Healthcare on the Internet

There are many reasons for the growth of healthcare information on the internet. First, the internet is the ideal way to publish this large body of complex and constantly changing information. Second, most people prefer to investigate their health concerns in the privacy of their homes before trotting off to see the doctor. (In fact, a study done by The Pew Internet & American Life Project reported that 41% of Americans used the internet to determine whether or not they would seek medical help). Finally, patients appreciate the opportunity to discuss and commiserate with other patients in internet discussion groups.

Using the internet for health information, treatment information, and drug information is one of the most popular consumer uses of the internet. In fact, online, baby boomers are more likely to visit healthcare sites (66%) than financial information sites (50%)! And surprisingly, among teenagers, gathering health information (albeit much of it about STDs and illicit drugs) is more popular than online games. In 2002, more than 110 million Americans gathered health-related information from the internet, and a study by the California HealthCare Foundation found that 70% of them report that what they find influences their treatment decisions. Women (72%) tend to be more frequent health gathering users than men (51%). Harris Interactive looked at "cyberchondriacs" (frequent users of the internet for health-related information) and found that 82% of this group are age 18 to 29; 84% have a post-graduate education; and 77% have incomes more than $75,000.

Types of Sites

How do people find healthcare information on the internet? Harris Interactive (May 2002) found that, of all users, 53% look for healthcare information first by doing a search to find the best site via a portal or search engine; 26% go directly to a healthcare site; and 12% go to a general site, such as Yahoo or MSN that has a healthcare section.

The many different sites that deal with healthcare information include:

Commercial Health Information Sites

These are sites such as WebMD and Intelihealth that provide consumer information from a variety of reputable sources.

Pharmaceutical-Sponsored Sites

These sites are positioned as general consumer sites and can be easily found when searching for a specific condition. For example, acidcontrol.com and GERD.com are both sites designed and sponsored by AstraZeneca, one of the leading pharmaceutical companies that manufacture proton inhibitors for the treatment of GERD and heartburn. These sites are part of a large direct-to-consumer (DTC) marketing push that includes websites, print, and television.

Government and Academic Sites – USA

Governments and universities have traditionally produced large amounts of health information, which is now readily available online. The National Institutes of Health (NIH), in the United States produces comprehensive information on most major conditions. NIH is also home to the Clinical Trials Database that contains medical studies around the country and information about whether or not clinical trials are right for an individual. In addition, NIH provides a direct link to more than 9,000 medications on Medline. On the NIH site you will also find research on a wide range of subjects including Complementary and Alternative Medicine, Rare Diseases, Minority Health, Bioethics, and Social Science. And the Centers for Disease Control (CDC) is recognized as the leading US federal agency for protecting the health and safety of people in the US and abroad, with their focus on developing and applying disease prevention and control, environmental health, and h ealth promotion and education activities.

Government Sites – Canada

In Canada, Health Canada, is one of the most popular destinations for health information on topics such as healthy living, diseases and conditions, and healthcare.

Non-profit and Association Sites

Most charities and associations now have elaborate websites. These sites are used for general information and often include links to the latest research and clinical trials. The sites are also used to educate people and elicit donations. Almost all major medical charities have websites. Some examples include the American Cancer Society, Canadian Cancer Society, American Diabetes Association, Canadian Diabetes Association, and many more.

Medical Journals

In the United States, medical journal sites are the most visited for healthcare information (45%), followed by commercial health pages (44%) and academic or research institutions (43%). Many doctors depend on these sites to keep up to date. For some consumers, however, these journals are relatively complex and assume the reader has some medical knowledge. Examples include The New England Journal of Medicine, The Journal of the American Medical Association.

Hospital and health plan sites.

In November 2002, Manhattan Research did a study of the use of hospital and health plan sites and found the following: use of hospital sites tripled over the previous year; 38.5 million consumers are now interested in receiving information from hospital websites; users of health plan websites have higher per capita incomes; and people who use health plan websites tend to have chronic health conditions (77%).

General Consumer Sites

In Canada, of the three most popular sites for health information, two are general consumer sites – Sympatico.ca and Yahoo.ca. In the United States, general sites are among the most visited sites on the web. These sites tend to purchase licensed medical information from a number of reputable sources and they often have a physician on staff to answer specific questions, e.g., Dr. Sanjay Gupta on CNN.

Personal Sites

Personal sites can range from the informed to the misinformed to the outright dangerous. Many of these sites can have spurious objectives (selling vitamins or non-approved medications for which there is no proven benefit) to providing a useful service to patients who can talk frankly about what it is like to live with a specific condition. Some sites, though, provide misleading and often dangerous positions. Sites such as those that glorify anorexia are of the most concern to the healthcare profession.

Using the Net in the Doctor's Office

Physicians, while being one of the highest users of email for personal use, have been among the most reluctant to use the web for patient care. A spring 2002 Harris Interactive study found that 90% of surveyed Americans said they would like to be able to contact their physician on the internet; 40% said they would pay for this access; and 77% said they would like to be able to ask questions online rather than visit the doctor's office. Doctors are however reluctant to provide this service. In a Forrester report, "Why Doctors Hate the Net," doctors reported that it would be an additional burden on an already over-crowded schedule. They are also concerned about liability, privacy, and getting paid.

A study by Blue Shield and ConnectiCare found that they could provide online health visits for much less money than in-office visits and compensate the physician fairly. One unexpected, but obvious, benefit of the electronic system is the increased openness of the patient. Many patients feel much more comfortable about writing it down rather than talking about it directly to the doctor.

Increasing Accountability Among Medical Professionals

Consumers of health services can now find out where a physician graduated, if s/he has any outstanding lawsuits, can find out how the hospital they are using is ranked relative to others, and can compare nursing home ratings for their mother-in-law!

Next Generation

A new generation of internet-based tools promises even more interactivity and will make available tools such as interactive buying sites to help consumers choose healthcare benefits. Bringing individual patient records online is on the horizon. And with breakthroughs in guided learning and artificial intelligence, it is possible to see a world where we interact with a machine for many of our health needs! Consumers are driving developments and this is good news for all of us!