Commodifying Content Through IT: Could Physicians Be Next?

by Thomas H. Lee M.D.

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Over the past several years, it's become increasingly evident that the newspaper publishing industry is not just struggling, but struggling to survive. Venerable institutions ranging from the Boston Globe to the San Francisco Chronicle face bleak economic futures, while others such as the Seattle Post-Intelligencer and the Rocky Mountain News have already closed their doors.

But what appears to be specific to newspapers today could occur to other forms of content and media in the near future. IT is rapidly disrupting the landscape of content and content publication, and it is agnostic to form or function. Witness the rise of Wikipedia, Blogger, YouTube, iTunes, Kindle, and Hulu.

Some might describe this as the great commodification of content.  Large, entrenched owners of valuable content are being outcompeted and replaced by smaller, tech-savvy substitutes who have found a better way to deliver content more conveniently and affordably.  Business models and businesses are being disrupted, while content is becoming more accessible and affordable to all.

Though physicians may take comfort in practicing out of brick-and-mortar service businesses, a significant part of health care is essentially a content business. Consumers seek answers to clinical questions. Today, that content (or knowledge) primarily resides in the inconvenient and expensive domains of physician office visits. 

Is it simply a matter of time before physicians are replaced by expert online medical content? Will all professional knowledge ultimately become Googlefied? Or are there limitations to where the disruptive nature of IT can reach?

More to Content Than Meets the Eye

To better understand the nature of this commodification process, it's helpful to be more specific about what we mean by content and how value is being created and destroyed.

In media circles, there's an overused phrase that often is stated as mantra: "Content is king."  For most of us, content generally is assumed to be the end-product that we see or read.  It's the comedy show that you see on television. Or it's the editorial article you read in a newspaper.

But a quick look at the low incomes of screenwriters and journalists tells you that content, in and of itself, has been far from king. That's because content is more than just the creative work product. It's an amalgam of three important layers of content and content production:

  • Knowledge (having the right expertise or perspective);
  • Production (having the ability to communicate, capture and produce the actual piece of content); and
  • Distribution (being able to share and disseminate the content to the right audience).

While all three layers are important and interdependent, the production and distribution layers have owned a disproportionate share of control and revenue over the last several decades. Think of Hearst, CBS or Universal Studios. Those companies became kings because the costs of production and distribution were high. The economics favored larger, more sophisticated entities with significant economies of scale.

The Inverted Landscape

IT, however, is quickly changing that landscape. Cheaper computers, software applications, and digital media devices are facilitating an attack on the costs of production, allowing individuals to produce whatever content they want inexpensively. Similarly, Internet connectivity, online applications and communities are allowing anyone with a computer to post and distribute their own news, photos, music or videos.

The importance of dramatically lower production and distribution costs is substantial, and the implications are far-reaching.

Most obviously, there is an exponential proliferation and availability of content, both good and bad.  Anyone with a keyboard, microphone or video camera can instantly become a journalist, musician or director.  And, as Wikipedia or YouTube has shown, people aren't necessarily motivated by financial gain to produce online content.

Because of the overwhelming volume of available content, companies that offer compelling search or community become much more important in the new digital order. Finding and sharing the right content has become more valuable than producing it, and distribution has become more about pull than push. Google has become the 21st century Hearst Corporation but without the traditional costs of content production.

Lastly, valuable content doesn't become popular because of mass production by a few companies, but rather by being searchable and relevant based on populist merit.  With the barriers to content production and distribution, content truly becomes king.

The Limits of Commodification

As concerning as the trends are for traditional newspaper and media companies, is it plausible for the same disruptive forces to influence health care? Will physicians be competing with online content aggregators for the attention of their patients? At first glance, the analogs appear worrisome.

Health care is, after all, a content-rich, consultative business.  Consumers typically want to find information related to the diagnosis and treatment about their ailments. That knowledge exists ubiquitously in traditional journals and books, as well as with health care providers who've studied those written materials.

If the cost trends for production and distribution continue to go down, it seems only likely that more individuals and companies will produce medical consultative materials online. And Google will help people find the best versions of that content.

Is it inconceivable that, in the near future, someone could review a dermatology atlas online and make a self-diagnosis? Is there anything to prevent someone from codifying physician knowledge to be more accessible and relevant to patients, making office visits obsolete?  Is there any reason to believe that health care or any other knowledge/service business is immune from the disruptive forces of content commodification?

A deeper examination reveals that there indeed appear to be at least three brakes or limitations to the forces of commodification.

First, not all content is created equal. What someone should do after getting a bee sting is fairly standard and easy to produce. What elderly diabetic patients should do if they feel lightheaded and can't remember what insulin dose they took two hours ago is a different story. The more personal the content is, the harder it is to commodify.

Second, some content is best experienced in conjunction with a physical experience. The classic example is an IMAX movie theatre.  Though the content of a film also could be viewed online, it has more appeal in a large theatre filled with sophisticated sound systems and an audience cohort. Similarly, in medicine, content sometimes is best delivered in person by a professional wearing a white coat. There is more to the experience than just the content. There is a sense of trust and completeness that's desired above and beyond the content.

Lastly, and perhaps most importantly, content commodification ultimately will be driven by the economics of the content business.  Today, few companies are making enough money to support their online content as stand-alone businesses. And the concerning trend is that consumers are used to paying very little for that content. Without a viable business model, most forms of content will remain in their traditional silos, free from the disruption of IT.  And for some physicians, that may be the only news they need to hear.

Kurt Grossman
Physicians will never be replaced by an Expert Online Medical Content system nor should they be. The ESRI Index identifies different status; "Non-urgent", "Urgent", or "Emergent." There are not many people that I know that would search for proper content to deal with Urgent or Emergent healthcare! Doctors ask questions; look for indications in an examination; use diagnostic devices to gather data; interpret that data; recommend, treat, and refer; and explain the various options. Doctors create content for individual patients with individual symptoms. "HIT" is disruptive but not displacing. HIT is ENABLING TECHNOLOGY! HIT is a tool to remove the redundant; communicate information freely without involving valuable staff time; simplify storage and retrieval; and provide valuable notifications or reminders, when there are conflicts between rules, methods, or policies in the system that a provider has violated; as a tool to avoid human errors.
Scott Endsley
Tom makes a good point but doesn't go far enough. As John Seely Brown observed in The Social Life of Information, all content has context, and this context is what defines value of the content. Its not that i have a DISEASE, but that I have a disease. Like paper, the physician-patient face to face interaction, will always have a place. Content aggregators will never be able to appreciate context nor provide a relationship.

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