NORC is pleased to present this white paper entitled “Consumer Use of Computerized Applications to Address Health and Health Care Needs,” commissioned by the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services (DHHS). The paper seeks to create a better understanding of the ways in which individuals use information technology (IT) to improve their health and manage health care tasks.
As a growing number of health applications are available online, it is important to understand how and to what extent individuals are taking advantage of these applications. Given the existence of disparities in health status among individuals of different ethnic, racial, and socioeconomic backgrounds, it is useful to examine whether use of health-related IT also varies by these dimensions. Finally, to the extent that such applications have been demonstrated to have a positive impact on patients’ behaviors and health, it is worthwhile to understand barriers to wider use and potential opportunities to address them.
Computerized applications allow individuals to engage in a range of activities. This paper will highlight some of those tasks:
- Seek health information - Consumers can use search engines to find, or be directed by their physicians to visit, websites on a range of health and medical topics.
- Take action to monitor and improve health - Individuals can receive assistance in decision making and tracking their chronic conditions or wellness behaviors.
- Communicate with relatives, friends, and other patients - Interactive technologies allow individuals to stay up-to-date on the conditions of friends and loved ones from afar, and foster new avenues of communication among patients with similar diagnoses.
- Interact with the health care system - From locating providers and learning about their performance, to scheduling appointments and refilling prescriptions, to communicating with providers, the internet can allow for a range of transactions between patients and providers.
- Use a personal health record (PHR) or multi-function portal - PHRs allow individuals to organize and selectively share data about their health. If integrated with a provider portal, these resources can also grant patients access to their lab results and online communication tools.
There are several pathways through which individuals can access these applications. A number of resources are sponsored by government, nonprofit, commercial, and academic entities and are publicly available online for all interested consumers. Other individuals receive these services through an insurer, a health care provider, or employer.
The extent to which individuals use these resources varies greatly by application. While the majority of internet users have viewed medical or health information online, by some estimates fewer than 4% of Americans use an electronic PHR. Although the data are limited on how use of these services ranges across population groups, some trends emerge. Individuals with more education and those who are neither very young nor very old are the most frequent users of health IT.
In order to address these inequities and to expand use of consumer health IT, certain conditions will likely need to be met:
- Consumers need the resources to access computerized applications, including technology and the skills to use it.
- Consumers need to be aware of the applications.
- Economic and technical problems must be addressed to encourage the use of these applications.
- Applications must guarantee privacy and be of high quality so they will be appealing to consumers and health care providers.
The federal government as a stakeholder has a role in helping to accomplish these goals. It can help coordinate standards to improve privacy and overcome some of the technical problems that may prevent these tools from being as attractive as possible to consumers. Reimbursing providers may encourage their use of health IT and increase their likelihood of endorsing these tools to their patients, thus indirectly spurring on consumer use. Additionally, the federal government could help steer the research agenda to foster an understanding of the current use of these resources across subpopulations and the components of effective consumer-centered technology.
Methodology. This paper was informed by an extensive literature review and a series of discussions with thought leaders in the field. More than 60 documents were reviewed in the process of drafting this report (see bibliography). In order to gain a broad understanding of the current state of knowledge about consumer use of health IT, the authors conducted searches of the published literature using Medline and other bibliographic databases. In addition, reports from government agencies—including the 2006 report Expanding the Reach and Impact of Consumer e-Health Tools from the Office of Disease Prevention and Promotion in DHHS—and other research organizations were consulted. To get a more complete picture of the types of survey questions that have been asked about the prevalence of consumer use of IT for health reasons, the authors also searched the Polling the Nation database.
Although there are a number of articles and reports on the topic, most of the rigorous, national data on prevalence rates of health IT use comes from two sources—a biennial survey conducted by the National Cancer Institute and research from the Pew Internet & American Life Project. Additional articles that describe health IT use typically focus on smaller, convenience samples. To supplement these written sources, the authors of this white paper consulted with representatives from federal agencies, research organizations, commercial web-resource providers, and health provider organizations. Throughout the report, we will often refer to the comments and perspectives of these experts.
Organizations Represented in Discussions with Key Informants
|Government and research||Centers for Disease Control and Prevention
National Cancer Institute
Pew Internet & American Life Project
|Health provider||Group Health Puget Sound
Palo Alto Medical Foundation
|Web resource||Google Health
Microsoft Health Vault
This paper begins by describing the needs that individuals can address by using their computers or going online and discusses some of the ways in which consumers can access applications to meet those needs. The next section summarizes the data on how many people are using these applications. It also includes a brief summary on the existing evidence about the effectiveness of these health tools. The fourth section discusses how use of health IT varies among different subpopulations of consumers. Next, the paper discusses some of the obstacles for greater uptake of consumer use of health IT. This paper concludes by identifying policy approaches and stakeholders to foster increasing use of these applications.