Medicine on the Net

In order to make good decisions about managing patients, providers have to integrate the best available external evidence with clinical expertise. Evidence-based medicine (EBM) is the conscientious and judicious use of best evidence in making medical decisions. The discipline was developed at McMaster University in Canada and soon spread to the U.K. and then to the U.S. The primary EBM organization in the U.K. is the Centre for Evidence-Based Medicine in Oxford. Their goal is “to promote evidence-based healthcare and provide support and resources to anyone who wants to make use of them.” This site was launched in an effort to meet that goal.

Answering medical questions online

David Toub, MD, points out that “There is a fine line between providing general information and making diagnoses and treatment.” Toub is the medical director of Newton Resource Group, a digital media company that develops Internet sites for the healthcare industry. He also answers patients’ questions related to his specialty-OB-GYN-at and, the site of the Philadelphia Inquirer and Daily News.

How can doctors answer medical questions online, either on the Web or via a mail list, without encroaching on the relationships patients have with their own healthcare providers? Here are Toub’s thoughts on the online doctor’s role

Web-based viral marketing Viral marketing spreads the name of your practice in much the same way as a computer virus spreads. Despite its nefarious aims, you have to admire the computer virus and its biological counterpart. Now think of that virus’s potential to carry word of your practice. When it comes to getting a message out in very little time, for very little cost, with minimal effort, nothing on earth can beat a virus. No, I’m not suggesting that you hire a hacker to create a virus that will infect computer after computer. But I am suggesting that we learn an important lesson from the virus about spreading information through a community.

Non-technical obstacles to telemedicine

Among the chief obstacles to implementing telemedicine programs are technical problems. But Stephen J. Schanz, JD, president of Legamed, Inc., a legal/medical information company, says some of the non-technical challenges are equally daunting.

Probably the most daunting of these is payment. But after figuring out who will pay for the service, Schanz says, the next two most troublesome issues are licensure and liability.

Why healthcare information systems fail

A new paper posted on the Web suggests that many healthcare information systems fail because of a gap between the current reality and the design conceptions of the new system. The paper, “Why Health Care Information Systems Succeed or Fail,” points out that the problem is often found in one of three common “reality gaps.”

New eHealth Code of Ethics

In May, 2000, the Internet Healthcare Coalition released the final version of the “International e-Health Code of Ethics.”

The code, which was first introduced for public comment in draft form on February 18, 2000, centers around eight themes: candor, honesty, quality, privacy, professionalism, informed consent, responsible partnering, and accountability. “We feel very good about this document,” says John Mack, IHC president.

Tailoring Consumer Information
Neal Sofian, CEO of the NewSof Group, a health management consulting company, believes that many consumer health sites have dropped the ball.

“If consumers read the material on a site but don’t do anything with the new information they have,” says Sofian, “you haven’t really helped them. The success of a consumer site should be measured by the extent to which it changes patients’ behaviors.”

Sofian, who is working with the American Cancer Society, Procter & Gamble, and other organizations to develop sites that measurably affect consumer health, says we should look to the tools developed by the experts in changing behavior: the advertising industry.

The role of the Web in DM
The goal of most modern disease management (DM) programs is to help people manage their conditions, as well as aspects of their lifestyle that affect their disease states. The process usually includes providing information that can influence the patient’s behavior, monitoring the patient to determine before a crisis when an intervention may be appropriate, and helping patients comply with drug regimens and lifestyle changes recommended by their providers.

DM programs, normally paid for by employers or managed care organizations, traditionally required a lot of one-on-one interactions. Typically, a healthcare professional would visit patients on a regular basis to monitor their conditions.

While healthcare organization are sometimes able to justify the cost of such programs based on measures like fewer hospital stays, DM can normally be used only for the most high-risk patients.

In an effort to save money and reach more patients, over the past year or so a number of companies have instituted Web-based DM programs. These programs replicate many of the services provided by human caregivers. Patients are taught to monitor factors such as blood sugar, blood pressure, number and severity of asthma attacks, or number of pills taken each day. They enter that information into an online form that sends the data to a database.

HONselect, a new healthcare search integrator
Health On the Net (HON) is a not-for-profit Swiss foundation that has been a major force in improving the quality of health information on the Net. Probably its best-known effort is the HON Code of Conduct (HONcode), a set of principles for healthcare Web sites.

The second best-known HON initiative is its healthcare portal, with its centerpiece: MedHunt. Now its newest effort, HONselect, seems destined to play as important a role in furthering health information on the Web as the foundation’s earlier offerings.

Helping consumers In 1998, an ultrasound test performed on a New Jersey woman showed that the child she was carrying, her fourth, would have the birth defect spina bifida. The baby girl would be born paralyzed below the waist and probably brain-damaged. Their doctor told the women and her husband that the only alternative was an abortion. They rejected that option and settled in to wait apprehensively for the life they would have to live after the baby was born. To help prepare the couple, a cousin researched the condition on a number of consumer health sites. At one of the sites, he read a news article about Vanderbilt University in Nashville experimenting with fetal surgery to repair spina bifida.
The couple contacted doctors at Vanderbilt and was accepted into the program. The fetus underwent the pioneering surgery in her mother’s womb. The surgery was successful. The girl is now able to stand and walk. Her parents, who had no computer and only vaguely knew about the Web at the time of the surgery, are now convinced and regular Web surfers, especially on healthcare sites.

That may be one of the most dramatic consumer health site success stories, but there are thousands of other examples. Consumer sites are likely the most important factor now encouraging and enabling patients to be more medically sophisticated and more involved in decisions about their healthcare. Certainly the Web has been primarily responsible for saving at least some lives, improving the lives of many others, and avoiding medical errors.