Int. J. Environ. Res. Public Health 2009, 6 512 Figure 14. Personal environmental monitoring tools: PEIR and Current Cost. 3. Discussion of Emerging Patient-Driven Health Care Models One mechanism changing how health and health care are understood and realized is patient-driven health care models, particularly health social networks, consumer personalized medicine and quantified self-tracking. These models support an early shift to patient-driven health care as individuals are starting to measure, track, experiment, intervene, treat and research their conditions and symptoms, genomes, biomarkers, behavior and environment, both individually and in collaboration with others. This discussion section focuses on several themes and potential future implications that arise from the analysis of emerging patient-driven health care models and includes some speculative and forward- looking thoughts. The areas examined here in more depth are the future of health care and the evolving health care delivery model, the changing role of the patient, the changing role of the physician, the advent of health social networks as influence entities, evolving legal, economic and regulatory institutions, the future of clinical trials via vertical and horizontal stratification and changes in drug discovery and after-market studies. 3.1. The Future of Health Care and the Evolving Health Care Delivery Model The main characteristic of the evolving health care delivery model is that it is starting to become more collaborative; moving to a co-diagnosis, co-care model between physicians, patients and other parties [23]. The physician could start to be seen as a colleague and advisor, as one of many input sources in fashioning a care plan. The patient could become more of an informed participant, an active responsibility-taker, the owner, administrator and coordinator of his or her health program and health data. Future interactions may be those of knowledgeable patients bringing quantitative reports from their self-testing and self-tracking activities to medical professionals for consultative co-interpretation of the results. The concept of health care could be extended to being a complex, ongoing, data-rich process of managing acute, chronic, general wellness and enhancement conditions using a wider variety of traditional and non-traditional health resources such as collaborative peer networks. Health care services could become location and time independent, provider de-linked and commerce-enabled such as American Well’s on-demand web-based physician consultation services with video and chat