Unlike many patients of the past, today's health-care users want to become more informed about their illnesses, and they want the most current information. The Internet has become a popular way to access current information, and since its introduction more people are turning to it to find medical information. Studies report that anywhere from 36% to 55% of the American population that use the Internet is using the Internet to research medical information, and these percentages have been rising. Cancer is 1 of the top 2 diseases about which people seek information on the Internet. Some studies have specifically asked whether breast cancer patients access the Internet for medical information; estimates range from 10% to 43% of breast cancer patients who use the Internet, with higher usage being associated with more education, greater income, and younger age.
To identify where breast cancer patients find medical information about their illness and to track changes over time, from active treatment to survivorship status.
Participants were 224 women who had been recently diagnosed with Stage I, Stage II, or Stage III breast cancer. Each woman was contacted approximately 8 months and 16 months after diagnosis and was asked about 10 different information sources they could have used to obtain information or support about their breast cancer.
Eight months after diagnosis, the top 3 information sources used by women were books (64%), the Internet (49%), and videos (41%). However, at follow-up (16 months after diagnosis), the most frequently cited information source was the Internet (40%), followed by books (33%), and the American Cancer Society (17%). We found that women continued to use the Internet as a means of gathering information even after their treatment ended. Significant unique predictors of Internet use were more years of formal education and younger ages. Cancer stage was not a significant predictor of Internet use.
Previous research has been mixed about the percentage of cancer patients who use the Internet to gather information about their illnesses. The results of the present study corroborate 2 other data sets of breast cancer patients, as just over 44% of the women reported using the Internet after diagnosis. Sixteen months after diagnosis, the percentage of women using the Internet dropped slightly, but other chief sources dropped sharply at that time. The Internet continues to play an important role for cancer survivors after medical treatment has ended, and health professionals can use this knowledge to provide their patients with Internet advice.
Breast cancer; Internet; Internet use; Internet search
The Government has invested £7 million (approx. $11.5 million) to connect all Primary Care Practices in Scotland to the National Health Service Intranet (NHSnet). This provides General Practitioners (GPs) and Practice Nurses with access to the Internet and a wealth of healthcare information of varying quality.
This study examines Primary Care Staff's use of the Internet, their views on the reliability of healthcare information available via the Internet, and their interaction with patients who have presented them with information downloaded from the Internet.
A postal questionnaire was distributed to a random sample of 300 GPs and 130 Practice Nurses throughout Glasgow. There was a response rate of 60%.
Time restraints (20%) and concerns that they lack the necessary skills (17%) were highlighted as the most common reasons for not accessing the Internet. Sixty-nine per cent of GPs and 70% of Practice Nurses had looked at the Internet for healthcare information. Forty-eight per cent of GPs and 41% of Practice Nurses were concerned about the reliability of Internet information. Fifty-eight per cent of GPs and 34% of Practice Nurses have been approached by patients with Internet healthcare information. Sixty-five per cent of the information presented by patients was new to GPs.
The majority of Primary Care Staff now have access to the Internet and use it to look up healthcare information. Almost half of GPs would consider referring their patients to the Internet for further information about their condition. Results highlight that the healthcare information downloaded from the Internet by patients is accurate, but patients have problems correctly interpreting this information. An increase in the use of home computers and free access to the Internet will see a continued increase in patients approaching GPs and Practice Nurses with healthcare information downloaded from the Internet.
Internet; Consultation; General Practice; Information Technology; Patient Education
Chronic conditions are among the leading causes of death and disability in the United States. The Internet is a source of health information and advice for individuals with chronic conditions and shows promise for helping individuals manage their conditions and improve their quality of life.
We assessed Internet use for health information by people who had one or more of five common chronic conditions. We conducted a national survey of adults aged 21 and older, then analyzed data from 1980 respondents who had Internet access and who reported that they had hypertension, diabetes, cancer, heart problems, and/or depression.
Adjusted rates for any Internet use for health information ranged from 33.8% (heart problems only) to 52.0% (diabetes only). A sizable minority of respondents — particularly individuals with diabetes — reported that the Internet helped them to manage their condition themselves, and 7.9% said information on the Internet led them to seek care from a different doctor.
Use of the Internet for health information by chronically ill patients is moderate. Self-reported effects on choice of treatment or provider are small but noteworthy.
Patient Internet portals that allow patients to access their personal health information are an emerging form of enabling technology. The purported benefits from increasing use of information technology in healthcare, however, may not be universal because of a widening digital divide along racial and socioeconomic lines. In this pilot study, we surveyed 31 Medicaid beneficiaries to ascertain their interest in and projected use of a healthcare patient Internet portal. We found that most Medicaid beneficiaries were very interested in accessing personal health information about themselves or their dependents online. Moreover, ninety percent of respondents reported that they have access to the Internet, and sixty-eight percent of those with Internet access use the Internet once a week or more.
The purpose of this paper is to discuss the development of the Health Sciences Library Gopher at St. Louis University (SLU) Health Sciences Center. The authors will outline university criteria from the Office of Computing and Information Services, library selection criteria, bibliographical access, reference and instructional implications, data entry and maintenance, and the role of the library's Internet Committee. All libraries have been awed by the tremendous amount of resources available through the Internet; the challenge is to not be intimidated but to be innovative in designing systems that can present these resources to the library client in the most easily understandable approaches possible. The Internet Committee in the SLU Health Sciences Center Library has designed a framework for the construction of "menus" to lead the client to selected Internet resources. Some of the issues confronted include relating the Internet resources to the library's Collection Development Policy, coordination of Internet resources to other bibliographic sources (Journal Holdings List, Intelligent Catalog), and educating staff and clients to manage a wide range of new resources as well as traditional ones in electronic formats.
The World Wide Web is being used increasingly as a resource for accessing health-related information. In our study, we identified types of health-related Web sites visited most often, determined how often patients shared Web-accessed health information with their doctors, and examined factors that encouraged Internet use for locating health-related information. We also compared health-related Internet use among people who did not have any type of chronic disease with people who reported having one or more chronic diseases.
We merged data from the 2002 and 2003 HealthStyles surveys to generate frequency and descriptive statistics and used multivariate logistic regression to estimate odds ratios.
Approximately 35% of survey participants reported using the Internet to search for health-related information. Among them, the Web sites visited most often included health information portals, government agencies, and nonprofit organizations. About 53% reported that they "sometimes" shared Internet information with their doctors. The most important features of the Internet that would encourage its use for health information were ease of finding and using the information and clarity of the information provided. Internet use differed by sex and age and was strongly associated with income and education. Respondents who reported having a chronic disease (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.16–1.45) were more likely to use the Internet to access health-related information, especially among those with depression (OR = 1.47; 95% CI, 1.27–1.71) and high cholesterol (OR = 1.18; 95% CI, 1.02–1.37). In addition, respondents who reported having two or more chronic diseases (OR = 1.35; 95% CI, 1.16–1.56) were more likely to search for online health information than respondents who reported having no chronic disease.
Public health professionals have a unique opportunity to use the Internet as a tool to complement and supplement the health information that the public receives from health care professionals.
Internet disease management has the promise of improving care in patients with heart failure but evidence supporting its use is limited. We have designed a Heart Failure Internet Communication Tool (HFICT), allowing patients to enter messages for clinicians, as well as their daily symptoms, weight, blood pressure and heart rate. Clinicians review the information on the same day and provide feedback.
This pilot study evaluated the feasibility and patients' acceptability of using the Internet to communicate with patients with symptomatic heart failure.
Patients with symptomatic heart failure were instructed how to use the Internet communication tool. The primary outcome measure was the proportion of patients who used the system regularly by entering information on average at least once per week for at least 3 months. Secondary outcomes measures included safety and maintainability of the tool. We also conducted a content analysis of a subset of the patient and clinician messages entered into the comments field.
Between May 3, 1999 and November 1, 2002, 62 patients (mean age 48.7 years) were enrolled.. At 3 months 58 patients were alive and without a heart transplant. Of those, 26 patients (45%; 95% Confidence Interval, 0.33-0.58) continued using the system at 3 months. In 97% of all entries by participants weight was included; 68% of entries included blood pressure; and 71% of entries included heart rate. In 3386 entries out of all 5098 patient entries (66%), comments were entered. Functions that were not used included the tracking of diuretics, medications and treatment goals. The tool appeared to be safe and maintainable. Workload estimates for clinicians for entering a response to each patient's entry ranged from less than a minute to 5 minutes or longer for a detailed response. Patients sent 3386 comments to the Heart Function Clinic. Based on the content analysis of 100 patient entries, the following major categories of communication were identified: patient information; patient symptoms; patient questions regarding their condition; patient coordinating own care; social responses. The number of comments decreased over time for both patients and clinicians.
While the majority of patients discontinued use, 45% of the patients used the system and continued to use it on average for 1.5 years. An Internet tool is a feasible method of communication in a substantial proportion of patients with heart failure. Further study is required to determine whether clinical outcomes, such as quality of life or frequency of hospitalization, are improved.
Internet; disease management; congestive heart failure; physician-patient relations; communication
Patients who are active and involved in their self-management and care are more likely to manage chronic conditions effectively (6, 26). With a 5-fold increase in the incidence of chronic illness over the past 20 years, access to information can provide patients the tools and support to self-manage their chronic illness. New media technologies can serve as tools to engage and involve patients in their health care. Due to the increasing ubiquity of the Internet and the availability of health information, patients are more easily able to seek and find information about their health.. Thus, the Internet can serve as a mechanism of empowerment (4, 5). This is especially important for people with diabetes mellitus where intensive self-management is critical.
Objectives: To assess the accessibility of the internet, the level of interest from patients attending genitourinary (GU) medicine clinics, and explore potential concerns about confidentiality.
Methods: Questionnaire based survey of patients attending five GU medicine clinics in England.
Results: 41% of GU medicine clinic patients in 1999 had access to the internet (range 31%–52%) with access more common in younger age groups, and less common in women and black Caribbean patients. One in 10 patients (with internet access) had used the internet to find out more about the problem with which they had come to the clinic. 60% of patients replied that information on sexual health on the internet was of interest to them and a high proportion of patients said they would use the internet to access information about GU clinics (64%), book an appointment (64%) or get test results (63%). Almost a quarter of patients who made additional suggestions wanted an interactive website.
Conclusions: A high proportion of patients attending GU clinics have access to the internet with potential uses for health education and service delivery.
Key Words: internet; sexual health; genitourinary medicine
Although the Internet has evolved over more than twenty years, resources useful to health information professionals have become available on the Internet only recently. A survey conducted by the Regional Medical Libraries of the National Network of Libraries of Medicine in the fall of 1993 indicates that libraries at academic institutions are much more likely to have access to the Internet (72%) than are libraries in hospital environments (24%). Health information professionals who take on the challenge and exploit the Internet's resources find rewards for themselves and their clients. The basic electronic mail capability of the Internet allows colleagues to collaborate, communicate, and participate in daily continuing education. Internet terminal and file-transfer capabilities provide improved access to traditional resources and first-time access to new electronic resources. Through the Internet, online catalogs are available worldwide, and document delivery is faster, cheaper, and more reliable than ever before. Institutions can make organizational, full-text, online, and publication information available through Internet tools such as direct file-transfer protocol (FTP), menu-based Gopher, and hypertext-based Mosaic. The National Library of Medicine (NLM) is among organizations finding new ways to provide service through the Internet. NLM now uses electronic mail to communicate with users, FTP service to distribute publications, and tools such as Gopher and Mosaic to distribute publications and graphics and connect users to online services. The Internet allows service providers and health sciences information professionals to work in a rich, new medium whose potential is just beginning to be explored. At the same time, its characteristics--including lack of formal organization, standards, quality control, and permanence--pose a challenge.
The Department of Veterans Affairs (VA) operates one of the largest nationwide healthcare systems and is increasing use of internet technology, including development of an online personal health record system called My HealtheVet. This study examined internet use among veterans in general and particularly use of online health information among VA patients and specifically mental health service users.
A nationally representative sample of 7215 veterans from the 2010 National Survey of Veterans was used. Logistic regression was employed to examine background characteristics associated with internet use and My HealtheVet.
71% of veterans reported using the internet and about a fifth reported using My HealtheVet. Veterans who were younger, more educated, white, married, and had higher incomes were more likely to use the internet. There was no association between background characteristics and use of My HealtheVet. Mental health service users were no less likely to use the internet or My HealtheVet than other veterans.
Most veterans are willing to access VA information online, although many VA service users do not use My HealtheVet, suggesting more education and research is needed to reduce barriers to its use.
Although adoption of My HealtheVet has been slow, the majority of veterans, including mental health service users, use the internet and indicate a willingness to receive and interact with health information online.
Internet; technology; mental health; military medicine; health services; electronic medical records; severe mental illness; homeless
Patients use the internet to educate themselves about health related topics and learning about plastic surgery is a common activity for the enthusiastic consumers in the United States. How to educate the consumers regarding plastic surgical procedures is a continued concern for plastic surgeons when faced with the growing portion of the American population having relatively low healthcare literacy. The usefulness of health related education materials on the internet depends largely on their comprehensibility and understandability for all who visit the websites.
We studied the readability of patient education materials related to common plastic surgery procedures from the ASPS and ASAPS websites and compared them with materials on similar topics from 10 popular health information providing sites.
We found that all analyzed documents on the ASPS and ASAPS websites targeted to the consumers were rated to be more difficult than the recommended reading grade level for most American adults and these documents were consistently amongst the most difficult to read when compared to the other health information websites.
The internet is an increasingly popular avenue for patients to educate themselves about plastic surgery procedures. Patient education materials provided on ASPS and ASAPS websites should be written at recommended reading grade levels to ensure it is readable and comprehensible to their audience.
readability; internet; literacy; plastic surgery; websites
Although Posttraumatic Stress Disorder (PTSD) is a severe and disabling anxiety disorder, relatively few people with this condition access evidence-based care. Barriers to treatment are multiple and complex, but the emerging field of Internet therapy for PTSD may improve access to evidence-based treatment. However, little is known about the characteristics of people with PTSD who seek online treatment, or whether they perceive internet treatment as an acceptable treatment option.
An online survey was used to collect information about the demographic and symptom characteristics of individuals with elevated levels of PTSD symptoms, and this was compared to data from corresponding sample from a national survey. Previous treatment experiences, perceived barriers to treatment and treatment preferences for Internet therapy and face-to-face treatment were also compared.
High levels of PTSD symptoms were reported by survey respondents. Psychological distress and disability was greater than reported by individuals with PTSD from a national survey. Half of the sample reported not having received treatment for PTSD; however, 88% of those who reported receiving treatment stated they received an evidence-based treatment. Primary barriers to treatment included cost, poor awareness of service availability, lack of prior treatment response and not perceiving personal distress as severe enough to warrant treatment. Most survey respondents indicated they were willing to try Internet treatment for PTSD.
The Internet sample was symptomatically severe and multiple barriers existed to treatment. Internet therapy is an acceptable option for the treatment of PTSD in an internet sample.
Despite the increasing penetration of the Internet and amount of online health information, there are significant barriers that limit its widespread adoption as a source of health information. One is the “digital divide,” with people of higher socioeconomic position (SEP) demonstrating greater access and usage compared to those from lower SEP groups. However, as the access gap narrows over time and more people use the Internet, a shift in research needs to occur to explore how one might improve Internet use as well as website design for a range of audiences. This is particularly important in the case of novice users who may not have the technical skills, experience, or social connections that could help them search for health information using the Internet. The focus of our research is to investigate the challenges in the implementation of a project to improve health information seeking among low SEP groups. The goal of the project is not to promote health information seeking as much as to understand the barriers and facilitators to computer and Internet use, beyond access, among members of lower SEP groups in an urban setting.
The purpose was to qualitatively describe participants’ self-identified barriers and facilitators to computer and Internet use during a 1-year pilot study as well as the challenges encountered by the research team in the delivery of the intervention.
Between August and November 2005, 12 low-SEP urban individuals with no or limited computer and Internet experience were recruited through a snowball sampling. Each participant received a free computer system, broadband Internet access, monthly computer training courses, and technical support for 1 year as the intervention condition. Upon completion of the study, participants were offered the opportunity to complete an in-depth semistructured interview. Interviews were approximately 1 hour in length and were conducted by the project director. The interviews were held in the participants’ homes and were tape recorded for accuracy. Nine of the 12 study participants completed the semistructured interviews. Members of the research team conducted a qualitative analysis based on the transcripts from the nine interviews using the crystallization/immersion method.
Nine of the 12 participants completed the in-depth interview (75% overall response rate), with three men and six women agreeing to be interviewed. Major barriers to Internet use that were mentioned included time constraints and family conflict over computer usage. The monthly training classes and technical assistance components of the intervention surfaced as the most important facilitators to computer and Internet use. The concept of received social support from other study members, such as assistance with computer-related questions, also emerged as an important facilitator to overall computer usage.
This pilot study offers important insights into the self-identified barriers and facilitators in computer and Internet use among urban low-SEP novice users as well as the challenges faced by the research team in implementing the intervention.
Digital divide; health information seeking; health disparities
It is possible to provide patients with secure access to their medical records using the Internet. Such access may assist patients in the self-management of chronic diseases such as heart failure.
To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff.
A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored.
One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 vs. 85, p=0.08), but was superior in general adherence (MOS compliance score 85 vs. 78, p=0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 vs. 8, p=0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system.
Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.
Heart Failure; Congestive; Patient Participation; Patient Advocacy; Patient Compliance; Internet; Randomized Controlled Trial; Electronic Communication; Electronic Health Record
INTRODUCTION: Information is of utmost importance for patients at risk of developing cancer who require regular screening. Quality assessment is vital to ensure correct information is published on the Internet. METHOD: A postal questionnaire was sent to patients under follow-up for Barrett's oesophagus and colonic polyps. Questions related to computer/Internet access, where patients had previously sought information, whether web-sites would be of use, and what information they would like displayed. A review of on-line patient literature for Barrett's oesophagus and colorectal adenomas was performed. RESULTS: Of the 200 questionnaires sent, 161 patients responded (80.1%). The majority of patients (88%, n = 141) wanted more information on their condition, with 45% (73) having home Internet access and a further 32% (52) having web access from other sources. Only 8% (12) had used the Internet as a source of information; however, the majority of patients (57%) would access a recommended web-site. The Barrett's search resulted in 10/200 sites with full information (i.e. score > 8/10 points). For colorectal polyps there were 12/200 sites. CONCLUSIONS: Accessing quality Internet health information is very time consuming. Recommended web-sites that provide the best information would help patients avoid being overwhelmed with irrelevant and confusing literature.
To understand what patients expect from physicians regarding information seeking on the Internet.
Waiting rooms of 4 community-based primary care offices.
Of 494 patients invited to participate, 330 completed the survey for a response rate of 67%. Of 177 respondents who used the Internet for health information, only 15% agreed that physicians should ask them about their Internet searches. Most (62%) agreed that physicians should recommend specific web sites where patients can learn more about their health care.
Primary care physicians should recognize that many patients would like guidance as they turn to the Internet for medical information. Physicians can utilize quality assessment tools and existing resources that facilitate referring patients to authoritative, commercial-free, patient-oriented medical information on the Internet.
Internal use information seeking patient expectations; physician guidance
OBJECTIVE: To examine patients' use of the Internet to obtain medical information, their opinions on the quality of medical Web sites, and their attitudes towards Internet-based consultations. DESIGN: Questionnaire study. PARTICIPANTS AND SETTING: 398 patients, aged 10-95 years, visiting the orthopaedic outpatient clinics of a London district general hospital over a 2-week period. MAIN OUTCOME MEASURES: (i) The rate of Internet use by patients; (ii) the perception of the quality of medical web sites; (iii) future intentions and attitudes towards Internet-based consultations; and (iv) concurrence between information obtained from Web sites and advice given by the orthopaedic surgeon in the clinic. RESULTS: From 369 respondents (response rate 93%), 55.3% of patients had accessed the Internet. Of these, 52.0% had obtained medical information from this source. Access was linearly correlated with age (r2 = 0.975, P < 0.01) and was also related to social status. Of the 12.3% of patients who had researched their particular orthopaedic condition, 20% reported that the advice received from the surgeon in the clinic contradicted that obtained from the Internet. A total of 35.7% of patients would undergo an Internet-based consultation, whilst a further 25.5% would consider this, depending on the medical condition in question. CONCLUSIONS: Over half of the patients studied were willing to access the Internet for medical information, with younger patients more likely to undertake this activity. Moreover, a significant proportion of respondents were willing to undergo an Internet-based consultation. The increased use of medical Web sites by patients raises important issues regarding the need for quality control, and impacts significantly upon the surgeon-patient relationship.
Internet-based interventions to assist in diabetes management have the potential to provide patients with the information and support they need to become effective self-managers.
To assess the feasibility, acceptability, and effectiveness of an Internet-based virtual clinic designed to facilitate self-management in patients who used insulin pumps to manage their diabetes.
For a period of 6 months, 17 patients joined the virtual clinic. The system allowed patients to communicate with health professionals, interact with peers and access information. HbA1c, quality of life, and self-efficacy were monitored at baseline and after 6 months. Questionnaires and qualitative interviews examined patient experiences.
Participants found the virtual clinic easy to use and positively rated its design. Peer support was the most valued aspect and the discussion boards the most used component. All participants highly rated the virtual clinic in terms of improving communication with peers, but few agreed it had improved communication with health care professionals. No significant improvements in physiological and psychological measurements were found. Regarding HbA1c measurements, there was no significant difference found between the pre- and post-test results (P = .53). Mean ADDQoL scores at baseline were -2.1 (SD 1.1, range -3.4 to -0.5) compared to -2.0 (SD 1.2, range, -4.6 to -0.4) post-test (n = 12), (P = .62). Surprisingly, patients’ confidence in their ability to perform self-care tasks was found to be significantly reduced from baseline to follow up (P = .045).
An Internet-based system to aid the management of diabetes appears feasible and well accepted by patients. The pilot study did not identify evidence of an impact on improving quality of life or self-efficacy in patients who used insulin pump therapy.
Internet; diabetes mellitus; intervention studies; virtual systems; self-efficacy
Little is known about to what extent patients who underwent medical treatment access the Internet and whether they benefit from consulting the Internet.
To understand if cardiopathic patients use the Internet for health-related information and whether they find retrieved information understandable and useful.
Telephone interviews, using a semi-structured questionnaire, were conducted with 82 patients who had undergone off-pump coronary-artery bypass grafting at the Center for Less Invasive and Robotic Heart Surgery in Buffalo, New York, USA. Study design was multidisciplinary, combining expertise of medical and communication science. Sources of medical information were identified (doctor, Internet, magazines, newspapers, television, radio, family members). Accessibility, quality, and readability of Internet medical information from the patients' point of view were investigated.
Out of 82 patients, 35 (35/82, 42.7%) were Internet users. Internet users had a significantly higher education level than Internet non-users (college education: 42.9% of users, 10.6% of non-users; P < .001). Among the Internet users, 18 (18/35, 51.4%) had used the Internet for retrieving medical information; 17 (17/35, 48.6%) had not. No statistically significant differences in demographic data were found when comparing these 2 sub-groups of patients. Family-members' involvement was high (15/18, 83.3%). Internet medical information was rated helpful in most cases; readability was acceptable for only 3 patients (3/18, 16.7%). To improve on-line medical information, all patients interviewed suggested sites designed by their physicians.
Although 1 in 5 patients in our sample has used the Internet to retrieve medical information, the majority of them experiences difficulties comprehending the information retrieved. Health-care providers' should provide Internet medical information that is adequate for the non-medical public's needs.
Internet/statistics and numerical data; Questionnaires; Data Collection; Attitude to Computers; Coronary Artery Bypass; Patient Education; Readability
Objective: Although the patient Internet portal is a potentially transformative technology, there is little scientific information about the demographic and clinical characteristics of portal enrollees and the features that they access.
Design: We describe two pilot studies of a comprehensive Internet portal called PatientSite. These pilots include a prospective one-year cohort study of all patients who enrolled in April 2003 and a case-control study in 2004 of enrollees and nonenrollees at two hospital-based primary care practices.
Measurements: The cohort study tracked patient enrollment and features in PatientSite that enrollees accessed, such as laboratory and radiology results, prescription renewals, appointment requests, managed care referrals, and clinical messaging. The case-control study used medical record review to compare the demographic and clinical characteristics of 100 randomly selected PatientSite enrollees and 100 nonenrollees.
Results: PatientSite use grew steadily after its introduction. New enrollees logged in most frequently in the first month, but 26% to 77% of the cohort continued to access the portal at least monthly. They most often examined laboratory and radiology results and sent clinical messages to their providers. PatientSite enrollees were younger and more affluent and had fewer medical problems than nonenrollees.
Conclusion: Expanding the use of patient portals will require an understanding of obstacles that prevent access for those who might benefit most from this technology.
Ongoing improvements in the content of the Unified Medical Language System, coupled with the recent release of the Internet-based Knowledge Source Server (KSS), have prompted us to develop an interface between the KSS and our computer-based patient record. We confronted many challenges while developing a robust interface to an Internet-based server, and in integrating the process of codification into the workflow of clinicians. An initial evaluation of the interface in the clinical environment suggests that acceptable performance is attainable. The benefits of using an Internet-accessible tool in a clinical information system appear to justify the effort required.
The Internet is a widespread source of health information for health-care professionals and patients. Social inequalities in Internet access have been well studied but not practices. This study was conducted to determine whether differences exist in the frequency of Internet use for health information among online health seekers.
We conducted an Internet-based survey from November 2006 to March 2007. The 3720 residents of France who had searched for health information during the previous year were considered.
This study reveals different practice of online health information seeking between men, women, the general population and people who work in the health sector. Health status and active Internet use were associated with higher frequencies to varying degrees. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use in the general population.
The Internet seems to be used as a substitute information tool when issues of communication or confidence with physicians arise as well as to lead people to question physicians and medicine.
Physician and public health actors should remain cautious about these disparities in online health information seeking access and practices, quality issues concerning online information and about possible self-exclusion from the health-care system.
Adolescent; Adult; Age Factors; Attitude to Health; Caregivers; Consumer Health Information; methods; Female; France; Health Status; Humans; Internet; Male; Middle Aged; Questionnaires; Sex Factors; Socioeconomic Factors; Young Adult
The United States health care system is an outdated model in need of fundamental change. As part of this change, the system must explore and take advantage of the potential benefits of the "e-revolution," a phenomenon that includes everyday use of the Internet by the general public. During 2002, an estimated 100 million Americans will have obtained information — including health information — from the Web as a basis for making decisions. The Internet is thus an influential force; and, as such, this medium could have a revolutionary role in retooling the trillion-dollar United States health care industry to improve patient self-management, patient satisfaction, and health outcomes. As a group, physicians use the Internet more than do many other sectors of the general adult population. However, physicians have not received sufficient information to convince them that they can provide higher-quality care by using the Internet; indeed, few studies have assessed the Internet's value for improving patients' medical self-management and health behavior, as well as their clinical outcomes and relationships with health care practitioners. New e-technology formats introduced to the growing consumer movement will drive the next generation of self-care by allowing patients to manage their own health conveniently and proficiently.
Consumer participation; Internet; medical informatics; patient education; physician-patient relations; self care; technology; disease management; computers
In 2001, the Institute of Medicine (IOM) and the Health Insurance Portability and Accountability Act (HIPAA) emphasized the need for patients to have greater control over their health information. We describe a Boston healthcare system's approach to providing patients access to their electronic health records (EHRs) via Patient Gateway, a secure, Web-based portal.
Implemented in 19 clinic sites to date, Patient Gateway allows patients to access information from their medical charts via the Internet in a secure manner.
Since 2002, over 19,000 patients have enrolled in Patient Gateway, more than 125,000 patients have logged into the system, and over 37,000 messages have been sent by patients to their practices. There have been no major security concerns.
By providing access to EHR data, secure systems like Patient Gateway allow patients a greater role in their healthcare process, as envisioned by the IOM and HIPAA.