Musings on the Internet and its value to physicians
Alfred Bove, MD
Associate Dean for Practice Plan Affairs
Temple University Hospital
Philadelphia, PA
Editor, American College of Cardiology Web site

accepted for publication in Medical Computing Today May 1999

In the past few months, several conferences have addressed the business of health care on the Internet. Businesses anticipate that 60 billion dollars annually will be spent on health care information services in the next several years. At present, about 20% of those expenditures are for Internet based information services and the proportion being devoted to the Internet is increasing each year. Obviously there are opportunities for business to grow in this health care information area, and the trend toward more information, more connectivity, and more patient oriented information will provide many new services for physicians who incorporate the Internet into their practices.

Where are these trends and directions taking us in medicine? The topic of a conference on Physicians and the Internet, held this month in San Francisco, provides some important insights. Surveys show an increasing number of physicians use the Internet for practice-related activity. Although the percentage is still small (less than 10%), it is growing each year. Patients, however, are not as shy. Some studies show that 70% of all Internet users obtain health information from the Internet. This trend, and the corresponding growth of consumer medical Web sites, will significantly change the way patients approach their physicians with medical information.

Many of the medical information Web sites are directed to patients, rather than physicians. These sites provide advice, information about therapy, medications, practice standards, and outcome information, and offer up-to-date news on new medical discoveries, clinical trial results, and new drugs and therapies. Often this information is available to patients on the Web before the usual medical channels provide it to physicians. Potentially the physician could be confronted with new therapies of which the patient is aware before the physician has the opportunity to evaluate data supporting the value of the treatment. Many patients join Internet discussion forums about their illness to share information about medical management from a variety of practices. These discussion groups may provide misleading information through testimonials from individual patients or, on the other hand, may provide useful information about newer treatments or therapeutic trials available in only a few centers. Discussion groups are also valuable for patients to learn from other patients and, for families, to learn how to cope with devastating illness in a friend or family member.

For the physician, the Internet offers a variety of opportunities. Searching the National Library of Medicine's Medline abstract database can now be done at no cost over the Web. You will find Web services for physicians which offer up to date medical reviews of recently published studies and clinical trials on sites like Medscape. Journals, such as the New England Journal of Medicine, are frequently available in abstract form for all visitors to the site, and full text may be available to subscribers. Professional organizations provide robust Web sites for members and other health care professionals, and many provide patient information specific to their specialty. The American College of Cardiology, for example, provides practice guidelines, training and credentialling standards, information on educational programs it sponsors, the program of its national meeting, cyberconferences, and Web-based continuing medical education.

The business community is looking for opportunities to generate income from Web-based activities. To date, a few Web sites like Yahoo are profitable, but most are not. Business interest has caused some innovative alliances, such as the recent merger of Healtheon and WebMD. Microsoft is investing $250 million in Healtheon/WebMD and helped bring in other investors including Intel and Excite. Among other reasons for its move, Microsoft believes that consumers looking for medical information and advice will continue to flock to the Web. In addition to its professional services, the new partnership is developing a consumer site that will provide similar information; its approach is to gain credibility by recruiting professional societies to provide consumers with patient-oriented information.

Even with the best projections, the growth of the Web and the innovative approaches to information distribution defy the most astute predictors. The information and misinformation the Web provides have endless potential for changing health care and patient/physician relations. If patients can obtain detailed, credible information about their medical condition, recommended practice guidelines, and therapy and medications, then physicians must also be up to date on that information to maintain their patients' confidence. I feel this change is for the better: my patients will be better informed, and will become true partners in their care.

The impact on physicians will be enormous. We will need to actively use the Web to keep up with the information that patients will have available. The business community saw this new era of medical information coming and responded by taking part in its growth. Now health care providers must also be ready to participate.

Disclaimer: The American College of Cardiology, of whose Web site Dr. Bove is editor, has business relationships with Healtheon and Medscape.
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