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With a few clicks on the Internet, patients are entering a medical cyberworld that gives them unprecedented information about their conditions and ultimately greater control over their treatment. They can search through medical journals, visit a "virtual hospital," get a list of pending clinical trials, review material on newly approved drugs, check physicians’ credentials and health plan ratings, or chat with other patients or health professionals.
These Internet-educated patients come to physician visits armed with the material they have gathered. While physicians worry about the validity of some of that information, inarguably the Internet has become a powerful tool for patients who want to monitor and improve their outcomes.
Here are two examples of consumer-oriented web sites that help patients manage a chronic disease and learn about outcomes data.
By tapping into "arthritisconnection.com," patients with arthritis enter a virtual "Better Living Spa" within the Arthritis Connection. The spa contains four rooms, including "The Juice Bar" for ideas about nutrition and food preparation, "The Locker Room" for daily living tips, "The Doctor’s Corner," and "The Fitness Center."
With its emphasis on practical advice and forum for sharing ideas, this World Wide Web site was immediately successful when the Skokie, IL-based pharmaceutical firm Searle launched it in September. In October alone, readers accessed various pages of the web site 32,000 times. Information at the site is updated every other month.
The popularity of sites like the Arthritis Connection contradict the stereotypes. "Most people think of the Internet as being a Generation X technology," says Pam Rasmussen, MS, Searle’s director of public relations. "But it’s uniquely suited for people with disease."
In fact, older people represent the fastest-growing segment of consumers who are purchasing computers, says Katie Bates, director of on-line services for SeniorNet, a San Francisco-based nonprofit organization that educates older people about computer technology. SeniorNet has 92 learning centers around the country.
On SeniorNet (www.seniornet.org), older patients with chronic diseases or depression find support from others who faced the same struggles. Now, they also can receive medical advice. In January, SeniorNet launched a six-month pilot project with Kaiser Permanente of Northern California. The health maintenance organization will provide a nurse practitioner to answer health-related questions on SeniorNet message boards.
Bates envisions a time when physicians communicate with their patients via e-mail and web sites. Patients may even schedule appointments on line, she says.
"There’s a great deal of interest on the part of health care organizations as to how they can use this medium to reach consumers," she says. "The possibilities are endless in patient communications."
"Would you buy a new car by flipping through a couple of brochures and then choosing the lowest-priced option? Not likely. . . . Just as you evaluate a car on certain cost and quality features, you can also evaluate a health plan," the Web site reads.
After urging web readers to "Go on, look!", the California Consumer HealthScope (http://www.healthscope.org) delivers with pages of ratings and consumer-oriented information about health care and health plans.
For example, the report card on preventive care first explains why preventive care services are important to patients and to managed care organizations. Then, consumers can learn about what preventive care checkups they should have, or they can click onto a chart showing whether health plans scored above average, average, or below average on preventive health measures based on the Health Employer Data Information Set (HEDIS) 3.0. HEDIS creates a standard patient satisfaction tool for all plans accredited by the National Committee for Quality Assurance in Washington, DC. (For more information on HEDIS 3.0, see Patient Satisfaction & Outcomes Management, September 1996, p. 97.)
HealthScope was launched in November and is sponsored by the Pacific Business Group on Health, a San Francisco-based coalition of 33 public- and private-sector purchasers of health care, and the Kaiser Family Foundation in Menlo Park, CA.
"For the first time consumers have access to all this report card information at one site," says Anne Castles, MA, MPH, project manager of the coalition’s Consumer Information Hub, which coordinates the HealthScope project. "From an informational point of view, it’s extremely exciting."
As early as this spring, HealthScope will include physician-specific ratings from a standardized patient satisfaction survey. Patients responding to the survey will receive a follow-up questionnaire in 18 months to two years to determine changes in satisfaction and health status, Castles says.
The HealthScope site has an average of 80,000 "hits" a week of people viewing various web pages. Still, the coalition continues to print brochures and maintains an 800 telephone number to capture consumers who haven’t yet tapped into the Internet.
"There’s potential for the Internet to become a good consumer tool, but we haven’t hit that potential yet," says Castles.
Meanwhile, employer groups and health care purchasers around the country have expressed interest in HealthScope and the use of the Internet to publish report cards. "I think we’re only going to see the further spread of the Internet and interactive tools," Castles says.