (that he co-authored Shel Israel) had a big impact on me when I was gearing up to take the reins at Direct2Dell back in 2006. Robert’s one of the best in the business about what’s next in technology. Look at his other books as an example. Age of Context focused on how sensors and big data will continue to impact business. He and Shel are currently working on their third book called Beyond Mobile. Virtual Reality and Augmented Reality is not surprisingly one of the main topics that book will cover. Fresh off the news that he’s joining UploadVR as their Entrepreneur in Residence, Robert dove right into the topic of virtual reality and augmented reality. He discussed companies like Magic Leap and Meta that will play a part in the future, as well as other established tech companies like Facebook, Microsoft and Google. This technology is already showing up in our world… self-driving cars use sensors and tons of data to map the world around them. Heavy machinery company Caterpillar is already using AR to help train mechanics on repairs. According to Robert, augmented reality (where we interact with virtual objects superimposed on top of real-world objects) is going to have the biggest impact. We’re still 3 – 5 years away from the truly ground-breaking stuff that will occur has hardware gets smaller, faster and cheaper. It’s coming though, and in my opinion, there’s much to look forward to. You can check out Robert’s session at about the 1 hour 38 minute mark of the Movers and Shapers livestream.
Jesse Knish Photography
  • Patrick Moorhead, President and Principal Analyst, Moor Insights & Strategy
    Patrick’s topic was The Future of Healthcare is Closer Than it May Appear. Before becoming an industry analyst, he spent over 20 years in the tech business, focused on things like product management, product marketing and strategy. For 15 years he served on the board of St. Davids’s Medical Center and the Austin Heart Hospital (where he also chaired the board for five years). Besides sing the bureaucracy first hand, he was struck by the number of people so passionate about helping others. He mentioned that we spend over $3 trillion dollars in Healthcare annually. An estimated 90% of that goes toward chronic diseases like diabetes and high blood pressure. And an estimated 80% of those could be prevented with better healthcare along with personal responsibility. He also said the biggest issue in healthcare is the disconnect between payment and service. During the session, he called out that Moor Insights was welcoming Yuri Teshler to lead the Healthcare vertical  You can check out Patrick’s session at just over the 1 hour 58 minute mark of the Movers and Shapers livestream.
Jesse Knish Photography
  • Natanya Anderson, Sr. Marketing Director, 365 by Whole Foods Market
    Natanya talked about the Mandate to Innovate, which is a good topic for her given how much she has done inside the walls of Whole Foods before taking on the charter to expand their 365 effort. She touched on disruption and called out Whole Foods’ recent investment in Instacart as an example of how Whole Foods is working with innovative companies instead of against them. Figuring how to innovate inside a big brand was something she struggled with at first. Her light bulb moment came when she spoke at the Foresight & Trends Conference about 18 months ago. She spoke to many people there who were part of innovation groups, or in some cases, even innovation business units. Many of them spent time analyzing trends to help figure out what areas lend themselves to innovation within their respective companies. That’s when it hit her. Instead of thinking, “How do I get that (innovation) job?” She realized the better question was, “How do I make innovation part of my job?” She started by establishing a mandate to innovate for herself. That’s when she starting actively looking for places where Whole Foods could innovate. Then she extended the that intention to innovate to her entire team. She found that some people on her team were more receptive to it than others. The tipping point was when she tied innovation to the team’s goals overall and they worked as a group to figure out how to measure the innovation part of their efforts. Hint: It wasn’t ROI. You can check out Natanya’s session at just over the 2 hour 14 minute mark of the Movers and Shapers livestream.
Jesse Knish Photography

Check back soon to learn more from other speakers and what amazing insights they offered at Movers & Shapers!



Lionel Menchaca currently serves as Director of Corporate & Strategy at W2O Group. Feel free to connect with him on LinkedIn or reach out to him on Twitter at @LionelGeek!


Learn more about W2O Group:  About  Work  Contact.

Our PreCommerce Summit started off our events with a bang. Hard to believe, but 2016 marks the 6th annual version of the summit. We built it around a series of 10-minute Ted-style talks, and rounded it out with a few panel discussions and a couple of fireside chats.

These discussions featured insights from executives and leadership from some of our top clients and partners. It’s a view into what’s next, the technology that’s impacting all of us, how its changing business, as well as other aspects of our lives outside of work.

  • Lord Peter Chadlington, Founder of Shandwick and Huntsworth Group; See Lord Chadington’s preview interview here.
    Lord Peter Chadington discussed global communications trends with our own Bob Pearson. In terms of global trends, Peter pointed out that 50% of the world’s population have just started getting access to the Internet.  Lord Chadlington is someone who’s dedicated much of his work to politics and shared his thoughts on the impact that social media is having on politics. According to research they did in the UK, 72% said social media and the Internet made them more involved in politics. They feel empowered. You can watch Bob’s interview with Lord Chadlington at about 33:15 mark in the PreCommerce livestream.


  • Amy von Walter, EVP Global Communications and Public Relations, Toys ‘R’ Us
    During Aaron’s introduction, he shared the news that Amy is now EVP at Toys ‘R’ Us. Amy gave a powerful talk about first impressions. She’s passionate about encouraging confidence in her employees. It’s an extension of her confidence which comes from her experiences overcoming first impressions.  And she’s an expert there, based on her reality of being from South Korea and raised in Minnesota by her adopted parents. She referenced the work of Dr. Hendrie Weisenger’s about the many ways you can build confidence. You can watch Amy’s session at 58:04 in the PreCommerce livestream.

Amy von Walter - SXSW -SXW2O

  • Manny Kostas, SVP and Global Head of Platforms & Future Technology, HP
    Manny discussed breaking through silos to get into more conversations with customers. He’s a person with unique perspective since he’s been CMO at both Symantec and a division of HP and now he’s responsible for 3,000 engineers working to reinvent HP’s printer business. Manny’s passionate about not imposing our business structure on our customers, which breaks the dialog with our customers. You can watch Manny’s session at about the 1:07 mark in the PreCommerce livestream.

Manny Kostas-SXSW-SXW2O

Before the first panel, my friend and someone I really respect, Robert Scoble joined Aaron on stage to share his recent news that he will be joining UploadVR as their Entrepreneur in Residence. All the best to you in the new gig Robert. Your early work at your Channel 9 days at Microsoft and you (and Shel’s) book Naked Conversations helped me prepare for taking the reins as Dell’s chief blogger back in 2006, Onward and upward, my friend! You can watch Scoble’s news at about the 1:24 mark in the PreCommerce livestream. Thanks to Jeremiah Owyang for the live pic.

Robert Scoble #SXW2O

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  • Susan Glasser, Editor in Chief, Politico and Peter Cherukuri, EVP Audience Solutions & President, Politico
    Susan and Peter discussed the evolution of sponsored content. Interesting perspective from the two of them and how they’ve made a new publishing model work for Politico. To do it, they re-invented what it means to be an online news platform in an era where journalistic speed a given in the space. That meant diving deep into new types of stories and experiences to stay ahead of their competition. You can watch their session at about the 2:16 mark in the PreCommerce livestream.

Susan Glasser-Peter Cherukui-SXSW-SXW2O


  • David Kirkpatrick, CEO, Techonomy, author of The Facebook Effect and Graham Weston, Founder/Chairman, Rackspace
    David sat down with Graham to get his take on where the cloud was headed. Before jumping into the conversation, Graham took a minute to thanks Robert Scoble for his 7 years at Rackspace. Rackspace is a $2B company who provides cloud infrastructure and integration services for AWS and Azure clients. His company’s still focused on providing “fanatical” support in the midst of a changing competitive landscape. Lastly, David asked Graham about his considerable community efforts in the city of San Antonio and beyond. You can watch their fireside chat about the 2:47 mark in the PreCommerce livestream.

Graham Weston-David Kirkpatrick-SXSW-SXW2O

  • Jeremiah Owyang, Founder/CEO, Crowd Companies
    My good friend Jeremiah spent a few minutes getting into the future of Crowd business models. He shared examples of how the collaborative economy is already disrupting traditional businesses and also shared his take on how it would evolve moving forward . Key takeaways 1) Common digital technologies empower people to get what they need from each other. 2) The crowd is becoming like a company—bypassing  inefficient corporations. 3) Like the Internet and social, corporations must use the same digital strategies to regain relevancy 4) This requires a business model change: Product>Service>Marketplace>Repeat. You can watch Jeremiah’s session at about the 4:08 mark in the PreCommerce livestream.

Jeremiah Owyang-SXSW-SXW2O

  • Greg McCullough, Senior Director Partnerships, Medtronic and Gail Day, VP, Publisher Harvard Business Review
    Greg and Gail sat down to discuss what’s next in brand/ media partnerships. Gail attributed part of HBR’s success to the organization’s commitment to a goal to rid the world of bad management. That focus also extends to their partnerships. They’re strict about working with their brand, and that’s why they choose to work with limited partners. Medtronic was one of those partners. Their collaboration resulted iYou can watch their session at about the 4:31 mark in the PreCommerce livestream.


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  • Becky Brown, VP Digital Marketing & Media Group, Intel
    Becky spent a few minutes discussing The New Digital. Becky reiterated that marketers are all aware of consumers’ aversion to ads—look no further than ad blockers and the fact that they are willing to pay a premium for services without ads. Intel is answering this co-creating with companies like Buzzfeed and Mashable. And now, taking that idea with new ESPN where they integrated technology into the X Games, which allowed both companies to create new kinds of content. And they are building on the success of their online magazine called Intel IQ, where they will introduce original programming next month. You can watch Becky at about the 5:28 mark in the PreCommerce livestream.

Becky Brown-SXSW-SXW2O


  • Amy Hoopes, CMO, Wente Vineyards
    Amy took some time to discuss how user experience is becoming the new marketing. The family Amy works for has been in the wine industry for 133 years, in the Livermore Valley area of California. They were always good at making great wines. To understand the history of Wente Vineyards, Amy did extensive interviews with the family. Through that research, it was clear that the Wente family had been doing many innovative things, like operating a full-service white tablecloth restaurant that recently celebrated it’s 30th birthday. Amy talked about here SMS strategy: Simplify, Motivate and Share. You can watch Amy’s session at about the 5:43 mark in the PreCommerce livestream.

Amy Hoopes-SXSW-SXW2O

  • The third panel of the day, All Hype Aside featured 1) Michael Putnam, SVP Consumer Marketing, AmericanWell 2) Lorie Fiber, Global Corporate Communications, IBM Health and 3) Jeroen Brouwer Director of Marketing, Sales and Business Development, Philips
    Our own Rob Cronin moderated this esteemed panel of guests to discuss how digital health will impact our lives in the future. You can watch the panel discussion at about the 6:20 mark in the PreCommerce livestream.

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  • Alex Gruzen, CEO, WiTricity Corporation
    Alex discussed the future of wireless charging and how it will impact us with all the smart devices we carry with us every day. When he says wireless, he means it. Their technology doesn’t require a charging pad to be plugged into on outlet. It’s about moving power over a distance. WiTricity Corporation’s technology works with all kinds of devices: from Bluetooth headsets, to laptops and tablets, and event electric cars. You can watch Alex’s session at about the 6:56 mark in the PreCommerce livestream.

Alex Gruzen-SXSW-SXW2O

  • Amber Naslund, SVP Marketing & Chief Evangelist, Sysomos
    Amber used her time to discuss the Future  of Analytics: Social Data and Beyond. She started by talking about how much customer expectations have changed. They expect answers in 30 – 60 mins, and they also expect those answers on nights and weekends. She  also talked about how creative design is even more important as a way to reach customers. Then, she discussed the importance of bridging the gap between data scientists and marketers or communicators. Analytics is currently a specialized skillset. But back in the 50s, typing was a job that was done via dedicated employees. Amber argued that data analysis will ultimately become a core skill just like typing did. You can watch Amber’s session at about the 7:10  mark in the PreCommerce livestream.

Amber Naslund-SXSW-SXW2O

  • Shiv Singh, SVP Global Head of Digital & Marketing Transformation, Visa
    Shiv discussed how to open source your brand.  He started with a simple but painful premise: that customers don’t trust your brand. And then he offered examples of how Visa reached out to the startup community for innovative ideas. One outcome: they are opening up the Visa network as an API for developers. You can watch their session at about the 7:20 mark in the PreCommerce livestream.

Shiv Singh SXSW SXW2O

  • Hugh Forrest, Director, SXSW Interactive and John Battelle, CEO of NewCo and co-founder of Wired Magazine & The Industry Standard
    This fireside chat was a blast. John interviewed Hugh on the past, present and future of SXSW. See my earlier blog post here for a much more detailed summary of that lively discussion. The interview covered a lot of ground. My favorite quote from Hugh? “TED is this finely curated meal. And that’s wonderful. [SXSW] is a 24-hour all-you can eat buffet, and that’s wonderful at times too.” You can watch Hugh Forrest’s interview at about the 7:40 mark in the PreCommerce livestream.

Make sure to tune into W2O Group’s Movers & Shapers event.


On the annual springtime migration to Austin, our clients, partners and friends—without fail—take one look at the super packed SXSW Interactive schedule, get excited, get overwhelmed and then proceed to have nasty flashbacks to first year course selection at university. Well, with deep gratitude to my esteemed colleagues Kristen Grant and Melissa O’Hara for their SXSW sleuthing skills, we’ve tried to take out some of the guesswork.

The team waded knee deep through the SXSW Interactive Health & MedTech stream of events to find what we hope will be some of the golden nuggets. Just think of us as your team of guidance counselors, here to help you pick your major, minor and maybe a couple electives.

But before we get to the list, I want to highlight our own MDigitalLife team who will have a standing presence at the SXSW Health & MedTech Expo. They will be showcasing how we can help you understand and leverage the online healthcare ecosystem, having mapped the digital footprints of over 700,000 stakeholders worldwide. Be sure to stop by and visit them as you make your way around the sessions.

Now, let’s get to our recommended sessions. Each link takes you to the relevant page on the SXSW site where you can add the event to your schedule.

Friday, March 11, 2016

2016 SX Health & MedTech Expo

Time: 10:00am-6:00pm

Location: JW Marriot, 110 East 2nd Street

SX Health & MedTech is an integral part of SXSW Interactive, brings together many of the conversations being discussed at SXSW – not to mention that everyone has a personal relationship with health. Look for the 2016 event to expand the number of exhibitors, broaden and deepen the discussion topics, and make it even more accessible for the SXSW community to participate in the conversation.

Saturday, March 12, 2016

Value Revolution: Transforming the Health Business

Time: 9:30am – 10:30am

Location:  JW Marriott, Room 203-204 110 E 2nd St

This panel will explore the groundbreaking solutions to the problems that have driven the system to the breaking point, along with specific regions and ecosystems that are making those solutions real.

Apps and Better Medical Outcomes: Real Solutions

Time: 11:00am-12:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

This panel will discuss cutting edge mobile solutions that help with communication among caregivers, educational or job re-entry, organization of medical records and independence

Virtual Health: Is it Real or Just Fantasy?

Time: 11:00am – 12:00pm

Location: JW Marriott, Room 203-204 110 E 2nd St

Experts will speak about a number of topics including the historical legislative and policy initiatives that have hindered and promoted the use of virtual health at the state and federal levels and the rapid development of technology that is enabling these platforms to provide improved access and quality driven outcomes.

A New FDA: A Partner for the Digital Future

Time: 12:30pm-1:30pm

Location: JW Marriott, MedTech Stage 110 E 2nd St

Leading this charge is Bakul Patel, Assoc. Director for Digital Health at the FDA, who will provide insights into the FDA’s current and future plans for regulating digital health and answer those questions you were afraid to ask.

Rare in Common: Building Rare Disease Communities

Time: 12:30pm-1:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

This session will explore the potential and impact of these digital communities with rare diseases in common from the point of view of multiple stakeholders: the people facing rare diseases themselves, companies dedicated to developing medicines for them, and thought leaders in rare disease communications.

Virtual Physicians: The Future of Healthcare

Time: 12:30pm-1:30pm

Location: JW Marriott, Room 203-204 110 E 2nd St

Join us to explore the revolutionary role virtual humans may play in your healthcare future! Part of the IEEE Tech for Humanity Series.

New Prescription: Mobilize Patients’ Communities

Time: 3:30pm-4:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Hear from the President of Seton Medical Center Austin and CEO of Rallyhood, who created an innovative program to mobilize patients’ personal communities that aide hospital recovery.

Digital Health and Outcomes: Where’s the Evidence?

Time: 3:30pm-4:30pm

Location: JW Marriott, MedTech Stage 110 E 2nd St

This panel, moderated by BuzzFeed’s Stephanie Lee, will explore how digital health companies can use clinical evidence to succeed through the lens of a company that has commercialized its outcomes (Omada Health), a company that validates emerging products (Evidation Health), and an investor that evaluates hundreds of companies each year (Rock Health).

The Future of Medicine: Where Can Tech Take Us?

Time: 5:00pm-6:00pm

Location: JW Marriott, MedTech Stage 110 E 2nd St

From the prospective of a leading physician, scientist and innovator who is Chair of Medicine at Singularity University, this talk examines rapidly emerging, game changing and convergent technology trends and their potential to change the face of healthcare and the practice of medicine.

Are Medical Devices and Systems Hack Proof?

Time: 5:00pm-6:00pm

Location: JW Marriott, Room 203-204 110 E 2nd S

As clinicians increasingly rely on computers vs. common sense, and medical devices become increasingly vulnerable to security breaches, it’s time for new dialog on trust and security for Medtech.

Sunday, March 13, 2016

2016 SX Health & MedTech Expo

Time: 10:00am-6:00pm

Location: JW Marriott, 110 East 2nd Street

Look for the 2016 event to expand the number of exhibitors, broaden and deepen the discussion topics, and make it even more accessible for the SXSW community to participate in the conversation.

Telling Health Stories with Interactive Storymaps

Time: 11:00am-1:00pm

Location: JW Marriott, Room 402-403 110 E 2nd St

This interactive workshop will use Esri’s storymapping technology and teach participants how to find health data, combine different data, and display them through interactive storymaps that create unique, holistic depiction of personal and community health. Bringing your own health data is encouraged!

Revolutionizing Med Education to Transform Health

Time: 12:30pm – 1:30pm

Location: JW Marriott, Room 203-204  110 E 2nd St

Experts on the front lines of this revolution will discuss how medical schools are changing, what this means for students, educators, patients and the community, and how technology and innovation will help create physician lead in the evolving education landscape.

Hacking for Healing: MedTech & Chronic Disease

Time: 12:30pm-1:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Four experts will discuss their platforms, research, and deep experience to give chronic disease patients new ways to think about managing their health — shifting from precision medicine to precision prevention.

Imagining the Future of Personalized Medicine

Time: 3:30pm-4:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Jennifer Darmour, wearable tech expert and designer, David O’Reilly, leader in digital medicine, and Alan Levy, veteran innovator of specialty pharma products, debate the best path forward toward more engaging and personalized healthcare and lay out future possibilities that will astound you.

The President’s Precision Medicine Initiative

Time: 3:30-4:30pm

Location: JW Marriott, MedTech Stage 110 E 2nd St

The Precision Medicine Initiative, unveiled by President Obama in January 2015, is a bold new cross-government initiative to build the technology, data and policy frameworks to catalyze new insights and therapies so that every patient can have individualized, tailored treatment.

(Video) Gaming the Healthcare System

Time: 5:00-6:00pm

Location: JW Marriott, MedTech Stage 110 E 2nd St

Games, video games in particular, have shown a much more significant contribution to healthcare by providing a connective community and therapy to both physical and cognitive impairments, as detailed by our expert panel. Come play!

Millennials in Medicine: Good or Bad for Health?

Time: 5:00pm-6:00pm

Location: JW Marriott, Room 203-204 110 E 2nd St

This panel of leading millennial physician-innovators will offer a provocative prognosis for the future of US healthcare and debate the net value of physicians disrupting rather than providing healthcare.

Deadliest Catch: New Cancer Diagnosis Approaches

Time: 5:00-6:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Biomarkers are recognized as a critical tool for bringing new drug candidates to market and driving personalized medicine. Now, this groundbreaking science provides a powerful new opportunity to detect and prevent lethal cancers and save lives.

Monday, March 14, 2016

Wearables: The Powder Keg for a Health Revolution

Time: 9:30am-10:30am

Location: JW Marriott, Room 201-202 110 E 2nd

Join Garmin, a global leader in connected fitness and wellness technology, and Validic, the healthcare industry’s leading digital health platform, as they discuss how wearable technology innovation and adoption is setting the stage for a healthcare revolution.

Rethinking Healthcare Through Design Thinking

Time: 11:00am-12:00pm

Location: JW Marriott, Room 203-204 110 E 2nd S

This panel will feature a nationally recognized health design leader to lay out the landscape of problems facing healthcare, and he will demonstrate how creativity and design can address – and have addressed – those challenges.

Consumer Reports: What’s Our Health Data Worth?

Time: 11:00am-12:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Hear solutions for balancing individuals’ right to privacy with profound opportunities to serve the public good, advance science & innovation, and achieve a more effective health-care system. Takeaways include ideas for new regulations, systems, and best practices, plus actions we can all take to manage our valuable health data more responsible.

CDT/Fitbit: Ethics and Privacy in Wearable Research

Time: 12:30pm-1:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Through a visually engaging presentation, the presenters will offer details on the project goals, methodology, findings, and analysis, as well as present the final guidance recommendations.

Wearables in Health: In Theory and in Practice

Time: 3:30pm-4:30pm

Location: JW Marriott, Room 201-202 110 E 2nd St

In this dual presentation, Dr. Sam Volchenboum will speak to where we’re at and where we’re headed regarding the challenges and benefits of using wearable data to inform treatment and clinical trials. Dr. Ray Duncan of Cedars Sinai Hospital will share the practical hurdles, insights, and success stories of integrating wearable data with EMRs at one of the most connected health systems in the country.

Tuesday. March 15, 2016

Tech in the Golden Years: How Tech Changes Aging

Time: 9:30am-10:30am

Location: JW Marriott Room 201-202 110 E 2nd St

In this panel, SXSW goers will gain a fresh perspective on emerging tech in senior healthcare from an often unheard generation at SXSW: a baby boomer. HomeHero, Heal and PillPack will speak on the need for quality caregivers, physicians and easy access to medication, while the aging senior can share his own perspective.

We the People: Healthcare and the 2016 Election

Time: 11:00am-12:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Join Jane Adams, Washington insider & Senior Director of Federal Affairs, Johnson & Johnson, & Lauren Chauret, Partner at PTV Healthcare Capital, as they discuss the 2016 election, its implications on the healthcare system & show you how to come out on top!

Inhale and Exhale: The Future of Health Data APIs

Time: 3:00pm-4:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

A generation of startups are taking on the enormous task of building simple, portable APIs for health data. These companies are building solutions that will finally bring about the interconnected health system that we are all desperately waiting for, and could hold the keys to cracking open the health IT market.

Fixing the Patient Behavior Change Gap

Time: 5:00pm-6:00pm

Location: JW Marriott, Room 203-204 110 E 2nd St

This panel explores why behavior change is so difficult, even when it’s in our best interest, and how new technologies and smarter design can help us solve the largest problem in healthcare tech — behavior modification and engagement.

Improving Physicians’ Understanding of Patients

Time: 5:00-6:00pm

Location: JW Marriott, Room 201-202 110 E 2nd St

Based on case study data, participants at a recent health app design challenge developed a FHIR-compliant application that intuitively communicates the patient’s status to any interested party.

Of course, while SXSW sessions can be hit and miss, we hope that this curated list of recommendations helps you navigate the maze of SXSW and have a better overall experience at SXSW. And if you have other recommendations or feedback on our shortlist, please be sure to let us know in the comments below.

Learn more about W2O Group

These are exciting times to be involved with the medical device and diagnostic industry. It had hit a bit of a rough patch with a bloated “me-too” market, some bad press and an investment void for early technology… but things are looking up, according to buzz on the Street.

There’s a shift occurring, and this entrepreneurial, burgeoning-teenager of a market is maturing before our very eyes. Proof points include consolidation at the top with major M&As happening as manufacturers strategically align and restructure within the confines of our new healthcare landscape and regulatory environments.

As start-ups and emerging companies continue to fuel the industry with smart and intuitive innovation, the FDA’s recent rollout of its Expedited Access Pathway (EAP) is an encouraging development that will help get life-saving innovation to patients in need, faster. And in an industry where a novel idea can still catch the eye and pocketbook of an investor, IPOs are at a healthy volume and bankers anticipate another banner year for venture-backed device and diagnostic companies, with maybe fewer but more robust investments.

I recently listened in on an industry webinar from Medtech Strategist. This, as well as other recent medical device industry reports have left me on the edge of my seat for what’s to come. But possibly even more exciting is the realization that W2O Group is in the trenches and involved from the ground up with many of the industry’s most history-making medtech.

I’ve been geeking out on medical technology since my entrée into the field with hips and knees, back when metal on metal sounded like a good idea… I’ve always been drawn to a cool, new medical device that disrupts the status quo and challenges you to think about health in a new way. And as with all big ideas that challenge the standard, sometimes you win (big) and sometimes you lose (big), but the learnings are invaluable for the field, as we’ve seen recently with renal denervation and previously in spine and orthopedics.

I’m surrounded by fellow medtech junkies here at W2O Group. And from a communications perspective, we are partly and sometimes wholly responsible for getting the word out to physicians, patients and investors about life changing, inspiring new interventional therapy options – which keeps me coming back for more everyday.

We work with some of the most promising new innovations in the market, like drug-coated stents and balloons to open clogged arteries, intuitive pacing devices for heart rhythm disorders, TAVR for valve disease and seemingly-futuristic technologies like miniature cardiac devices and ingestible sensors that truly amaze.

There is so much more on the horizon for this field in areas like diabetes, neurology, robotics, and digital health and I’m planning to have a front row seat.

Front row seat

As healthcare IT leaders across the industry gear up to let their geek flags fly at HIMSS15 next week in Chicago, here at W2O Group, that means it’s time to share the results from our third annual survey detailing “What Health System CIOs Really Care About.” Utilizing rich social analytics within our community of the nation’s most-socially engaged hospital and health system IT leaders, this year’s report provides key insights and notable trends on what provider CIOs, CMIOs, CINOs and other hospital and health system technology chiefs are sharing and caring about when it comes to using social – Twitter, specifically – to advance the health IT conversation and engage with their networks.

What did our social analytics team discover this year? How did it compare to last year’s results? Below are a few key findings to wet your HIT social media whistle until the full report is released on Monday, April 13. (Be sure to follow #HITsmCIO and @W2OGroup on Twitter for more information before, during, and after HIMSS15 for more insights and updates from our MDigitalLife #healthecosystem!)

When it comes to the top topics, not surprisingly, electronic health records (EHRs) take first place. Coming in second is mHealth, followed by innovation, big data and Ebola, the latter of which showcases just how important a medium social can be in the realm of public health awareness and communication among today’s hospital and health system IT leaders and their networks.

Top 5 Topics

As for the most mentioned CIOs, Beth Israel Deaconess Medical Center’s Dr. John Halamka leads the pack with the most @mentions among hospital and health system IT leaders from our MDigitalLife #healthecosystem community. The list of top mentioned CIOs includes:

• John Halamka, MD, Chief Information Officer, Beth Israel Deaconess Medical Center (@jhalamka)
• Edward Marx, Chief Information Officer, Texas Health Resources (@marxists)
• Luis Saldana, Chief Medical Informatics Officer, Texas Health Resources (@lsaladnamd)
• Sue Schade, Chief Information Officer, University of Michigan Hospitals and Health Centers (@sgschade)
• David Chou, Chief Information Officer, University of Mississippi Medical Center (@dchou1107)

Can’t wait until next week for more research results? Please be sure to follow the #HITsmCIO hashtag on Sunday, April 12, from 5:00pm-7:30pm CDT, as we live tweet from our #HITsmCIO Networking Reception, where we’ll be presenting a first look for some of today’s top CIOs, members of the media, and social influencers across the industry. (Invitation-only event. Please contact W2O Group for more information).

For more information on our 2014 research, please see here, and be sure to follow @W2OGroup and #HITsmCIO on Twitter for the latest updates from our 2015 research!

There’s been an outbreak of measles mentions on social media this year.

Unless you’ve been off the grid the past month, it’s likely you’ve seen, shared or even commented on the measles outbreaks happening across the U.S. My own Facebook page has become a battleground between parents angry at those who refuse to vaccinate and others who are concerned the shots could lead to adverse reactions. On Twitter, I’ve seen doctors argue about how to talk to patients who express unease, or hostility toward vaccines.

The overall flurry of social commentary on vaccinations rose in late January, as reports emerged that a measles outbreak could be traced back to a sick Disneyland visitor in December that exposed other guests. The stream of tweets, posts and comments subsequently became a deluge once top national politicians started weighed in on whether parents should be required to vaccinate their children.

Measles-Twitter Spike Chart

W2O Group decided to look at how doctors were addressing the topic on social media. We dove into our proprietary database, called MDigitalLife, which has created a ‘digital footprint map’ for more than 500,000 U.S. physicians. These digital footprints may include twitter accounts, blogs, Facebook pages, Instagram or LinkedIn accounts or practice websites. Like epidemiologists, we wanted to trace the outbreak of public, social commentary by physicians to see who was driving the conversation and spreading it the most.

Though the Super Bowl and the annual American Surgical Congress meeting were top retweeted topics in January, hashtags for measles and vaccines were also trending. In fact, while #health or #healthcare commanded a majority of the physician-originated tweets, #measles was the second hottest hashtag, with 25 percent of the posts measured. #SOTU, for State of the Union, came in third with 20 percent.

The volume of tweets mentioning measles went from a total of 92 in December to around 3,700 in January. There is a clear spike in mentions starting on January 21.

Measles-Infographic 1 

Interesting side note: while the jump in measles conversations is noticeable, it still is far below how much physicians were chatting about Ebola last year. That disease went from a single tweet mentioning it in February 2014 to 27,000 by October.

In January, the tweet from a physician that was retweeted the most by other physicians came from Dr. Jennifer Gunter, an obstetrician and gynecologist. It said: “Measles should be renamed McCarthy-Wakefield disease,” referring to Jenny McCarthy, the model, actress and TV host who is an anti-vaccine advocate, and Andrew Wakefield, the British former physician who’s (now discredited and retracted) 1998 paper in the journal Lancet linked the MMR vaccine to autism.


Some of the top shared tweets among doctors on the subject included a retweet from “God” that says “I’m bringing sexy back! Sorry, not sexy, measles.”


A tweet by NBC Tonight Show host Jimmy Fallon also got a lot of play among this set. It read: “There are now 102 measles cases. You know things are getting bad when Disneyland opens a new ride called It’s a Small Pox World. #falonmono


Another top retweet by physicians was a link to a letter penned nearly 30 years ago by Roald Dahl, author of Charlie and the Chocolate Factory, among other beloved children’s books. Dahl wrote the letter urging parents to get their kids vaccinated. He recounted how his seven-year-old daughter, Olivia, who had contracted measles in 1962 was seemingly on her way to recovery, when she suddenly seemed unable to move her hands like she wanted to.

“I feel all sleepy,” she told him. Then, he says, “in an hour, she was unconscious. In twelve hours, she was dead.”



The Washing Post’s Wonkblog’s article on “The devastating impact of vaccine deniers, in one measles chart,” was also widely shared by physicians. The post shows the cumulative number of new measles cases from 2001 to 2014. According to the chart, there were 644 new measles cases last year, in 27 states, per the CDC.

WaPo Measles Chart

Washington Post:

A tweet linking immigrants to the outbreak showed up among the top retweeted posts. Coming from Dr. Marty Fox, a self-described “Father, Grandfather, Husband, Patriot, Conservative, Plastic Surgeon, Former And Occasional Talk Show Host,” his tweet read: “Illegals with measles + reduced vaccination rates = a measles outbreak: @ChuckCJohnson”


A tweet by Dr. David Gorski, a “A breast surgeon doing his best to defend science-based medicine against pseudoscience. His opinions are his and his alone. Still blocked by Andrew Wakefield,” as his Twitter bio reads, took a sarcastic approach to the idea that the government shouldn’t force people to vaccinate their children. His tweet read: “Those aren’t measles on your kid’s body. They’re freedom spots. ‘Merica!”


The topic shows no signs of slowing down. There have been more mentions of measles alone during the first 10 days of this month than all of January. A noticeable jump occurred on February 5, when #MeaslesTruth was posted about 1,200 times on Twitter, driven in large part by Wendy Sue Swanson, aka @SeattleMamaDoc, a Seattle-area pediatrician, with 26,400 followers.

As outbreaks continue to be reported in Chicago, Santa Monica and other areas, and the media increasingly covering this from local, national, political and health perspectives, #measles and #vaccines are likely to stay trending for quite some time.

“I’ve said it before, and I’ll say it again: The most exciting innovation of the connected health era is … people talking to each other.”

Susannah Fox from Peer-to-peer health care is a slow idea that will change the world on, August 3, 2013

The concept of the empowered patient isn’t a new one – in fact, that characterization has evolved rapidly over the last several years. According to Health Online 2013 (Pew Internet & American Life Project, Susannah Fox) patients have actually advanced their level of empowerment from simple information-seeking to actual diagnosis – acceding to the report, 35% of American adults can now be classified as “Online Diagnosers.”

“As physicians, we have a moral responsibility to weigh in on dangerous inaccuracies in the media … Imagine a simple comment from … each of the American Academy of Pediatrics’ 65,000 pediatricians. We are in a position to own the search engines through our collective participation.” 

Bryan Vartabedian, MD from Participating in the conversation: A physician’s responsibility. Baylor College of Medicine Blog, August 7, 2013

We’ve seen a parallel movement among physicians in terms of online activity. Driven by a number of environmental factors. One of the most important is to balance the enormous amount of misinformation and spam online masquerading as health information – because doctors have the knowledge and experience to set the balance right. 

These two trends have begun to collide as never before. The best doctors are often the best students – they literally never stop learning and improving. Many of these leading-edge physicians have recognized that one of the greatest sources of learning are patients themselves.

“I do interact with patients online … I like to hear the stories about health issues they’re facing, and to follow their journeys … It helps me to understand what patients expect – or at least hope for – from their doctors.”

Danielle Jones, MD. Danielle Jones, MD – The MDigitalLife Interview. September 21, 2012

We’re now seeing a migration from relatively segregated Patient-Patient and Doctor-Doctor communities to online communities where both mingle freely, sharing and learning together. One of the most fascinating places to map that circumstance is on twitter, where the study of direct conversations between doctors and patients can be visualized to help us understand how those networks function. 

[If you have trouble viewing the embedded social network map, you can go directly to]

To create the chart below, we looked at the twitter conversations of 89 prominent ePatients and ePatient advocates to see how often they used the twitter handle (e.g., @DrAttai) of one of the more than 14,000 validated US physicians tracked in the MDigitalLife database. We then looked at the tweets from the 297 doctors mentioned by the ePatients, and identified every instance in which one of the ePatients was mentioned.

Using Google Fusion Charts, we were able to visualize those interactions to show the interconnectedness between the ePatients (yellow dots) and physicians (blue dots). Feel free to play around with the chart by dragging network nodes to change its shape, and buy changing the filters to show more or fewer nodes. 

While it’s difficult to gain many insights from viewing every single interaction, we found that when we looked only at doctors and patients who had interacted with each other at least 15 times, identifiable clusters began to emerge. A few examples:

  • There are clear communities based on therapeutic areas such as breast cancer (@DrAttai), heart health (@HugoOC) and blood cancers (@myelomateacher)
  • While there may be fewer online interactions outside the specialty/therapeutic area classification, ePatients and advocates like Dave DeBronkart (@ePatientDave) and Lisa Field (@PracticalWisdom) have a massive number of connections to the physician community, with no apparent focus on specialty
  • To a lesser degree, doctors like Bryan Vartabedian (@doctor_v), Howard Luks (@hjluks) have significant connections in the ePatient community that have little to do with their medical specialties (pediatric gastroenterology and orthopedic surgery respectively)

While it’s premature to assume that we fully understand the nature of those interactions, we can generalize in saying that these bellwether patients and doctors get benefit from their interactions in a more “meta” sense – they’re exploring the very nature of the evolving doctor-patient relationship.

I’ll end this post with a quote from one of my co-panelists at this week’s Digital Health Summit:

“Patients often only bring their narratives to the dialogue. If we want to get a proper seat at the table we need to do better than that.” 

Hugo Campos, ePatient Advisor, Stanford Medicine X

I’m fortunate to be on a panel at this week’s Digital Health Summit at the Consumer Electronics Show in Las Vegas with leading ePatients Hugo Campos and Donna Cryer; moderated by health technology thought leader Neil Versel  If you’re interested, you’ll definitely want to follow along with the #DHCES hashtag on twitter on Wednesday and Thursday, January 8 and 9. Our panel will be at 4:10 PM PST/1:10 PM EST on Wednesday the 8th, and is entitled “Loudmouth Patients: Making Noise and Making Change.”

With special thanks to the brilliance and hard work of Ben McKown and Yash Gad – they make data do strange and wonderful things!

[Note: This post offers an exclusive opportunity for doctors to receive an “alpha” version of the Online Activation for Physicians eBook; read on for details]

Face it:  Thinking that a re-tweeting of how much we want more doctors on Twitter by next year is just preaching to the social media choir.  After all, those on social media are already supporters.  How do we get physicians who are not on social media to understand its potential value to them?
– Dr. Westby Fisher, Let’s start a grassroots physician social media movement (via, December 31, 2013)

Having studied physicians’ online behavior for more than 5 years now, I’ve had a chance to see the highs and lows of their adoption of social media. Doctors like Mike Sevilla, Wendy Sue Swanson, Bryan Vartabedian, and Jordan Grumet have been online for years and years – and seeing them leverage the power of social media to connect, organize and re-establish the voice of the physician in public health dialog has been an incredible inspiration to me and many others. It’s why I started to write about physician innovators under the MDigitalLife banner in 2012, and have featured these folks and many others for their work.

Dr. Westby Fisher is another one of those pioneers – though one I haven’t had the opportunity to meet personally. In the piece that I quoted above (which is a must-read, by the way), Dr. Fisher notes that physician engagement in social media isn’t going to become the norm just because social media is “cool.” It’s only going to happen en masse when more doctors see a clear value proposition in investing their precious time in pursuing that engagement.

I’ve had the opportunity over the last two years to train over 100 doctors in the W2O Group’s “Online Activation” model. As that model has evolved, there are a few things I’ve found to be most impactful in terms of “unlocking” doctors in social media:

  • Spending more time than you’d think on goal-setting … what is it that each person actually hopes to achieve in their career, their practice, their research, etc.
  • Explaining that social media isn’t just about yapping incessantly. Our model has 4 components: Read, Connect, Share and Create – and we don’t even cover the “creation” aspect in the initial coaching session!
  • Removing tactical roadblocks – the most basic “how-to” of using social media tools and channels to achieve each doctor’s “use case”
  • Showing real examples of doctors who are using social media to add value to their particular set of goals

It’s this last item that Dr. Fisher’s blog post called to mind.

Those of us who are believers have to show them a well-organized RSS feed reader containing journal articles and news reports they’re want to say up up to date with and likely read.  We have to show them how to use social media to collaborate (in near real-time) with colleagues to write an article or crowd-source a talk.  We need to show them the contacts — many who they’d recognize — you’ve made around the globe.  Show them how they can lurk and get the information they need without having to expose themselves to any potential legal issues. 
– Dr. Westby Fisher, Let’s start a grassroots physician social media movement (via, December 31, 2013 – emphasis mine)

To that end, I decided to answer Dr. Fisher’s request – by sharing a bundle of RSS feeds representing the blogs of over 60 doctors (note: this is scratching the surface; we’re tracking over 2,500) using an amazing reading tool called Feedly*. So without further ado, here’s your physician-blogger “starter list” – along with the “alpha” version of the Online Activation Planning for Physicians eBook.

To subscribe to our list of physician blogs:

  1. Sit down at your laptop or desktop computer (This initial step can’t be taken via tablet or smartphone yet. After this initial step, you’ll be able to do everything via web, tablet or smartphone at your discretion).
  2. Download this OPML file you’ll find here [] and save it to your desktop (Don’t try to open it; it’s gobbledygook to look at on its own).

If you’re already a Feedly user:

  1. Log in to your feedly account.
  2. Under the “My Feedly” menu, click “Organize”
  3. Select “Import OPML”
  4. Click “Choose File” and select the file you just downloaded
  5. Click the blue “Import” button

If you’re not a Feedly user, just follow the steps in this Slideshare presentation:

And if you’re a doctor and would like to get a copy of the “alpha” version of the “Online Activation for Physicians” ebook, just complete this form and I’ll email you a copy.

If you’d like to know more about our MDigitalLife program for understanding, engaging and activating physicians online, feel free to email me at Thanks to Dr. Fisher for giving the right airtime to this important topic!

*There are many reasons that we use Feedly for this purpose, but the most important ones are: (A) It presents a beautiful and consistent reading experience on the web, tablets and smart-phones. (B) It allows 1-click sharing and saving to any social network or note-taking tool. (C) The Feedly leadership team loves the idea of a reader tool as a part of the revolution in physician communications, and have been working with my team to add new features that support that goal even more seamlessly.

Hello W2O,

Please see below for more insights coming out of the W2O Go. Ahead in Health Summit.

W2O Public Affairs (Kieran Fagan)
Kieran Fagan joined us to discuss W2O’s outlook for building out our public affairs offering. He pointed out that we can apply our analytics, creativity and public affairs practices to target and engage key decision makers of legislation and public policy, which will give us the opportunity to become more involved with legislations that impact our clients. By synthesizing data gathered through analysis of conversation, influencer identification, and the congressional digital database, we can use this information to help our clients stay ahead of issues and address them appropriately when they arise. The congressional digital database is a data set of all public online communications from all members of congress that allows us to know who is talking, listen to what they are saying and how it is trending, where they are saying it, and to what depth.

W2O has also partnered with a DC-based public affairs and lobbying firm based in Washington D.C. The firm brings senior-level participation in key executive branch and legislative processes that develop and shape public policy and regulatory decisions. This partnership will be a huge part in driving our public affairs efforts moving forward.

Panel: Affordable Care Act
Moderator: Elise Trent
Panelists: Jared Danielson, Brian Reid, John Osborn
Elise Trent prompted panelists to discuss the Affordable Care Act and its potential effect on our nation and company as a whole. Setting political views aside, the conversation opened up to the audience and our W2Oer’s asked some pertinent questions. All we know for sure is that there are still alot of lingering questions when it comes to how successful the ACA will be. Our wise panelists agreed that it will be the citizens that will determine the outcomes of this new Act.  Ultimately, whether we like or not, the ACA is enforced and we have to find a way for all parties to deal with it.

Clinical Trial Recruitment (Dorcas Lind)
Dorcas spoke about the changing landscape for clinical trial recruitment and how to address the current challenges with new, innovative approaches. With access to information increasing and patients and caregivers becoming more active online, it is more important than ever to ensure that patients are educated about treatment options and their benefits. Looking forward, companies will need to use analytics to drive strategy, engage key influencers and create awareness with customized content, implement multi-channel engagement, and activate study site coordinators on social platforms. This will help lead to better, qualified patients, accelerated enrollment and fewer dropouts.

Best Integrated Account (Greg Reilly and Danielle Whitney)
Merck – EMD Serono won this year’s Go. Ahead in Health Award for best integrated account. Greg Reilly and Danielle Whitney joined us to discuss how their team approached the challenge to deliver a multi-pronged program to coordinate digital strategy on a global scale. They explained that collaboration across multiple disciplines depends on team dynamic, relationships and execution. If we are providing diverse offerings then our client contacts should be diverse as well. Developing senior-level relationships and holding integrated planning meetings with our clients will help develop stronger partnerships and create more efficiency in driving our plans. From an internal standpoint, clarity of roles and responsibility, and flexibility are essential for operations. Discuss business problems frequently to come prepared with solutions.

Overall, the Go. Ahead in Health Summit energized and aligned our practice heading into 2014. We left the summit prepared to tackle the challenges ahead and continue to do great work for great clients.

Hello W2O,

Following up from our first update last week, please see below for a recap of presentations from our colleagues and special guests on Day 1 of the W2O Go.Ahead in Health Summit!

The Patient Perspective (Dorothy Jones, Vice President of Marketing at Susan G. Komen)

Dorothy spoke about the best practices in reaching patients and how digital channels are amplifying the patient voice and advocacy. In the changing digital landscape, we need to focus on the way we approach access, advocacy and digital channels. The digital space has helped us become more informed, however, people aren’t utilizing the information. Dorothy said it is important to empower people to act on this information by keeping your messaging simple, illustrating the benefits clearly and providing actionable next steps. Patients want information. Find out where they are, what they are looking for and in what stage of their journey they need this information. After the presentation, W2O employees were able to witness something truly amazing. Following a heartfelt story from a cancer survivor, W2O offered a generous donation to the Susan G. Komen foundation. The round-of-applause felt in the room solidified the importance of the work we do each day.

Panel: Future of Integrated Healthcare Delivery
Moderators: Jennifer Davis and Marisa Carullo
Panelists: Kathleen Hertzog, Vice President, Marketing & Communications at Availity, Elizabeth Gerstung, Managing Director at Evolent Health, and Betsy Kline, Vice President Global Marketing, Proteus Digital Health

The panelists spoke about how integrated health systems, companies and products are changing the way health is delivered today and in the future. Current trends are showing reduced hospitalizations and reduced costs associated with integrated health care delivery. We need to develop the market by educating people on these important shifts in health care along with what tools are available. We are going to have a broader audience, so it’s important to think about unique ways to engage them and take learnings from other industries on how to educate and drive action.

Involved physicians will create and empower informed patients and informed patients will take greater ownership of their health and their relationships with their physicians. With the evolution of the informed patient, patient engagement will rely on delivering integrated, personalized care tailored to the patient’s history, finances, demographics, etc. It’s about delivering the right information at the right place and at the right time.

Panel: Genomics Revolution
Moderator: Kelly France
Panelists: Tracy Garcia, Account Director, W2O, Raluca Kurz, MS, LCGC, Invitae, and Katherine Sutherland, MD, Women Physicians OB/GYN Medical Group, El Camino Hospital

The panelists discussed how genomics and personalized medicine are changing research, treatment and patient communication. Technology advances have brought sequencing prices down and has helped drive more interpretation of the genome, and the market for genetic testing is expected to increase with this trend. Genetics will likely ultimately create a revolution in diagnostics and personalized treatment. However, physicians are hesitant to use genetic tests due to the technology and uncertainty and insurers are worried about the expense. We need to demonstrate that the future of this technology will drive great medical advances and that reimbursement will work. Once this is achieved, genetics will ultimately be taken out of the clinic and brought directly to the consumer which will enable us to take action from a public health standpoint.

Panel: Putting it Together: Integrated Communications
Moderator: Audrey Gross
Panelists: David Witt, Christina Devi, Eric Hawkinson, and Carl Engelmarc

The W2O panel members came together to talk about overcoming the challenges of engagement, new opportunities, and lessons learned. When working with our clients, we need to be persistent on the value added in our propositions. Be aware of the current state of the industry and where the client sits, and use this knowledge to model how you can partner with them to be successful in the current climate.

These models should understand what the benefits are, measure those benefits and provide a summary of what the value is.
If our company is offering integrated communications, then our people should be familiar with all components of what we are offering – KNOW THE DATA. Clients want to know what the insights mean for them and how they will help their business. Have a clear process in place and look at the insights with a plan in mind. Work with your team to build integrated plans around these insights and client needs and bring options for solutions to a problem.

Stay tuned tomorrow for more updates!

-Roving Reporters

Today, FDA held a tweetchat to provide further clarity and answers around its guidance on mobile medical app regulation. The basic takeaway on the guidance (which can be found here) is … it’s good! It’s clear! It’s pro-innovation! That’s great for companies and developers, but doesn’t make for a very exciting Twitter exchange.

Essentially the types of medical apps the FDA intends to regulate are largely unchanged from the draft guidance, but impressively the areas where FDA intends to exercise enforcement discretion – in effect, a hands-off policy – are significantly expanded. As you may have read in my colleague, Brian Reid’s blog post on Sept. 24, big pharma and health care solution providers will, for the most part, be able to develop away with little interference.

Apps that help patients manage their own condition (without providing specific treatment suggestions), organize their personal health information, provide access to information regarding their condition or treatment, help them communicate potential medical conditions to care providers, automate tasks for care providers or enable patients to interact with their personal health records or electronic health records are all fair game.

And FDA certainly had its talking points down, per @FDADeviceInfo: “FDA’s final MobMed guidance supports innovation & protects consumers”. That was a message that got repeated.

FDA did provide a little more color around its philosophy:
• “Enforcement discretion” = FDA is not actively enforcing requirements for manufacturers to register and list with the FDA
• FDA will review apps in a way that balances risks/benefits without creating unnecessary burden for app developers
• The FDA guidance reflects its focused priorities on apps that pose greater risks to patients & is a big de-regulatory action
• Apps that require FDA review will be evaluated according the same risk-based system the agency applies to other medical devices

A brief recap of select Q&A from the tweetchat can be found below. The full tweetchat can be reviewed online at, #FDAapps:

Q. How will FDA be monitoring apps for compliance? Browsing the Apple/Google Play stores?
FDA: Our efforts are focused on education and clarity at this time; we are focusing on clarifying areas that need oversight and looking for voluntary compliance.

Q. Logging and recording data seems to be fine, but what about interpreting data and making care recommendations?
FDA: Apps that meet definition of a medical device but pose little risk to consumers are an area where the FDA is exercising “enforcement discretion”; however, making recommendations that change dosage would raise risk to consumers.

Q. Some dosing apps are simple calculations routinely used in clinical practice. Will FDA exercise enforcement discretion for them?
FDA: Yes – please see appendix B in guidance (pg. 23).

Q. Under what circumstances would FDA choose to alter its enforcement discretion paradigm as explained in the guidance?
FDA: We intend to follow this [enforcement discretion] policy unless we have new info that raises public health risk. If/when we change policies we will follow public processes.

Q. Is the FDA checking apps’ algorithms and/ or checking validation/evaluation of apps?
FDA: It depends on the risk of the device & patient exposure. With regards to functionality, it would be similar to other high risk development.

Q. Is there a time at which you hope to transition to another phase–one of enforcement and action?
FDA: We will allow reasonable time for app developers to be into compliance prior to enforcement actions.

Q. How long does app rev/approval typically take?
FDA: On average, it has taken 67 days for clearance but it depends on the complexity and functionality of the app.

Q. Approximately how many ‘clearances’ of apps are we talking about up till now?
FDA: The FDA has cleared about 100 mobile medical apps over the last 10 years

Other resources:
• For questions about a specific app, please email:
• Health professionals & consumers may submit reports of mobile medical app adverse events or problems to FDA online & by phone @ 1-800-FDA-1088

Click for full report

2012 was one heck of a year for new treatments against various different forms of leukemia. In the span of 5 months, the U.S. Food and Drug Administration approved four novel therapies. Drug approvals always come with a spike of media attention, but we at W2O Group have been curious as to how that flood of interest compares with other events throughout the year, not only in news, but in all of the other conversations we have online about cancer.

This is of special interest this week, as thousands of oncologists, patients, advocates and journalists begin arriving in Chicago for the annual meeting of the American Society of Clinical Oncology.

So we decided to look into how we’re talking about cancer, both at the broadest level and in the context of more specific cancers and more specific communities. We’ve collected the results of this analysis in a new report, the Social Oncology Project, that seeks to draw conclusions from hundreds of thousands of tweets, news stories, blog posts and forum entries. We looked both at overall mentions, as well as how doctors talk about cancer, relying on our MDigitalLife database of verified doctors active online.

Our analyses found both encouraging news about the nature of the online dialogue about cancer, as well as some more concerning findings. For starters, there’s no question that we’re talking about cancer. A lot. In the last year, more than 16 million articles, posts, tweets and entries about cancer found their way online in the United States. That’s a lot of talk, and a testament to the impact of awareness raising campaigns.

In fact, there is a direct correlation between awareness campaigns and online conversations. Overall mentions of cancer rise in October due to a surge in posting around Breast Cancer Awareness Month. But similar, if smaller, increases can be seen in almost every cancer type. Lung conversations are highest in November (Lung Cancer Awareness Month). Mentions of colon cancer rise during March (Colon Cancer Awareness Month). Prostate volumes are up in September.

Not surprisingly, the most-talked-about type of cancer is also the one with the biggest awareness push: breast cancer. More people are talking about breast cancer than the other four of the five largest cancer killers combined. (Lung cancer, which kills more than four times as many people as breast cancer, has only 20 percent of the dialogue of breast cancer. Colon cancer, the number 2 killer, has only 10 percent of the conversation compared to breast cancer.)

The larger question of what is driving those conversations, however, paints a muddier picture, one that may be best illustrated by looking back at leukemia conversations. The unprecedented string of new drug approvals in the second half of last year didn’t create so much as a blip in the overall number of online conversations about blood cancers. But football did: when Indianapolis Colts coach Chuck Pagano announced that he had been diagnosed with acute promyelocytic leukemia, mentions shot up tenfold. The next big spike in conversations was also football-related: when the story of Notre Dame linebacker Manti T’eo’s fake girlfriend – who T’eo had said died of leukemia – broke.

Click to enlarge

That’s not to say that celebrities and awareness months are the only drivers of attention, nor that the attention in one medium (say, Twitter) is reflective of discussions in others (say, online news). But, overall, we remain a social bunch online: raw data and “new chemical entities” from the FDA might not move us to share and reflect online, but human stories, be they in the news or those we hear from our friends and colleagues during awareness events, have a way of engaging us.

Scene from the ACR 2011 Tweetup. Photo by Lothar M. Kirsch (@Rheumatologe)

The first crocuses are poking up, a sign that the spring medical meeting season is upon up. This week, it was Conference on Retroviruses and Opportunistic Infections, and colleagues are preparing for everything from the American College of Cardiology meeting in a few weeks, to the American Society for Clinical Oncology and American Diabetes Association confabs in June. I haven’t seen the agenda for everything yet, but I’m confident that all of them will come up short in one profound way: patients will be underrepresented.

This isn’t new. Medical conferences in have long been tilted toward experts — those with data or experience. And attendees have long been rank-and-file health care providers who want to stay on the cutting edge of their field. In the old, top-down system, having patients at these confabs was superfluous. But those days are over, driven by three trends that are likely to reshape the health care system:

  1. The empowered e-patient is demanding the same information available to professionals. And if that information is available at medical meetings, that’s where the patients should be.
  2. Increasingly, information is transmitted not only from provider to patient, but patient-to-patient. It’s no longer a safe assumption to believe that information only travels in one direction.
  3. The patient experience is increasingly important in the treatment process. The way quality of life impacts benefit-risk calculations is highly personal, making an open discussion with patients crucial to understanding diagnosis and treatment.

These trends aren’t entirely hidden, and yet patients are still hard to find at meetings. Part of this is cost. Part of this is logistics. And part of this is the challenge that comes with overcoming the inertia of the existing presentation-first mentality. But there are enormous  benefits to be reaped for groups that can overcome these obstacles.

Last fall, I attended the American College of Rheumatology meeting, and I participated in an informal “tweetup” during the sessions. A group of individuals: half patients, half providers, found a quiet place in Chicago’s McCormick center and had a robust dialogue about how patients view medical advances and what new forms of communication might create bridges between professionals and information-hungry patients. Much of what I took in during the conference has already left me, but not the experience of that tweetup.

(For more on patients at medical meetings in general, and ACR in particular, please see Kelly Young’s recent publication in the Journal of Participatory Medicine.)

The goal, then, is to recreate that experience, on larger scales and at more venues. Conference organizers can play a part by engineering patient interaction into the program (though official, promoted patient activities). And all of us need to think through ways of reducing the cost burden that prevents patients for attending these kind of events, such as discounted rates and more aggressive sponsorship programs.

The result would be stronger patient communities, improved communication and — in the end — better medicine.

(Note: This is not an issue that’s exclusive to medical conferences. Patient voices need to be heard more often in as many diverse forums as possible. The annual SXSW Interactive conference kicks off tomorrow, complete with a health track. Yet patients are under-represented there, too. Is this a subtle plug for the patient-heavy panel I’m moderating on Sunday at 9:30 a.m., with Alicia Staley, Allison Blass, Kerri Sparling and Michele Polz? You bet. See you there.)

#MDigitalLife is a WCG program designed to learn from and to showcase physicians who are blazing new trails in the digital world – changing the way that medicine is practiced and better health is realized.  You can find previous posts here.

“The healthcare organizations who are going to do the best are the ones who can help and encourage their doctors to truly be a part of the community – to help make them human to the patients in the area.  Those are the doctors patients will want to go to for the long term.”

Jordan Grumet, MD

After completing his undergraduate degree at the University of Michigan, getting his MD from Northwestern and completing his residency in primary care at Washington University, Jordan Grumet was convinced that he wanted to be a hospitalist.

That didn’t fit properly, so he went into primary care with a large group at Northwestern.  But that wasn’t quite right either.  The sheer size of the group made it hard for him to really practice in a way that felt comfortable for him.  So he joined a sole-practitioner in Highland Park, Illinois in 2007 and has been there ever since – now as a partner.  The end.

Except that it’s not.  It’s true that ALL doctors are people – which means that they’re all unique.  But how many physician poets do you know?  How about physician-poet-fine art dealers?  Jordan is all those things.  In addition to the work on his blog, In My Humble Opinion, Jordan is working on his first poetry book.  In fact, Jordan’s journey into social media (and hence into MDigitalLife) started with a side project.

Several years ago, Jordan ran a web site selling fine art and figured that he’d need to start blogging in order to drive attention and subsequent sales.  It wasn’t until 2005 that he came to the realization that the social media skils he’d developed could also be applied to his real passion – medicine and health.  When you read Jordan’s blog, you’ll immediately notice some differences from most medical blogs.

“The remainder of the night was a blur. I couldn’t sleep because I was busy with other patients. The man’s wife and family came and went. It wasn’t till the next morning that the phone calls started to roll in.

Apparently my patient had three daughters from a previous marriage who were unaware of what happened. I took three calls that morning. I told three young women that they had lost their father. I waited patiently as they broke down. As I listened to their sobbing, I remembered what it felt like to lose my father. Each call lasted less then five minutes and left an indelible mark on my soul. I had never experienced a grief so pure and innocent as those young women’s. I will always feel responsible.

And this is what the chief meant by being “hurt.” If you practice medicine long enough, you will make mistakes. You will accidentally harm people. You will work long hours and deal with the most primitive human emotions. At some point you either learn to sublimate, learn to move on, or get crushed.

– Jordan Grumet, MD – excerpted from For My Son

A big part of Jordan’s blogging is for self-expression and his own development as a writer.  But it serves two other important purposes.

The first is to help his patients to get to know him in a way that they could never do in a short appointment (or even in a series of short appointments).  “Patients have to bare their souls to their doctors,” he says, “but unless doctors can find some way to equalize that relationship, they’ll never truly reach most patients.”  As a primary care doctor, Jordan describes one of his chief roles is to be “the ultimate detective.”  People come in with undifferentiated problems and symptoms, and you often have to work with them for months – or even years – to define their disease paradigm.  50% of any health problem has nothing to do with physiology – it’s about the psychiatric and emotional issues that come with it.  And the more his patients know and trust him (to the point of being willing to tell him when they disagree, or when they’re not adhering to their treatment), the better he is at helping them to get better.

“When my patients see that I care, it forms an incredible bond.  When they know that someone really understands, they just do better.”

Jordan Grumet, MD

The other reason for Jordan to do what he does is that he believes doctors have had their voice silenced by the system over the years – and that they need to regain it.  They’ve been painted as BMW-driving villains by the media and other players in the health system – and there’s nobody to tell their side of the story.  Through his writing, Jordan is laying down an example for other doctors – and in a small way, beginning to redress that balance.

“Doctors are human beings – and they have more in common with you than you think.”

– Jordan Grumet, MD

I, for one, couldn’t agree more … and I hope that doctors, patients, and people who simply appreciate good writing will visit (and subscribe to, and share) In My Humble Opinion.


A sample from Jordan’s physician reading list:

Westby Fisher –!/doctorwes

Bryan Vartabedian –!/doctor_v

Kevin Pho –!/kevinmd

PDara –!/jedipd

Jackie Fox:!/jackiefox12

Ramona Bates –!/rlbates

John Mandrola –!/drjohnm

Linda Pourmassina –!/lindap_md


Last month, Susannah Fox and the brilliant folks at the Pew Internet and American Life Project and the California Healthcare Foundation put out a report that quantified with great depth how people use the Internet to gain health information, revealing that nearly one in five patients looked online for peers with similar health concerns. It was a tour de force, not the least of which was because a large component of the research looked at the specific needs involved in rare diseases, a finding that was widely discussed in the press.

Less heralded — but perhaps more important — was a deep division in where people looked for certain kinds of health information. For support and basic advice on day-to-day living, most people turned to their peers, demonstrating the triumph of the web as an extended support network. But clinical information still came — in a huge percentage of cases — from a patient’s physician, not Dr. Google.

When patients wanted a diagnosis, they turned to health care providers 18 times more often than they turned to their peers. For prescription drug information, providers  beat out friends, families and fellow patients 81 percent to 9 percent. For emotional support, on the other hand, peers were twice as likely to provide information on emotional support. And in moments of need, offline information-seeking continues to dominate.

The Pew research lays bare a reality that too often gets forgotten in our enthusiasm for technology, especially in communications. There is a sense that society’s gatekeepers and middlemen are being picked off, one by one. Travelocity can stand in for travel agents. The algorithm-derived Google News feed seeks to mimic newspaper editors. Yelp replaces food critics. As — as my colleague Bob Pearson points out in his new book, Pre-Commerce — ratings sites and social media others make advice-dispensing salespeople disposable.

But not in health. As rich as the information is on the web, we’re still turning to doctors when the medical issues turn complex. The implications for communicators are clear. First, we need to understand exactly what people are looking for online (support, advice, diagnoses) and tailor online offering to those needs. And second, we need to understand that education patients still means educating health care providers (more on that next week).

Fox has said the Pew report was 5 years in the making, and it will no doubt be seen as a definitive work in online health. And those it clearly paints a picture of patients and caregivers with increasing digital savvy, it also serves as a reminder that doctors remain central to information seeking. Communicators who ignore that group do so at their peril.