Over recent years, healthcare organisations have had to adjust to many different changes – from advances in diagnostic and therapeutic procedures to the emergence of concepts such as managed care and telemedicine.
The e-health model represents another change, with broad implications for healthcare organisations. This model is based on restructuring healthcare delivery around IT and has led to a rapid increase in the application of information technologies in healthcare.
One such technology is the internet. The internet has transformed many aspects of society and various industries by enabling the widespread sharing of information and allowing the creation of new business relationships.
The amount of public information available on websites is continually increasing, and consumers use the internet to find information, communicate with friends and family, plan trips and shop. This has led to more people going online and it is expected that both the scope of applications available and the number of internet users will continue to grow, as technologies improve and new online applications continue to emerge.
In healthcare, the internet – with its powerful penetration and scalability – has the ability to empower patients, support information exchange and consequently result in new operational strategies, business and service delivery models.
There are currently more than 1.1 billion internet users worldwide, following a usage growth of more than 200% between 2000 and 2006. Almost a quarter of those users come from the EU-27 countries. The internet is now a ubiquitous presence in most people’s lives and is seen as being synonymous with extending information sharing in an inexpensive, easy-to-use way.
With penetration levels high and increasing steadily, the internet has become a major resource for many industries and seems set to revolutionise healthcare. Healthcare is the second most-searched topic on the web, with surveys consistently showing that 80% of internet users have used it to obtain online health information.
DRIVING FACTORS FOR USAGE
An experienced clinician needs close to two million pieces of information to practice medicine. Doctors subscribe to an average of seven scientific journals each – over 2,500 new articles each year – making it impossible to keep up to date with the latest information on diagnosis, prognosis, therapy and other health issues.
Furthermore, the interpretation of patient data is difficult, mainly because the expert knowledge required in each of many medical fields is enormous and the information available for the individual patient is multi-disciplinary, imprecise and often incomplete. There is an urgent need for tools that can aggregate information from multiple sources to improve decision-making, enhance health management and produce better patient outcomes.
A growing number of patients are also becoming increasingly involved in the healthcare they receive. These ‘power patients’ are another important factor driving the use of the internet in healthcare. They represent a growing share of the population and healthcare organisations will have to meet their needs.
Free choice of doctors, control over treatments they receive, access to quality information about their care and high levels of customer service are some of the expectations of these patients. These factors, among many others, are expected to further drive the use of the internet in the delivery and administration of healthcare services.
WHAT IS HOLDING US BACK
However, limitations do exist. A number of factors are slowing down the adoption of web technologies in healthcare. The main reason is that the care process is fundamentally more complex than in any other industry, such as retail, manufacturing or financial services. These industries can use the internet to cut processes down for efficiency and consolidate and modernize their marketplaces. Healthcare’s complexity, fragmentation and financial and regulatory disincentives, however, prevent it from becoming modelled on the likes of eBay or Amazon.
The internet may empower patients in new ways, but it does not replace face-to-face talks with physicians. Using the internet to exchange health information also raises serious security concerns, potentially risking the privacy of patients and their personal information.
Various technologies and procedures are being developed to tackle these security problems; however, security breaches do not require merely technical solutions, but also laws, detection of violations, enforcement and punishment.
CURRENT APPLICATION AREAS
A large number of stakeholders in healthcare take advantage of the internet and its capability to support communication and improve access to information. Although a number of technical, organisational and policy issues must be addressed, focusing on areas such as security, reliability and timely transmission of information, the internet has the potential to improve the quality of care and expand access to it, as well as reduce its cost.
From growing email use by patients and consumer e-commerce in the drug market, to rising electronic procurement by hospitals, internet diagnosis and online medical records, internet usage is increasing. Patients create online support communities, search for medical information and share their experiences, while healthcare professionals get access to the latest information in their field, consult with their colleagues and communicate with their patients.
The two most promising areas with future potential are internet-based health records and internet diagnosis. Internet-based health records can potentially influence the delivery of healthcare. The location and ownership of the record can be changed from one that is distributed amongst healthcare providers to one that is accessible anywhere in the world and is under the shared ownership and control of the patient and their providers.
Internet-based records can also enable the patient to communicate with healthcare providers, to request prescription refills and appointments, to see who has accessed their medical records, and so on.
Using computers to aid diagnosis is not a new concept, but using the internet to help self-diagnose is certainly an innovative one. Existing search engines offer unprecedented accessibility, an easy and simple user interface and an immediate return of information on almost any topic. Within the first year of its release, specialised search engine Google Scholar has led more visitors to biomedical journal websites than has PubMed.
A significant number of medical students and doctors prefer to use it because it indexes more peer-reviewed research and is especially quick in locating highly cited items. The ability to search for and access research material that is available free on the web is a great advantage. As scientific societies and associations consider moving their journals to open access models, popular search engines such as Google Scholar and Elsevier’s Scirus are likely to provide a reliable gateway to this information.
NET OR NOT
The internet is having a profound impact on healthcare. It has the potential to improve care delivery, empower and educate patients, support decision-making, enable interaction between patients and professionals, support the training and development of doctors and reduce inequalities in healthcare access.
Despite this, many questions remain. Organisations in the health sector continue to rely on private networks for many data communications tasks, and few healthcare organisations have integrated the internet directly into the provision of care. That’s not to say the internet is not changing healthcare, but the change is slower and more incremental than in non-healthcare industries.
As the industry moves more towards transparency, accountability, pay-for-performance and consumerism, the internet will correspondingly grow in significance and its role in everyday healthcare delivery will expand further.