When last week ago I posted my thoughts on what the troubles at Revolution Health signify for "Health 2.o movement" I hoped to initiate a discussion, but did not quite expect to be targeted with personal attacks.

But a serious discussion was certainly started and I am glad that my original post and the ad hominem attack by Matthew Holt unearthed some fundamental issues about the outlook for online health technologies. People should start paying attention to understand what claims they can rely on or not.

First, let me highlight everyone who weighed in on the matter:

• Weak analysis about the "demise of Health 2.0" : Matthew Holt calls me names, but a long comment thread finally gets around to surfacing many issues of substance re: Health 2.0 viability.
• Health 2.0: Fad Or Fundamental: Fard Johnmar does a great job putting my arguments and Matthew's retorts in perspective. He then suggests where to look for genuine new opportunities.
• Health 2.0: Addressable market opportunities: Vijay Goel expands on Fard's areas of interest, talks about changes in value chains and suggests a few new metrics to consider (bravo!)
• Revolution Health: Heralding the Demise of "Health 2.0": Ted Eytan says Health 2.o is not about any specific company or person, but instead "a new way of thinking of health". He labels me "anti-patient"
• For Sale: Revolution Health: John Grohol uses his 10-years of perspective with Internet health to show how little changed since those days. The comparisons with DrKoop.com are eye-opening.
• Gary Levin: Compares troubles of Revolution Health and Health 2.0 to RHIOs that have gone through their own bubble and bust cycle
• Neil Versel : Is hoping to see more "animated discussion"
• Zorgbeheer.com : Concise and clear: "This is how Health2.0 will end"

Now, that the debate has started I would like to note a few points that risk getting lost in the comment threads or have not been mentioned in the above coverage.

Why do I care about Health 2.0 overhype and why should you?

To put it plainly, this is not about protecting "widows and orphans losing their shirt in Health 2.0 IPOs". Any Health 2.o project, be it a new company, a VC investment or a project underwritten by an industry player costs money, often lots of money. There has to be some sort of payoff, by some sort of metric. So even if Health 2.0 is not going to create a standalone industry, as Matthew concedes, every project still has to deliver some kind of result for a sponsor to justify the price tag. This is not different from EHRs, RHIOs or anything else.

If you are making this type of investment decision, do you want to know both pros and cons of every idea, rather than just listen to platitudes? If you want to keep your job, you probably do. You are a buyer and you do not want to be oversold. In traditional healthcare IT world, buyers know where to turn. Groups like HIMSS put vendors through paces. Unlike some bloggers, analysts like Gartner actually do what their clients need. But in the bizzaro Health 2.0 world trees apparently grow to the sky, manna falls from heaven and lions live in peace with lambs.

When a "movement" is fueled by vendor hype targeted at people who are not necessarily able to critically examine oftentimes outrageous claims this creates perverse incentives for all market participants (think Wall Street). I believe this is wrong and needs to be remedied through transparency. Unless you are a vendor with something to hide, you should not fear healthy skepticism about the hype.

Now, what metrics show Health 2.0 fails to live up to lofty promises?

My original post about Revolution Health did not say much about that. I was just trying to kickstart the discussion, which apparently worked very well. But many metrics naturally came out from the comment thread started by Matthew's post. No matter how you look at it, most of "Health 2.0" depends on creating more consumer engagement online. We often see references to "60% of people using Health 2.0". This is a nonsensical and misleading number. The majority of online health consumers do little more than Google their topics of interest.

What we really need to look for are hard numbers on engagement, beyond the basic searching. This is a real problem with many Health 2.0 ideas: assuming that consumers want to do things we want them to do. While it is not hard to find early adopters and enthusiasts, the real test is gaining mainstream adoption. This is anything but easy and anemic growth of most Health 2.0 sites (when not propped up by advertising) demonstrates this. So the metrics to watch for are:

• # of total users
• # of daily active users
• % of organic vs. paid traffic
• frequency of return visits
• revenue or value per visit

Anyone who cannot answer these questions for their "best idea since sliced bread" is either clueless or deliberately misleading. Commentators ignoring these issues are not doing justice to their audiences, whether or not they realize that.

A "Former Revolution Health Employee" posted an excellent comment on Matthew's thread, the most important part of which I will quote here:

Health 2.0, much like Web 2.0, is about 75% to 80% hype. I can't find a single Health 2.0 company that is busting out in terms of ORGANIC traffic, revenues or a long-term business model. Getting lots of user-generated content + traffic is not, nor has it ever been, a legitimate online business model.

Basically, no matter how good your idea sounds on surface, if you are not able to get enough organic traffic you are toast. People should understand that.

What can we learn from these failures and what is on the horizon?

Fard and Vijay are doing an excellent job identifying some of the general areas of opportunity. But I would like to caution them and everyone else that the ideas for new structures in healthcare value chains are well, just ideas until proven. This does not mean experimentation should not continue. It is just that we should all learn from past mistakes, stop the hype and prove something by doing and turning in the numbers on organic traffic and monetization / value.

But once you have done it, what is the point of keeping Health 2.0 label, that is getting tarnished by less successful ventures?