In addition to helping individuals address their health needs, computerized applications can assist in navigating and interacting with the health care world. Individuals can go online to select an insurance plan, to learn about the benefits covered by that plan, and to find medical providers. Some providers also allow their patients to engage in a range of activities related to their medical needs through their web portals, including communicating with providers and ordering prescription drugs.
The majority of Americans receive their health insurance through employers. Firms are often active in providing their employees with information about the cost and quality of the health plans they can chose among. In an effort to boost productivity and reduce absenteeism, employers may also use their websites to promote wellness.
Online resources can facilitate the selection of health care providers and plans. An estimated 17% of individuals with private health insurance plans switch coverage annually and 11% of the population changes their doctor. Individuals can access directories of physicians from a range of national websites, including WebMD, appointmentnet.com, and the American Medical Association’s DoctorFinder. Health insurance websites often allow individuals to search the list of providers who accept that coverage. Individuals may also be able to find doctors and receive recommendations from other locals through websites and listservs that are established to share information about a particular community.
As individuals make these decisions, they can consult websites, like Medicare.gov, to gain information about the quality of new doctors or health plan options. In 2006 President Bush signed an executive order mandating that providers who see Medicare beneficiaries or otherwise have transactions with the federal government make cost and quality data available to the public by the beginning of 2007.Through the Medicare website, individuals can find hospitals and nursing homes and compare them based on some of these quality data. Beneficiaries can also compare Part D prescription drug plans, look up drugs in their formularies, and enroll in plans. Unfortunately, a survey conducted in 2005 found that only 2% of respondents ages 65 and older had visited the site—a slightly smaller percentage than individuals in that age group who had visited the commercial WebMD.
In addition to Medicare.gov and its related Hospital Compare site, information about the quality of providers is available through sites sponsored by a variety of types of organizations, including:
- Government agencies and nonprofit organizations that post data on clinical performance measures (ex. sites sponsored by state governments or hospital associations in at least 16 states)
- Media outlets (ex. the annual “America’s Best Hospitals” issue of U.S. News and World Report, other local and national magazines)
- Commercial websites that allow users to rate the quality of their providers (ex.RateMDs.com, Suggestadoctor.com, RevolutionHealth.com)
- Sites that have integrated comparative data on mortality rates, complication rates, and lengths of stay for selected procedures within search functions to find providers (ex. WebMD)
- Subscription or fee-based databases that are typically purchased by health insurance sponsors, groups of employers, and health care providers rather than individual consumers
After selecting an insurer, some individuals can visit the website of their insurance company to manage their health care needs. The Anthem Blue Cross and Blue Shield plan offered through the Federal Employee Health Benefits program illustrates some of the services that can be available online. The site lets enrollees see information about their membership; search for, select, or change providers; view information on health and wellness topics; and purchase discounted health-related products and services. Other popular features of insurer sites include allowing individuals to view their lab results, find medications on the formulary, and renew prescriptions.
Similarly, once enrolled with a provider, patients might gain access to assorted health applications if their providers have a web portal. Academic medical centers and integrated delivery systems are often more able to leverage sufficient resources to offer portals to their patients. In addition to private practices initiating these portals, government entities have gotten involved. For example, there are between 5 to 7 million veterans enrolled in the My HealtheVet program of the Department of Veteran Affairs (VA).  Community-based organizations can help fill these needs as well. Several such organizations in Sonoma Valley, California, collaborated to launch MiVIA in 2003 to help migrant and seasonal workers track their health care.
These portals can allow individuals to use a number of functions, which may include scheduling appointments, re-filling prescriptions, or otherwise communicating with physicians and office staff. Practices can establish automated systems to allow patients to directly schedule appointments, or they can accept appointment requests via email or other messaging systems. Patients are communicating online with their providers both about these logistical concerns and about their health needs. One study found that the most common type of message (comprising about two-fifths of the communications) was an information update sent from a patient to a physician. About one-quarter of the messages were requests for prescription renewals. Messages about test results and referrals each accounted for roughly 10% of the messages. According to one practitioner, some of these communications take the place of office visits.
Although practices can opt to use online interfaces, such as MyDocOnline or RelayHealth, to send and receive secure messages with their patients, one study found that the vast majority of doctors who communicate online with their patients simply use e-mail. Yet using a messaging platform may provide advantages, particularly if it is includes encryption for greater privacy protection, as well as other features like templates to help users craft more structured messages and systems to route messages to the appropriate staff members.
Emerging Trends in Consumer Health IT
Several of the experts consulted as part of this project highlighted social networking as an increasingly important trend. Blogging has emerged as a major force in the last several years. In May 2008, 33% of internet users said they had read someone’s blog and 12% have worked on their own blog or online journal. Some experts suggest that these statistics fail to fully capture the impact of blogs because of their multiplicative effect. Even if relatively few people report regularly reading blogs, information from blogs often finds its way into more mainstream media.
One expert talked about an increasing interest in wellness and speculated that as consumers are paying a larger share of their health care costs they may express a greater interest in maintaining their good health. Another expert spoke about the “chronically well”—individuals who are very interested in engaging in healthful behaviors who might want to be able to quickly track their diets or exercise regimens with a few taps on their PDA. Along a similar vein, many of the applications discussed above that are now focused primarily on helping patients with chronic conditions may be useful for consumers without such conditions. One expert predicted that pedometers would be an increasingly popular device whose readings could be integrated with a PHR. Also, consumers could receive reminders about flu shots and women could receive reminders at appropriate times throughout their pregnancy to alert them to when they should start or stop eating certain foods, at what stages they need tests, and which physiological changes should be expected at what time so women can consult their doctors about deviations. Alerts could come from more unusual sources. For example, sensors on pillboxes could generate automatic reminders to take medications that are routed to cell phones.
Future generations of disease monitoring devices could give children of ill parents visual representations of what is happening at a remote location. For example, one potential innovation is having a lamp in the child’s home that would change colors depending on a parent’s activity in his home—for example, the lamp could be responsive to data relayed from bed sensors to alert the child about when a parent gets out of bed.
Emerging applications might focus on practical aspects of health care. Health IT could help patients with chronic diseases better manage their time—including incorporating doctor’s appointments into consumers’ workflows. Another area under exploration is helping people manage their health expenses. Around 8 out of 10 respondents of one survey expressed an interest in tracking insurance payments, out-of-pocket expenses, and other health-related financial costs. This year (2008), Intuit, the maker of Turbo Tax and Quicken, launched Quicken Health. Individuals enrolled in several health plans can sign up to have their claims and benefit information transmitted to this online application. The program then translates the information into language that is designed to be more clear for consumers. For example, it explains why a claim was denied and advises the consumer on steps to take to address the problem. Although not currently integrated with Turbo Tax, the application provides users with the total eligible expenses that could be used to complete the appropriate form for a medical expense tax deduction.