Web 2.0 is the buzzword on everyone’s minds, but how is it changing the game for health care?

The Internet is rapidly evolving from an environment where static pages exist for people to search and read information (a.k.a. Web 1.0) to one where users from all walks of life can create and share content online. 

Patients now have the potential to go beyond just researching health facts on the web to actively sharing their experiences with each other – not only for emotional support but also to benefit from collective intelligence and gain clinical knowledge from each other.  They increasingly have the ability to take greater control and play a larger role in the management of their own health.

Not surprisingly, a recent survey showed that patients are starting to consult Internet-based resources, including social media, more than they consult their physicians.

59% resort to Internet-based resources (including Web sites, search engines, online advertisements, blogs, forums, and social networks) for health- and wellness-related information (versus 55%  who ask their physician)

Source: iCrossing

Physicians themselves are starting to utilize Web 2.0 as well.  Sermo.com is an example of a social networking site exclusively for doctors which enables members to come together to share their knowledge in order to “accelerating the emergence of trends and new insights on medications, devices and treatments.”   

Here is a small sample of the many health-related Web 2.0 resources out there:

It is clear that Web 2.0’s popularity will start to change the way in which patients, physicians and researchers collaborate and learn about illnesses and therapies, and manage patient health. 

Web 2.0 holds great potential for both health care professionals and patients alike, but it remains to be seen how issues surrounding privacy and security, which are especially heightened in the health care space, will be overcome.

Read my full article on Health 2.0.

A new study reveals that Danes beat out other leading nations in using information technology (IT) in delivering patient care.

Among the findings, Danish GPs regularly exchange clinical information over asecure network. In fact,  over 90% of clinical communications are exchange online and only 41 GPs are not connected to the network.

Healthcare providers can’t be thrilled by a Massachusetts website provision in its new state health care reform law. The new provision would allow consumers to shop and price compare different operations such as ultrasounds and tonsillectomies on the Internet.

This measure in effect commoditizes certain medical procedures far beyond what is presently the case. Doctors and health systems will not like this at all. However, I don’t know too many expecting mothers that will choose their Caesarean section based on a quoted price on a website. Politicians in Massachusetts however hope the move will save money.

In addition to cost comparing for tests, surgeries and therapies, the state website will also allow users to compare the quality and ratings of different hospitals and clinics.

This of course is not simply a theoretical stretch. You can get a glimpse into the future by doing a search for "dialysis" at www.Froogle.com. Of course, no surgeries are currently listed, but you get the point…

Read Web site would let consumers compare costs of operations

Background at Massachusetts Health Care Quality and Cost Information

With the help of a $1.8 million investment from Canada Health Infoway’s Innovation and Adoption program, VIHA will implement electronic tools to match clients with mental health and addictions challenges with the most appropriate care in the community.

“Electronic health initiatives are improving and modernizing the delivery of better, faster and safer health care,” said Health Minister George Abbott. “B.C. is leveraging investment and partnership opportunities from Canada Health Infoway to lead the country in developing electronic health information systems and we may see achievements in B.C. replicated in other jurisdictions."

“We are very grateful for Canada Health Infoway’s investment in this innovative project,” Waldner said. “By leveraging VIHA’s electronic health record system and introducing new web-based decision support technology, we can provide our clinicians with comprehensive information at the point of care, allowing them to make the best possible treatment decisions based on their clients’ needs.”

As in many other Canadian jurisdictions, VIHA clinicians do not currently have a standardized method for identifying and recording clients’ needs and risks, nor do they have access to an inventory of services available in the community. With paper-based processes still being used to document clinical information and refer clients to community-based services, transfer of critical health information and treatment can be delayed.

“This is a remarkable example of electronic tools supporting the needs of patients with acute or chronic conditions,” said Richard Alvarez, Infoway’s President and CEO. “This innovative solution will help reduce wait times and lead to more appropriate care and could serve as a model for other jurisdictions across the country,” he added.

With Infoway’s investment, VIHA’s Mental Health and Addictions Services team and Information Management/Information Technology staff will work closely with two of their existing technology providers, Cerner and Strata Health Solutions, to develop standardized electronic assessments forms and decision support tools specific to mental health and addictions needs. Clinicians will document a client’s assessments in Cerner’s PowerChart tool. Using that information, Strata Health’s web-based Strata PathWays’ ™ tool will provide access to a real-time inventory of mental health and addictions services available in the community that meet the needs of the specific client. VIHA expects it will take approximately 24 months to develop, test and implement the new electronic tools and train staff to use the new technology.

Strata PathWays™ is part of the B.C. eHealth initiative to build an integrated, electronic system that improves outcomes for patients by making their specific information available in hospitals, doctor's offices – wherever and whenever they need to seek health care services.

Read more at Canada Health Infoway invests in mental health apps

A deeper look at online destinations shows that while Americans may not be acting upon the information they are researching online, at least some are interested in information and tools to help them slim down.

Statistics gathered in the month of May by Neilsen/NetRatings Netview show that of the 143 million Americans surfing the web, more than 11.5 million of them visited health, fitness and nutrition related websites. 

Of the top 10 Online Health, Fitness & Nutrition Destinations for the week ending May 7, 2006 (listed below) only one did not have nutrition and/or fitness related information or resources on their home page.

Source: Neilsen//NetRatings Netview

Week ending May 7, 2006 US, Home and Work

This causes one to wonder –  of these millions of health conscious websurfers, how many of them are counted among the 174 million of Americans considered overweigh or obese? That we do not know. 

What we do know is that the data collected for the month of April for the health, fitness and nutrition category indicates that of the individuals that makes up its 58.6 million unique audience counted:

-         60% are women

-         More than 50% are 45 years old or older

o        Of that group, 25.5% were 55+

-         And approximately 45% of visitors have household annual incomes between $50k and $99K

With more and more people taking charge of their health, and taking advantage of health related data available to them at the touch of a mouse, it is no wonder that health related sites are increaseing in numbers with every passing day.

The Medical Library Association finds the following web sites particularly useful (sites are listed in alphabetical, NOT ranked, order):

• Cancer.gov
• Centers for Disease Control and Prevention (CDC)
• familydoctor.org
• healthfinder®
• HIV InSite
• Kidshealth®
• Mayo Clinic
• MEDEM: an information partnership of medical societies
• MEDLINEplus (English | Spanish)
• NOAH: New York Online Access to Health

“The Consumer and Patient Health Information Section (CAPHIS) of MLA evaluates web sites based on the following criteria: credibility, sponsorship/authorship, content, audience, currency, disclosure, purpose, links, design, interactivity, and disclaimers.” (see "Top Ten" Most Useful Websites).

I’ll add a few others that I feel should be added to the list:

• HealthyOntario.com
• NHS Direct
• WebMD
• Hitting the Headlines

Who knew Bangladesh was so advanced in their use of health information technology?!?

Computer Meridian Diagnostics (CMD), an internet-based computerised health check-up system, is gaining popularity in Bangladesh (Source: The Daily Star – Bangladesh).

CMD claims to diagnose illness and report on 12 main organs of a human body such as heart, lungs, kidney, liver, gallbladder, stomach, digestive system and pancreas. Reports are generated in as fast as 20 seconds.

CMD technology provides one with the analysis of the latest state of one's health taking readings fingertip skin scrapings. Proponents say the system builds a fitness profile and measures the energy level of 12 vital organs.

Uh-huh. You'll forgive my skepticism on complete health profiles built in 20 seconds based on fingertip samples. Well perhaps there is something to it... this technology was developled my the Russian Space Agency.

The people in Chittagong, Bangladesh, came to know more about the technology when a stall offered CMD check-up facilities at a three-day IT fair. Around 70 people received the CMD check-ups at the stall.

The Bangladesh Softalk Online Private Limited, a Dhaka-based software firm, was the first to launch the system which originated in Europe. At present, 23 centres in Bangladesh offer CMD testing.

Professor Dr. Hasanuzzaman Bhuiyan, working at Preventive Health Care, said scientists and researchers in China, Japan, Germany and Soviet Union developed the CMD system after 35 years research at the Russian Space Agency.

If the Soviets started it then it has to be good, right?

Read more about Online health check-up gains popularity

According to a recent Consumer Preference Index (CPI) poll conducted by Prospectiv, 51% of consumers use the Internet as their primary source for health, beauty and fitness information. 

A greater number of consumers (73%) want to receive health-related content via online channels in the future and that number jumps to 91% if the information is tailored to their specific needs and interests. 

The number of people thinking about their health on a regular basis is rising along with the demand for online content.  Eighty percent of those polled said they are more aware of their overall health today, when compared to five years ago.  In fact, 95% reported being conscious or very conscious of their health. 

When do consumers address their health? 

• 72% of those people think about their wellness 12 months a year
• 67% work on their health and fitness regimen year-round
• 16% said they jump-start their regimen between April and June
• 12% begin in January through March

With all of this effort put into maintaining a healthy lifestyle, it is not surprising that 82% of consumers surveyed have used coupons for health-related purchases.  In addition, 40% of consumers surveyed reported doing most of their health and wellness shopping at discount stores; 25% shop at department stores and 22% prefer specialty stores.

Though only 10% of coupons used for health, fitness and beauty products are obtained online, 80% of consumers said they welcome future online promotions tailored to their interests and favorite products.  This indicates a huge opportunity for health/fitness/beauty marketers to drive sales with online coupons.

How are consumers spending their money? 

• 42% purchase over-the-counter prescriptions most often;
• 34% buy beauty products and
• 23% invest in diet/fitness programs and services.

Online marketer Prospectiv conducted the 2006 Health survey online, gathering responses from over 1000 consumers across the United States. The survey was conducted from April 17 – 24, 2006.  

 
To be honest, the announcmenet and service is a little underwhelming. For the time being, this so-called portal is nothing more than just a collecation of search queries at the time being. Therefore, it's not really a portal... not yet.

Google will no doubt invest in this initiative with the goal of being one of the most trusted health destinations on the Internet. The key to success and an aim of Google will be to filter out the unreliable health information and focus on the good information and tools that users want to quickly find.

Read more on Google announces healthcare search clustering ((E-Health Insider))

(By Dr. Mike Evans, From Saturday's Globe and Mail, Dr. Google is in)

Heather Copeland had a bad rash. It hurt even before you could see it. It was just on one side, blistery, and very red. Heather's mother had a similar affliction 10 years ago. Heather and her mom both had shingles. The only difference between Heather and her mother was that Heather knew exactly what it was before she went to the doctor. Heather has something her mother never had: Dr. Google.

A just-released survey by Pew Internet and American Life reveals that the next time the average person is seeking reliable information about a health problem, they are more likely to first turn to the Internet for an answer before their health-care provider.

As the number of people turning to cyberspace for help increases, so does their faith in the results. Research in the esteemed Journal of the American Medical Association showed that patients perceived (which may be different than the truth) that the Web increased their understanding and allowed them to self-manage their acute or chronic problems 30 per cent of the time.

Why wouldn't you visit Dr. Google? She is accessible, available 24/7 and has all the time in the world for you. No waiting room filled with coughing people. No speculums or rubber gloves -- in fact, none of that yucky physical exam stuff.

More on Dr. Google is in

(Las Vegas – Forum for Healthcare Strategists) Healthcare technology is delivering wins for providers and patients.

Here are just some of the case study success highlights from the Forum for Healthcare Strategists in Las Vegas:

Consumer health & wellness

• 72% of all online adults searched for health information in 2005 (WSJ/Harris Interactive – cited by Greystone.net)³
• Approximately 57% of users indicate they have discussed online health information with their physicians (Manhattan Research – cited by Greystone.net)³
• Health website user priorities according to Harris Interactive (cited by Greystone.net)³
• Ask question that doesn’t require a visit (77%)
• Schedule/ Cancel appointments (71%)
• Refill a prescription (71%)
• Receive test/lab results (70%)

Electronic Health Record (eHR)

Sutter Health has spent millions of dollars on their her system, but the rewards have been high. “We absolutely believe that eHR has more than paid for itself,” says Cecilia Montalvo, a VP with Sutter.

• Mammogram completion rates (Sutter Health patients) more than double with those patients who use electronic health records (eHR); and more than quadruple when the patient receives an e-mail reminder (Sutter Health²)
• Older patients (Sutter Health) are more likely to use eHR with the highest enrolment and use by age skew is 60-69 years old (about 10% of patients that are 80-89, and 90+ years old are using eHR)²
• 96% of patients (Sutter Health) using online messaging with their physicians and e-visits are satisfied or very satisfied with their eHR system²
• 90% of physicians (Sutter Health) are satisfied or very satisfied with their eHR system²

Here’s a telling quote from a Sutter Health patient using their eHR system called PAMFOnline²: “I do not put off appointments or asking my doctor a question.  I can ask a question and find out if I need to come in, have a lab test or that nothing is needed. I feel so secure that I can message Dr. S. – he responds so fast – and with my medical problems fear is one of the worst things I deal with. Know my doctor is an (eHR) message away comforts me. He is the best!”

Return on Investment

• By implementing a ‘targeted knowledge transfer’ (TKT) system, Bon Secours Health System was able to enhance revenue and reduce costs by $54 million¹.
• The Internet as a physician referral marketing channel is second only to Yellow Pages in generating revenue from marketing activities (almost $1.2 million) for UK Healthcare⁴

^-- 

¹ The Marketing Challenge: Technology Trends & Transition, Michele van Zuiden and Stephanie McCutcheon, HealthTech

² A Technology Milestone: Getting Patients Online, Cecilia Montalvo & Bill Black, MD, PhD, Sutter Health 

³ The Broadband Media Strategy, Michael Schneider and Robin Snow, Greystone.net

⁴ Demonstrating Marketing and Communication Accountability, William R. Gombeski Jr., Director, Strategic Marketing, UK HealthCare

(Las Vegas – Forum for Healthcare Strategists) Technology has always driven change in healthcare. However, those running and managing healthcare delivery have never been more aware and supportive of technology driven change.

Driving support and investment in healthcare technology are the CEOs. In a recent survey by HealthTech, CEOs were asked, “In the future, what role would you like technology innovation to play in the development, communication, and implementation of your organization’s strategy?”

100% of the CEOs said that technology would play a greater role than today – 67% said “significantly more” than today with each hoping to be a “technology leader” (source: HealthTech¹).

Other survey findings from HealthTech found…

• Satisfaction is lagging with the technology planning process (about 60% expressed dissatisfaction or only “slight satisfaction” with their planning process
• Top five barriers to technology planning:
• Prioritization with limited resources
• Balancing impact on cost/quality
• Physician bias/enthusiasm
• Time availability
• Physician input/involvement

So while enthusiasm has never run higher, there exists an enormous opportunity for healthcare technologists to help minimize the gap between current and desired end state.

HealthTech is one of those ceasing the opportunity. HealthTech is a non-profit “pooled expert-led research center for delivery systems and health plans” with funding that is “independent” of technology vendors. One of three key organizations along with Kaiser Permanente and VHA Health Foundation, HealthTech and others are driving a an innovation learning network called A-ICU.

A-ICU has the chief objective of reducing the net cost for healthcare for most expensive chronic disease patients by 40%. The network will connect participating health provider organizations with the focus being “accelerated adoption of innovations and emerging technologies.” A-ICU is currently being designed (6 months) and is due to be implemented by October of this year.

¹ The Marketing Challenge: Technology Trends & Transition, Micheele van Zuiden and Stephanie McCutcheon

The National Patient Safety Agency in the U.K. has launched a new website called Please Ask that encourages patients to share their healthcare experiences.

Please Ask encourages users of the national system, NHS, to write about their experiences and opinions. The site also provides useful tips for using the system including celebrity interviews.

The information architecture of the new engagement website features five major sections:

• Be informed - tip sheets about inpatients, outpatients, medication, emergency admissions, and sick children and relatives. 

• Share your experience – encourages complaints, incident reporting, finding support, etc.

• Register for updates - receive regular news about patient safety.

• Accessibility - site accessibility features.

• Contact the NPSA - options to e-mail, phone, etc.

This is a strong concept with some very good content. And NHS is very frank. For example, the FAQs section provides some very candid answers to some tough questions such as, “How safe is the NHS?”

Answer: “Every day more than a million people are treated safely by the NHS. But occasionally things go wrong, no matter how dedicated and professional the staff. It is estimated that something goes wrong for about ten percent of people treated in an NHS hospital. That's about 900,000 people a year in England. About half of these incidents could probably have been prevented.”

Wow. That’s an amazing answer. Let me just say that again… wow! I’d like to see an HMO be that frank.

My one criticism of this site is that it’s poorly designed and yet another NHS website. How many websites do they need? Why not just put this as a sub-section under the big NHS Direct portal?

RELATED READING:

Online medical advice and patient services

© 2006 Prescient Digital Media

The trip to the doctors office need not be so time consuming and daunting. Aetna and other healthcare providers are looking to launch new online patient services that allow patients to have direct online contact with their primary care physicians.

Beginning May 3, Aetna members in Florida and California will be able to access online consultations via a new website, RelayHealth.com. RelayHealth enables online communication between doctors and patients, including clinically based doctor-patient consultations, appointment requests, the ability to get referrals, lab and test results, and electronic prescriptions and medication refills.

As part of the program, Aetna will cover online consultations, called webVisits®, between fully insured members in California and Florida and their primary care physicians, if they participate in both Aetna’s and RelayHealth’s networks. Self-insured employers can opt to have their employees who are Aetna members in these states participate.

RelayHealth is more secure than e-mail. Unlike e-mail, which relies on multiple servers across the Internet, RelayHealth uses a single, centrally managed database for doctor-patient communications.

In Canada, the Ontario Government plans to launch a new online medical enquiry service for Ontarians seeking health information on a variety of conditions via their consumer health portal at www.HealthyOntario.com. The service is staffed by registered nurses with a doctor providing medical oversight. While the new service called Ask An Expert does not offer medical diagnosis or emergency services, the service provider, Prescient Digital Media, hopes that service will augment existing services offered over the phone such as Telehealth Ontario.

A similar service in the United Kingdom through NHS Direct Online which processes an average of more than 100 enquiries per day in 2004. NHS Direct Online is the web component to NHS Direct, a telephone triage service used by the UK public to contact a nurse for any kind of health problem.

In addition to online consultations, Aetna members in Florida and California can make online appointment requests with their doctors and get referrals, lab and test results through the RelayHealth service. Members also will be able to receive new prescriptions and orders for prescription refills electronically from their physician. Members will be responsible for their office visit, based on their plan design, for the online doctor visit. There is no charge to members for the other communications services.

Those Aetna Members looking to access the online service can do so through the www.relayhealth.com website or through their physician’s website if their doctor participates with RelayHealth. On May 3, members can go to DocFind, Aetna’s online provider directory available on www.aetna.com, to see which Aetna participating physicians offer RelayHealth services.

Aetna has been involved in online consultations since 2001, when the company participated in the Silicon Valley Employers Forum pilot in California with RelayHealth and several Silicon Valley independent practice associations. The pilot enabled employees to communicate online with their primary care physicians for non-urgent medical consultations.

A sick patient who wants an online consultation, known as a WebVisit, can list symptoms via an e-mail link and receive their doctor's assessment, often within a few hours. A co-pay equal to that for an office visit is required.