Healthcare on the internet has exploded on the internet and virtually changed information technology in this industry. A growing number of healthcare sites have emerged to help consumers find information on diseases and drugs. Electronic medical records and digital communications with healthcare professionals is a growing phenomenon around the world. The internet is allowing patients to create online communities for support, personal stories, and even the latest research on their illness. Sites will also order drugs and equipment online, communicate with physicians or other health professions, and will provide with fitness regimes and tips. Healthcare professionals are also using sites to get the latest information in their field or consult with other colleagues.
People use the internet for everything from commerce to entertainment to online payments and now, healthcare. Benefits of healthcare online ensure that the internet increasingly will be integrated in healthcare. Patients can now have a variety of new ways to communicate with health care providers which can give them more control over their own health. Patients can email their doctors, buy medicines online, and even communicate interactively with medical professionals. The internet is easy to use, the information is diverse, and opens up communication between people that have the same illnesses or interests (West and Miller).
Modern healthcare is based on friendly, seamless, secure, and cost-effective use of advanced technology. The internet provides a new area and tools that translate more flexibility and creates more possibilities. Medical professionals find that there is “better compatibility with different computer platforms, better service and response to needs, better access using available internet connections, etc.” Healthcare on the internet will not only create new possibilities, but enhance the goods and services already set in place (Jegelevicius, and Vaidotas).
The driving forces for digital healthcare are as valuable as national leaders in striving to bring healthcare into the 21st century. The government spent an enormous $2 trillion a year on healthcare, equal to 16% of the GDP. With an expecting rise to 20% of the GDP, there is a lot of pressure on public and health care systems. “Although individual consumers typically report a high level of satisfaction with their personal care, the United States performs poorly on a variety of aggregate health indicators.” In response, the US has spent $19 billion on health informational technologies in 2000 and in 2006 it jumped to nearly $31 billion (West, and Miller).
To deal with demands in economy, efficiency, and effectiveness, President George W. Bush signed an executive order in which healthcare would be digitized to improve quality of healthcare, reduce costs, and organize medical care more efficiently. To roll out the order, healthcare professionals will use new technologies to enhance diagnostic support, computerize claims, processing and eligibility, and medical records. Former U.S. House of Representatives Speaker Newt Gingrich agrees that information technology in health care will reduce service problems and reduce costs in healthcare. Having electronic medical records will reduce errors and communication with healthcare professionals will be more efficient digitally. Also, in 2008, Senator Barack Obama supported that electronic information would improve communication, cut costs, and overall quality would increase. He proposed spending $10 billion annually over the next 5 years would cut costs by $77 billion each year (West, and Miller).
Medical experts found that information technology would save closer to $81 billion a year. If prevention of chronic disease was implemented in the information technology system that number would nearly double. A study with eighty controlled clinical trials found that there is a strong association with positive health outcomes and the use of computerized and telephone communications “for follow-up, counseling, reminders, screening, after-hours access, and touch-tone interactive systems.” In another randomized controlled trial, the study found that patients that could communicate with their physicians via secured messages about appointments, prescription refills, and referrals were more satisfied with overall care (West, and Miller).
“Information-sensitive, and health information has become an important commodity in the marketplace. Information technology is rapidly transforming healthcare and its delivery to consumers.” It enables us to test and enhance old tools and invent new ones that will “inform our decisions, guide our actions, and prepare us for future challenges.” We need to identify issues and concerns, and then provide solutions and/or tools for addressing these issues (Anderson, and Goodman).
In a study done by the Wall Street Journal Online/Harris Interactive Health-Care Poll, in 2006, with ordinary Americans found that health information technology would improve overall healthcare. Of those polled in this national study, 68% thought that the use of electronic medical records would improve the quality of care “by reducing the number of redundant or unnecessary tests and procedures; 60 percent thought that electronic medical records could significantly reduce health care costs, and 55 percent believed that such records could significantly decrease the frequency of medical errors.” This study suggests that digital medicine can have potential improvements in healthcare (West, and Miller).
More than half of hospitals have implemented the electronic medical records. It is not only important for consumers to make informed choices, but also clinicians and medical providers to provide appropriate quality and health plans and others to asses outcomes, to control costs, and monitor quality. There are, however, some major issues to security of patient data and also to increase the role of information technology (Anderson, and Goodman).
Although internet usage has risen dramatically over the past decade, few Americans are taking advantage of online healthcare. According to a study from the Wall Street Journal Online/Harris Interactive Health Care Poll of almost 3,000 adults across the nation, only a small number of those polled used information technologies on the internet to their advantage. Only 4% get email reminders from their doctors, 3% scheduled appointments through the internet, 2% received results through email, 2% percent had electronic medical records and 2% relied on sending their results from the home monitoring services through email to their health care provider. This study also found if the patient had the opportunity to communicate online they would do so (West and Miller).
Barriers to health information technology will delay the development of the internet in health care. Political, social, and economic challenges as well as security concerns, digital divide, and ethical conflicts contribute to the difficulties in launching healthcare on the internet. Patients fear that, although it is convenient to make your appointment online, the quality of care provided online is not as thorough as in-person consults. In order to push through the barriers of the “electronic revolution in health care,” everyone needs to be on board; patients, physicians, insurers, political officials, and other health care professionals (West, and Miller).
Politics is an issue in health care around major political parties as well as interest groups, hospitals, pharmaceutical companies, insures, and ordinary consumers. There is such a severe divide between parties that change is very difficult. Many question the intensions, aims, and motives of health care changes and it results in a major change only once every generation. President Clinton tried to implement a health care change in 1993-94, but was denied by Congress. Because of this widespread fear, political leaders unfortunately stay away from attempting any reform that would make a meaningful change (West, and Miller).
Privacy and security issues arise when people have to give their financial information out. Even though there are safeguards to ensure the protection of your information, the perception is that the internet has a lack of security and will result in many people not taking advantage of healthcare online. A recent national poll found that 62 percent of adults felt that using electronic medical devices makes it difficult to ensure their privacy. Americans fear that if they use these resources online their information will be compromised (Cain, and Mittman).
Lack of trust by consumers for the healthcare site is an issue that is difficult to overcome. It is difficult to build a loyal consumer base when dealing with financial transactions and sometimes even when users would have to disclose personal information on their health. According to a study on customer loyalty, for content-based websites, “results reveal that loyalty to the health-site is satisfactory driven.” Building trust includes consistency, responsiveness, the feeling of security, and technical functionality and could result in loyal and returning consumers (Gummerus, and Liljander).
Although this nation is technologically advanced, that does not account for all Americans. It is estimated that between 31 and 40 percent of Americans use the internet for healthcare while only 5 percent use the internet to purchase their prescriptions and to email their health care providers. This research suggests that healthcare online is progressing at a slower pace than hoped. People who have low incomes, are poorly educated, and live in rural areas typically have less access to the internet, which contributes to less access to healthcare. The way in which these healthcare sites are written are at a much higher reading level than some people can understand (West, and Miller).
Another obstacle in online healthcare would be the technology costs. Not only is there concern on the overall cost on the new devices, but concern on who will be paying for them. The estimated cost of the adopting electronic health records would be about $276 and $320 billion over a ten year period. Hospitals would have to spend approximately $2.7 million in development and $250,000 in maintenance each year. Hospitals and other medical organizations will rule out this option because of limited financial resources. “The major barrier to investment has been that costs are concentrated while benefits are spread out among many people, which makes it difficult to build the political coalition necessary for financing major expenditures.” It is very difficult to get funding for a project like this and even more difficult to convince others that it is a great use of the public’s money. It would be simpler if more of the public were able to join this digital revolution (West, and Miller).
Ethical conflicts are also a big concern in putting healthcare online. In this technology, private sites are more likely to feature ads that are pushed by the sites sponsors. The accuracy of viewpoints and the quality of information may suffer with this conflict of interest. In contrast, public sector sites accept no commercial advertising or offer products in ads that will turn in profit. With private sites being sponsored by for-profit entities, it is close to impossible to people to protect themselves against “self-interested medical advice or commercial advertising.” The lack of content standards results in information being incomplete and inaccurate or is “sponsored by pharmaceutical interests.” An alarming statistic found that 75 percent of Americans do not check the source or date of the medical resources that they find online (West, and Miller).
Other interesting ethical issues are posed by how the information is used. Should these websites be used by consumers to assist or to identify their illnesses? Figuring out who the appropriate user would be, whether it is physicians and nurses or the general public is also a challenge. It can also be difficult to figure out if or any should be accountable if something should go wrong because so many people are involved with creating these sites (Anderson, and Goodman).
Health information provided on the internet will always present the world with uncertainty. Efforts have been made to develop standards and guidelines to follow for medical and health websites. “More than a dozen companies that provide health information online have formed an alliance to develop a code of conduct to assure consumers of the reliability and safety of the information they provide.” Health care technology groups, non-profit organizations, and journals of health care organizations have published guidelines that for quality internet health information (Anderson, and Goodman).
Online content and sponsorship plays a very important role in healthcare online. More often than not we find that private sites display conflict of interests in accepting advertisements from interested parties and sponsors. This poses a problem on accuracy of content that is unbiased. Private sites are also known to create their site targeting an audience based on age, gender, race, income, or a specific disease. Providing more of a wide range of information for all consumers would make the sites more credible. Other sites are clear that they are government sponsored because you will not find any commercial ads, sponsored links, or product placement ads on their sites. Site visitors will recognize that the site has no other motives, but to provide up-to date accurate and comprehensive information for the public (West, and Miller).
Private sites like, WebMD.com and About.com, will have information regarding specific illness, but advertisements will attack your screen to order medications for those illnesses. Commercial sites will be more subtle, but they may “push products linked to the corporate interests that finance the sites.” Over 100,000 websites are devoted to health-related subjects ranging from commercial to private to non-profit. Of course, WebMD and About.com are two of the most popular sites, but Google Health, Microsoft, and Revolution.com have been increasingly gaining visitors. They have developed new ways to offer health and fitness information to consumers by allowing anyone to become a “contributor.” They can go as far writing their own pages that will be helpful in medical care (West, and Miller).
Health claims that are untrue or unproven are all over the internet. The Federal Trade Commission (FTC) identifies hundreds of website promoting cures for AIDS, multiple sclerosis, liver disease, arthritis, and cancer. The FTC has reached a few legal settlements with websites that have advertised cures for major illnesses, but it is impossible for them to invest all of the health websites considering the amount there are. These investigations are time consuming and require scientific information to prove the content wrong (Anderson, and Goodman).
Content becomes influenced in private or public sectors when there are different incentives. Private sites are more likely to have content on a specific illness that correlates with the advertisement for a treatment or drug for that specific illness. In turn, relying on commercial advertising makes them less likely to be accessible to physical impairments or to non-English speakers. As a result, private sectors are less available to “underserved groups and exposes patients to real or potential conflicts of interest” (West, and Miller).
It is very important for a private site to have website quality controls in order to maintain a credible site. It is estimated at two-thirds of Americans cannot distinguish between accurate and inaccurate information. Only 20 percent of American can find the information that they need. The format of the sites and the way that the information is presented is sometimes very confusing to users. There is a lack of clarity involved when presenting the user with different site sponsors or sources. Some sites will feature interactive services while others will present the information with no links or features. Some sites mislead users by not presenting themselves as commercial when they really are or some “for-profit” sites try to act as if they are nonprofit sites through “unclear disclosure of their sponsors” (West, and Miller).
Since this may be confusing for consumers, The Health on the Net Foundation, have formed a code of conduct that has guidelines about presenting information authoritativeness, complementarily, confidentiality, attribution, justifiability, transparency of authorship, sponsorship, and honesty in advertising. Websites who follow the standards can put the HON seal of approval which will give credibility to the site. Few sites, however, have acquired the HON seal of approval, signifying that most sites are unable to guarantee accurate, clear, honest information (West, and Miller).
There is an increasing amount of healthcare on the internet today. The information on these healthcare websites vary with services to maintain health, treat a condition, or help a person live with a chronic condition while other websites will inform users about patient rights and protections. Some sites, however, are not well known or set at a reading level too high to understand for most users (Lesley, and Oerman).
Another issue that is of concern is the readability of the health websites. A study on English and Spanish medical websites found that the information on these websites was too difficult to comprehend for the average person. All of English-language websites and 86 percent of Spanish-language websites were found to need their users to have a high school reading ability, which many Americans do not have. In addition to readability, many websites had information that was inaccurate, out of date, misleading, or even dangerous to healthcare consumers (West, and Miller).
Most websites disclose the sponsor of the page. Government sites feature the state emblem and links to government agencies, while private sites have an “about us” section of the site. This link provides information on who sponsors the site and information regarding the site. Most information, however, has vague and minimal information such as name and address. Information about organizational goals, mission statements, and purpose are rarely mentioned in any detail. For example, WebMD has their “About WebMD” buried at the bottom of the page with many other links, that offers little information on whom operates the site and it forces the users to go to other links. The statement on the site lacks any real substance:
“The WebMD content staff blends award-winning expertise in medicine, journal-
ism, health communication and content creation to bring you the best health
information possible. Our esteemed colleagues at MedicineNet.com are frequent contributors to WebMD and comprise out Medical Editorial Board. Our Indepen-
dent Medical Review Board continuously reviews the sit for accuracy and timel-
Although the website seems as if it is open and honest, the link for MedicineNet.com is not clickable, which forces uses to leave WebMD and open up a new browser, which could be very discouraging. Consumers find it frustrating when you cannot click the link and often do not follow through. Users can find out information about board of directors and the management team by clicking through, but this too is vague (West, and Miller).
Accessibility to the website is very important to users with physical impairments, people with low literacy, or non-English speakers to ensure they have access to medical information. The U.S. Census Bureau reports that almost 50 million Americans live with a long-lasting physical impairment such as loss of sight or hearing, disabilities that limit basic physical activities, or severe learning disabilities. Since then, over 19 percent of the U.S. has one or more physical disabilities; it is in the governments’ best interest to make these websites accessible. Improving access will also boost traffic to the sites which is a great way to make technology cost effective (West, and Miller).
It is crucial to improve usability for people with physical impairments. Users that are visually impaired need color contrasts with website texts and backgrounds. It is also important to have text-equivalent “alt” tags on images so that software converts text to audio. Hearing impaired individuals, websites should display procedures using Text Telephones (TYY) or Telecommunications Devices for the Deaf that are tools used for deaf individuals to communicate with the government officials. Users with limited mobility require data tables need to be written in a clear and hierarchal way (West, and Miller).
Another crucial aspect of website accessibility is making sure the website is user friendly to people who speak a different language. About 18 percent of the population speaks a language other than English and it poses a problem when trying to comprehend healthcare information. Clear information about personal healthcare is vital. Although, over the years, language accessibility has risen over the past ten years, it is still not enough at about 44 percent in 2007 for government sites. For-profit sites have the same issue, but much worse at 16 percent. In contrast, non-profit sites do much better at 57 percent language accessibility. As a result, it seems as though commercial websites have a long way to go to provide equal access (West, and Miller).
About half the U.S. population read at an eighth grade level or lower according to national statistics. Building a website that understands a wide range of consumers is important for accessibility. “That imperative is especially salient given the growing evidence documenting significant health illiteracy and its relationship to cost and quality of medical care and access to it.” If the information that is provided on the health websites is written at a level that is too high for users to comprehend, then online technology will never reach the potential that it could be. This is especially important when reading warning labels, brochures, forms, and instructions. Researchers found that pamphlets and educational materials are often too complicated for the population (West, and Miller).
It is very clear that healthcare online has many concerns and issues that cast a doubt on whether healthcare will eventually be effective for cost, improve service, and gain productivity. We already know that commercial websites usually have more ads, greater conflicts of interest and unreliable content. At the same time we also know that the general population is not participating in the digital revolution. Improving digital medicine is important, but does pose a challenge, especially for health officials trying to gain trust on online healthcare (West, and Miller).
Inaccurate and out-of date information is a major problem in healthcare online as well. Although there is an abundance of health information out there, there is no guarantee of accuracy. Not only can the information be out-of date or inaccurate, but it can also be misleading or completely false. Websites that even sponsor major medical centers and research institutions may have contradicting information (Anderson, and Goodman).
Nearly 83 percent of the world’s population does not have access or use the internet. Startlingly, nearly one-third of Americans do not have access and another one-third does not use new technology. Improving education is very important to boosting information technology. Otherwise, as long as these large segments of the population do not use the internet it will be nearly impossible to “achieve the widespread use of electronic medical records, use of email for doctor-patient communication, or development of sophisticated websites that include detailed health care information.” One key component in improving information technology is advancing literacy. Researchers have found that poor people experience poorer health because they have do not have common kinds of preventative health and have less information on health (West, and Miller).
The portion of the population that does not have access to the internet is mainly because they cannot afford the costs of technology. Non-profit organizations have made an effort to develop low-cost laptops for poor people. “By providing electronic access at an affordable price, this kind of technology lowers the economic barrier to broader use and makes it possible for more people to gain digital access.” It will also be beneficial for healthcare professionals get the correct training on how to use this technology. Doctors and nurses should be trained about its benefits and costs and also taught how to use and transition the technology (West, and Miller).
Cost does remain a major barrier in adopting this new technology. It is estimated that it would be about $13,100 per provider, per year. The cost over a five year period would be $46,400, but it does pay off in the end with a total in savings in five years $154,900. One study that implemented the electronic medical records took both the personal and the financial costs and found that the total cost is $140,000. Both the staff and doctors had to go through the extensive training on how to operate and maintain the system. The study also found that it took a redesign of the office workflow and daily routines were changed in order to adopt the system. In the end, doctors found it to be extremely worthwhile (West, and Miller).
One of the major barriers that might also be the toughest is political and legal obstacles. It is difficult because the players involved, such as doctors, nurses, insures, patients, and pharmaceutical companies have different interests about how to move forward. An example of this would be who has control over the medical records, whether it is patients, doctors, hospitals, or insurance companies. Politically it is difficult because leaders must decide “what kind of reimbursement rates should be available for e-mail consultations, digital prescriptions, and other electronic health services.” As of right now, only twenty-three states allow digital prescriptions (West, and Miller).
In the same respect, health insurance companies do not reimburse for “electronic consultations,” so when doctors answer patient e-mails they are working for free. One solution to this problem is a flat rate paid by the patient ranging from $100 to several hundred per year. The advantage of doctor-patient emails is trust builds quickly and office visits seem more efficient and less “emotionally charged.” A challenge that some doctors face is that they feel that answering e-mails violates the HIPAA, which guarantees confidentially for the patient. There is no way to make sure that there will be confidentiality in the reply of an email (West, and Miller).
The website’s technical functionality is important to a user’s trust for the online services. The user interface is defined as the functionality of the site and design. A website will gain trust from the user if it reduces effort, provides a sense of security, and is responsive. In contrast, there are some researchers who believe that low website functionality provokes mistrust from the user, but high functionality does not impact trust at all. Usability can have impact in the beginning when a consumer decides to return to the site or not, but overall has no impact on trust, satisfaction, or loyalty (Gummerus, and Liljander).
The future of internet healthcare is in interactive digital television or DiTV. Interactive television combines television content with interactive components. It enables the users to request information, like still images or video clips and have it return to the broadcaster. Because television is already a well-established medium, interactive digital television has a great potential in healthcare. The aim in providing healthcare interactively is to “provide patients with easy and fast access at home to health advice information” (Nicholas, and Williams)
Interactive television is very valuable if people are prepared to search for information that they need. It would be more efficient if interactive television sites were easy to use and the content was credible. A few pilots researched found mixed results, but overall a market exists for digital health on interactive television. “Health-related programs, especially on themes of special interest to niche audience groups, will attract viewers, as will health-related videos on demand, provided they are of good production quality.” It was also found that when the information is coming from an already trusted source, viewers were more likely to return (Nicholas, and Williams).
Although there is no doubt that there are major barriers in online healthcare, but overall benefits supersede the downfalls. Privacy, politics, trust, and cost, limit the full possibilities that could be gained from online healthcare. Although policy makers seem a bit hesitant, it seems as though they will have little or no choice to adopt a plan to attain the full benefits of online healthcare. Healthcare costs are escalating at such a rapid rate that failure to act is not much of an option at this point. Extending the benefits of digital medicine to more and more people will speed up the healthcare revolution.