This is Part 4 of The Value of the Internet for Improving Healthcare. This is the last post in the series and it focuses on the capabilities, or "e-bilities" of technology to improve healthcare.
Patients and Web Content – “Reliability and Secure-ability”
Publishing reliable content on the internet is an important step toward achieving effective use of technology for healthcare. Many hospitals and practices are even using Social Media to promote services of their health systems. As a health blogger, I have used Twitter and other social media sites, but I had wondered why (and how) it could be used in healthcare — I can't imagine that a doctor would use Twitter to talk with his/her patients about their specific health conditions. This might be a major breach of privacy & security of personal health information. That said, there is increasing use of Social Media and web sites within the healthcare industry.
In 2007, according to a Harris Poll, 84% of American adults looked for health related information on the Internet. This figure is up 80% from 2006 and it seems to indicate that increasing numbers of computer-savvy patients seek information on the Internet before obtaining an opinion from their doctor. They may be seeking information to self-diagnose, or for education and treatment of their symptoms (or those of a family member). Unfortunately, the potential for “mis-information” can create anxiety and/or panic for patients.
Beyond the idea of a patient’s use of the Internet, medical practices may soon be creating websites to engage patients and families – one of HHS’s “meaningful use” policy priorities. A key care goal in the meaningful use criteria is to “Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health.” Specifically, one of the measures for 2011 is providing patient access to electronic personal health information, patient-specific educational resources, and clinical summaries. In 2013, one of the objectives for providers is to offer secure patient-provider messaging, and real-time access to patient health data within a Personal Health Record (PHR).
Furthermore, the use of a provider’s or facility’s website may be the most economically feasible (i.e. as opposed to major print or broadcast media) way to provide substitute notice of a privacy and/or security data breach, where direct notice cannot be achieved under HHS’ recently promulgated Interim Final Rule on Breach Notification. This Interim Final Rule becomes effective September 23, 2009 — which is an indication of how fast and furious regulatory change is occurring within the industry. Qualified or certified EHR technology must support the goals of meaningful use with respect to security and privacy.
Website “Usability and Readability”
A child of five would understand this. Send someone to fetch a child of five. (Groucho Marx Quotes)
When (probably not if) a practice creates a website or portal for providing patients with access to health information, it must be designed with “Usability” and “Readability” in mind. These are key issues regarding use of computers and the Internet. Usability and readability implies that fonts, background and foreground colors, and contrast on websites are used in a manner that makes reading easier. For example, a light font color on a white background is not easy to read – at any age. In addition to color and contrast of a website, use of the mouse to navigate the site can be challenging for those who have little experience with computers.
Organization and navigation of a website is another important consideration: it defines how easily a person can navigate through a website’s content (this is sometimes referred to as a site's Information Architecture). Imagine reaching an interesting web page only to find that you are unable to locate the contact information – a common design flaw (and one of my personal pet peeves). Effective design means that anyone can easily locate information that the website’s owner publishes on the site. This is particularly important for individuals who are less experienced with the use of computers and the Internet.
Other barriers to usability and readability can be attributed to “vision, cognition and/or physical impairments.” Generally, websites that are designed to overcome these barriers will adopt: less advertisements, no pop-up windows, no blinking content, visual clues to navigation and links, and the ability to change font size. An example of the ability to change font size is shown below on the Department of Health and Human Services website. As a result of these and other web page design difficulties, a user can get “lost” in cyberspace.
Finally, performance is an area of widespread consideration. If a web page takes longer than 10 seconds to load, people will loose interest and go “surf” elsewhere. I call this the internet “nano-second attention span.”
Accessibility & Internet Infrastructure
... infrastructure … consists of core telecommunications networks, databases, software, hardware, and procedures
The Internet would not be possible if it were not for its ubiquitous infrastructure. The TCP/IP protocol, and the hardware that supports it, is reliable enough that it is generally available on a 24/7 basis. Analogous to the telephone and electricity grid systems, IP infrastructure is the foundation of the Internet. A robust and highly available infrastructure has contributed to the emerging use of telemedicine. Telemedicine (among other things) is a form of patient-physician video conferencing to affect healthcare delivery for adults, often used for those who live in rural areas. While the advantages of telemedicine and other remote monitoring technologies are still being evaluated by the industry, it may have some potential benefit toward meeting very specific healthcare needs.
Consider the internet as a “network exchange.” The underlying infrastructure of the Internet may make Health Information Exchanges (HIE) a soon-to-be reality (of course significant work remains since infrastructure alone is necessary, but not sufficient). The ability to exchange data between providers, facilities, local, state and federal entities is indicated within the meaningful use definition. Medical Clearinghouses are an example of Internet uses for health data exchange, even if the information is manually typed into the clearinghouse’s web portal. In a recent article, I read that the ONC is seeking to partner with Medicaid for software that enables health data exchange between Medicaid and other state health offices, as well as with federal and commercial health service agencies. It is anticipated that secure, authenticated, and encrypted data and formats for exchange, using secure networks, will support the underlying infrastructure for HIE.
Although all of these efforts are certainly directed toward addressing the nation’s rising healthcare costs, IP based networks and the technologies that they enable, may still be years away from being either as simple or as reliable as the electricity grid.
Diffusing medical knowledge among the people would not only tend to improve the art, and to banish quackery, but likewise to render Medicine more universally useful, by extending its benefits to society (Buchan, 1785).
Once again, Dr. Buchan proves his visionary expertise. The Internet may soon provide significant – and recognizable – value regarding healthcare for adults. Many adults have shown considerable interest in prescription drug research as well as research related to specific illnesses. Slow adoption of technology seems to stem from the following basic issues: trust, security, privacy and confidence in web content, complicated technology use, and overwhelming volumes of information.
The Government’s vision toward collaborative use of HIE has the potential to provide a comprehensive patient history at the point of care. The availability of this information can help to improve medical treatment alternatives, collaboration among providers and facilities, as well as potentially lowering healthcare costs resulting from administration of redundant tests and treatments for illnesses.
Additional uses of the internet for healthcare could include: patient initiated medical response systems, home monitoring systems, mobile robotic devices, and online support groups. Also, there is increasing interest in the internet for wellness programs, disease management for chronic conditions and pharmaceutical management. In fact, some of these are already in widespread use.
Ultimately, patients have the most vested interest in managing their health and related costs. They are the quintessential intelligent “agents.” From an industry perspective, focus on local healthcare markets as central delivery points and relevant data collection at that level, could bring about significant changes in the way that healthcare is delivered in the future. Clearly, the aging computer-savvy baby boomers are poised and ready to demand and expect, quality healthcare information, services, and treatment, within manageable cost structures.
The Internet and “meaningful use” of electronic health records and data exchange has the potential for a positive and significant impact on the delivery of healthcare and its associated costs. The Internet and other enabling technologies are now mature enough that their robustness is no longer seriously questioned (i.e. how long have we been doing online banking?). That is not to say that the road ahead will be easy; far from it. Adoption of technology will ultimately be an improvement to the "status-quo," but there will be pain along the way, and probably lots of it. Our collective challenge is to minimize the pain as much as is humanly possible, by sharing lessons learned and using collaborative, iterative methodologies that have proven successful in other industries.
To read prior posts on this topic, click on the links below.
The recently enacted HITECH Act totally transforms the HIPAA regulatory landscape with respect to privacy and security, changing it from a paper tiger into an electronic beast. In order to effectively cope with this beast, better tools need to be made available.
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