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What is Internet Health Care?
Technology has changed forever the way consumers perceive healthcare. the internet is utilized by millions of user to perform daily life activities such as shopping, bills paying, communication with colleagues or family members, dating, and now health care (Bau, 2001). In the past, only physicians were the source and provider of health care information and services to their patients (Hesse & all, 2005). Also most information pertaining to health was only accessible in libraries, through medical books.
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In this new age of advanced technology, the internet has become the go to tool for patients seeking health information as mild as flu symptoms to more serious and life threatening disease as cancer. As much as 72% of world-wide-web users seek health information though the internet (Pew 2012). “Health seekers” utilize this tool to learn more about their condition, seek new treatments, interact with others in the same situation, and get answers to questions at any given moment day or night. The internet is allowing its users access to a wealth of information, all that in the privacy of their homes and at less cost. The “informed consumers” are getting more and more involved in every aspect of their care and they want to participate in “shared decision-making” (Sunday, 2000). Internet health information seeking can help patients be better informed, which can lead to better health outcomes, a better utilization of health service resources, and a stronger physician-patient relationship (Kassier 2000; Murray et al 2003).
But, health information on the Internet may be misleading or misinterpreted, compromising health behaviors and health outcomes, or resulting in inappropriate requests for clinical interventions (Eysenbach, Kohler, 2002; Murray et al 2003). To access the full potential of internet as a source of health information, physicians need to recognize the potentials of this technology, while being mindful of possible dangers to patients’ health (Powell & all, 2003).
What is the trend?
Worldwide about 4.5% of all internet are health related (Morahan-Martin, 2004). In less than a quarter of century, the internet users grew from 42% to 81% (Fox & Rainie 2014). Seventy two percent of U.S. adult reported looking for health or medical information online for themselves or for others at least once in the previous 12 months (Fox & Duggan 2013).
The internet not only is a research tool for those seeking information regarding their condition, bit is also a tool diagnosis tool for those searching for answers online. Indeed the 2012 Pew Research Center’s Internet & American Life Project health survey revealed that among the health seekers, 35% were “health diagnosers” meaning people looking to find answers for specific medical conditions online themselves or relatives might have (Fox & Duggan, 2013).
Across studies, the general observation was that higher education levels was strongly correlated to higher rates of Internet use for health but internet use was not a function of household income (Jansen & Spink 2006). Most of the online health seekers (77%) start their search from general search engine like Google or through medical web sites (13%) proving some specific health information (Fox & Duggan 2013). These results are somewhat inconsistent with a more targeted study by Dickerson, Reinhart, Feeley, Bidani, Rich, Garg & Hershey (2004) accessing patients internet behavior in three urban primary care clinics were the majority of the patient (73%) reported starting their search on a medical website.
Half of the inquiries are on behalf of a loved one which translates to 39% of the online health seekers population (Fox & Duggan, 2013). Often women (64%) would report searching the net for health information than male (53%) even though they equally access the internet (Fox &Duggan, 2013).
Why health seekers like the Internet?
Seekers of online information always cite tree main reasons for going online. First, the Internet allows them to seek information at any hour; second, they can get a wealth of information and; finally, they can access the information anonymously (Fox & Rainie, 2000).
Seekers of online health information are of two kinds: those with a diagnosed chronic condition and those without (Dickerson et al., 2004). According to studies, they tend to have a different approach toward online information seeking. Indeed, multiple studies revealed that people that perceive themselves as being unhealthy tend to be more proactive at seeking online information that will help them get a better understanding of their condition, or to seek for second opinion, or seek advance treatment of their ailment (Fox & Rainie,2000; Dickerson et al., 2004) .
Most users actually attributed their improve understanding of health issues to the use of internet and some even went further admitting internet has impacted how they manage their health care needs and their choice of a health care professional (Jansen & Spink, 2006). The internet is a powerful education tool and a great support to consumer looking to get more involved in their health care and participate in share decision making. Internet improves users understanding of their chronic condition, treatments for their chronic condition, or other symptoms, conditions, or treatments, effects decisions about health or health care or on use of the health care system.
Potential benefits of online health information
Online health information has the potential of improving patients’ participation in some aspects of their care and their interaction with the care giver (Baker, Wagner, Singer, & Bundorf, 2003).
Most users go to health sites for research and reference purposes. Physicians and patient alike use the internet for health information-seeking and communication purposes. Physicians glean the internet to keep up with the latest innovation in their field. It is also a way to connect with colleagues from all other the world as there are no borders restrictions on the World Wide Web. Few use it to communicate with their caregivers or to buy medicine.
Most health seekers have been able to get the information they need without revealing personal information. Anonymity is another great benefit offered by the internet. Anyone can go online and look for any symptom or condition without revealing it identity. For extremely shy people or for embarrassing health conditions, the internet is a good alternative to understanding or treating the condition without getting exposed. According to studies
Many are using the Web to gather information on behalf of family and friends. Those who are in excellent health often seek online materials to help someone else; those who are in less-than-excellent health are more likely to be hunting for information for themselves (Fox & Rainie, 2000). The 2012 Pew health survey reported that about half of the internet health quests are on behalf of a loved one (Fox & Duggan, 2012). In addition, Internet has been proven helpful in assisting caregivers in their ability to provide care to cope and support for the person in their care (Fox, Duggan, & Purcell 2013). A Pew internet health tracking survey from August to September 2012 revealed that 24% of caregivers (adults ages 18+) surf the net for reviews on prescription drugs, 30% got information , care, and support from people with the same condition, as much as 46% went online for diagnosis, and 72% gathered health information online (Fox, Duggan, & Purcell 2013)
In general, health seekers use the internet to seek information on present or immediate medical condition. It is important to note that in most cases, in person visit with a physician precedes the seeking of online health information. Often, a diagnosis following a doctor visit always urges patients to seek online information in order to better understand their condition. But then again, the decision on when to meet with the physician depends on who the patient is. In general, health seekers looking for information on behalf of a loved one will go online after a doctor’s visit, while health seekers looking for self will go online before the doctor’s visit, so that they can actively participate. The Pew health survey reports that 53% of “online diagnoses” reported their online findings to their physician and 41% had their diagnosis confirmed (Pew, 2012). Those results contradict a study by Diaz et al (2002) conducted on primary internal medical private practice patients who reported that nearly 60% of the patient did not discuss their findings with their physicians.
Second opinion seeking – health seekers use the internet to get a second opinion.(develop on this)
Interactive and E-connecting- (use the article on cancer) there are countless number of online support groups for nearly every disease and condition, with infinite discussion topics (Forkner-Dunn, 2003). But just as important as the information exchanged in these e-discussions is the emotional support they provide. Being able to interact with others that can relate to the seeker situation is a coping mechanism. “My coping mechanism was to learn as much as I could about my cancer and my treatment, and the most convenient avenue for this was the Internet” said Karen Parles a cancer patient. Indeed, patients reported being less stressed about their disease once they are able to communicate with others in similar condition. Karen Parles a lung cancer patient sated “because of the sheer numbers of patients online, I was able to find others just like myself, and I no longer felt like the only 38- year-old nonsmoker on the planet with lung cancer.” This wealth of personal experience and support can be recorded for future reference of patients, clinicians, or health care planners (Forkner-Dunn, 2003).
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E-monitoring –mentioned the internet is a tool that can be utilized to monitor patients conditions (Forkner-Dunn 2003). Chronic conditions like diabetes, heart diseases, and obesity can specially benefit from e-monitoring. Internet can facilitate home management of medical condition via monitoring devices. For instance, monitoring device testing blood glucose level are widely popular among diabetic patients and these devices connected to the internet can transmit real time results to patients care giver. Patients can also monitor and transmit their weight via e-scale or access their heart or respiratory rate using e-shirt (Forkner-Dunn, 2003).
Internet and physician-patient relationship – A study accessing the impact of the internet on physician- patient relationship by Murray et al (2003) found that most physicians agree that patient bringing information to the visit was beneficial to the physician-patient relationship, but negatively affected time efficiency. Moreover it had no effect on health the quality of care or the health outcome. Health information on the Internet may make patients better informed, leading to better health outcomes, more appropriate use of health service resources, and a stronger physician-patient relationship (Murray et al. 2003).
The internet can have a positive outcome on patients and be the best support they can expect when facing life threatening condition. According to a cancer patient in one study “The Internet has impacted my relationship with my oncologists and my surgeon in a very positive way. I would say that the information I learn on the Internet enables me to ask different questions, to affect the agenda, and to feel involved in my care. Online support that I receive from other patients often relieves anxiety and resolves minor issues that I would otherwise raise with my doctors”(Penson et al 2002).
Negatives and obstacles of internet health information
Privacy violations – Health seekers are scared of what may happen to their information online. There is the fear of having their online activities exposed. Anonymity is one of the reasons people get online. To date this is no enforced policies preventing health websites from keeping tract on online users’ activities and selling those data without users’ content. The absence of enforced policies to guarantee a safe navigation and patients’ privacy renders the internet unsafe for the most concerned patients. Based on the Pew Research Center’s Internet Project telephone survey from July 11-14, of 1,002 adults ages 18 and older, 86% of internet users have tried to use the internet in ways to minimize the visibility of their digital footprints, 55% of internet users have taken steps to hide from specific people or organizations (Rainie et al 2013). Specifically 21% of internet users have had an email or social networking account compromised or taken over by someone else without permission. 13% of internet users have experienced trouble in a relationship between them and a family member or a friend because of something the user posted online.12% of internet users have been stalked or harassed online. 11% of internet users have had important personal information stolen such as their Social Security Number, credit card, or bank account information. 6% of internet users have been the victim of an online scam and lost money. 6% of internet users have had their reputation damaged because of something that happened online. 4% of internet users have been led into physical danger because of something that happened online. 1% of internet users have lost a job opportunity or educational opportunity because of something they posted online or someone posted about them (Rainie et al 2013).
Inaccurate, incredible and difficult to evaluate – few studies to date have been able to access the credibility, and accuracy of online health information. One major problem encounter by health seekers is that most of the information online is too general and outdated (Fox & Rainie, 2000, Rice 2006). Based on previous studies results, internet health seekers find it hard to find what there are searching online, or could not fully comprehend the information, or the information was overwhelming or unreadable (Zeng et al. 2004; Berland et al., 2001 ). Health seekers are equally divided when it come to the credibility of the information online (Fox & Rainie, 2000). The most common problems mentioned were: no new information, information too general, confusing interface/organization, and too much information to process (Rice, 2006).
Another obstacle to expansion of online health is inequality. The lack of necessary technology some part of the population is very problematic. Many senior, minority, and lower-income patients will be excluded if online forms of intervention were to be implemented nationwide for lack of access. Previous studies reported (who use the internet). There is a possibility that the expansion of this technology might prove to worsen inequality in the distribution and delivery of care rather than ameliorate it (DiMaggio, & Hargittai 2001).
Previous works have also pointed out wide variations in the quality of information available on the Internet. Inaccurate or poorly targeted information can to poor treatment choices. An excess of extraneous, irrelevant, or invalid information can burden health care providers and lead to the provision of efficiently care (Baker, Wagner, Singer, & Bundorf, 2003). An assessment of 121 websites on five common health topics to evaluate their credibility reported that only 24% of the sites met more than two-thirds of the published health guidelines for that health topic (Rice, 2006). Berland et al. (2001)also reported that Internet health information has an inadequate coverage of important medical information.
Destroy physician- patient relationship – the search of information online can lead to unrealistic expectations (Penson et al. 2002). Patients scattering the internet for information or alternative treatments, getting their hopes up only to have their physician reject it for cause of inaccuracy or irrelevancy may get frustrated put tensions into the patient-physician relationship. Murray et al. (2003) find a correlation between physician refusals to approve inappropriate requests, patients’ satisfaction, and a lower index of quality; particularly in managed care.
Physicians sometime feel as patients armed with online information are challenging their authority. This reaction was strongly associated with harms to the physician-patient relationship, quality of care, health outcomes, and time efficiency (Murray et al. 2003).
Suggestions include “kitemarks” (seals of approval) for quality Web sites, codes of conduct for development and content of Web sites, market forces, directing users to trusted Web sites, filters, rating instruments for users, and public education in evaluating the quality of online information (Murray et al. 2003)
Directing users to trusted web sites – providers can proactive in identifying the best internet health source to direct their patients. Suggested trustworthy organizations by Diaz et al. (2002) are the Health on the Net Foundation (www.HON.ch),the Internet Healthcare Coalition (www.ihealthcoalition.org),and Health Internet Ethics (www.hiethics.org). Past studies show that up to 35% of the internet users do not share their results with physician (Pew, 2014). The main raison being that physician did not ask or did not give the impression of wanting to get involved. Physicians can best assist patients by inquiring about internet usage and by helping in finding reliable source of medical information (Diaz et al. 2002).
Provide accurate, credible, Reliable Information– web sites aiming at providing internet information should thrive to assure accuracy, credibility, and reliability. Health information provided to patients ought to be useful, up to date, and must provide a list of sources that support the reliability of the information.
Privacy– HIPPA requirement for health organization using health IT should apply to health information web sites. Patients’ privacy should be respected and should not be shared without authorization.
All major changes always face resistance before people can warm up to the idea and then follow the acceptation phase. Like the introduction to telephone in health care more than a century ago, introduction of the internet as a form of health care delivery will take time before it can be viewed as a tool that add value to medical practice.
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