Information for Health: A Strategy for Building the National Health Information Infrastructure. The Personal Health Dimension

11/15/2001

Consumer attitudes about health and health care are another important element in the NHII. With health premiums rising steeply and retiree health benefits expected to diminish, consumers will need to take increasing responsibility for their own health and for decisions about appropriate treatments and acceptable outcomes.

Upgrading public health resources for the identification of bioterrorist threats: The Illinois Department of Public Health (IDPH) is notified of a credible threat that plague bacteria may be used in an act of bioterrorism. The IDPH sends out an alert through the Health Alert Network (HAN) to all local health departments. In addition, a similar alert is sent to all hospitals and emergency departments. The signs and symptoms of all forms of plague are incorporated into a software object that is then downloaded to the clinical information systems of clinicians throughout the State. Dr. T.'s system identifies two patients with a matching clinical profile in his practice. After approval by Dr. T., the system notifies the two patients by phone and their home health information system. They agree to come in later that day. That morning Dr. T. sees a patient who appears to have pneumonia and is coughing up blood. He prepares to send the patient to the hospital for x-rays and cultures when his office information systems warn him that this patient's symptoms fit the recently updated public health surveillance profile. He forwards a notice to the public health department and sends the patient into the hospital for further evaluation. The public health laboratory assists in making the diagnosis of a common pneumonia. Patterns of reports by Dr. T. and other physicians are monitored by IDPH as they continue to be alert to a potential terrorist act.

Consumers and patients have been rapid adopters of electronic communications and are using the Internet for information searching, social support, e-mail, health assessments, and other elements of personal health management. (See Table 3.) Patients are also demanding — and are willing to pay more for — online interaction with their healthcare insurers and providers. A recent survey found that 34 percent of e-health consumers would pay extra for the ability to manage their benefits online, and 25 percent would pay more for online interaction capabilities with their physicians. It was also found that 20 to 25 percent of these consumers would switch health plans or physicians to gain such capabilities. 31

In addition to these uses of information for self-care and for medical care decisions, citizen advocacy groups are increasingly using health statistics for their communities to study concerns such as environmental health and health disparities, in order to influence public policy and practices in these areas. Such efforts are engaging stakeholders from all three dimensions. e

Health information quality. One of the most important barriers to the use of information and communications technologies to enhance health is the variable quality of the health information available through the Internet. Consumers are at risk for wasting money on useless products, avoiding needed medical care, or accepting harmful treatments. The U. S. Department of Health and Human Services has addressed this concern by developing healthfinder®, a comprehensive, user-friendly portal to reliable Internet health resources and sites (www.healthfinder.gov). A free service, healthfinder® gives users access to more than 5,000 resources on more than 1,800 topics. The organizations that provide the resources have been reviewed and identified as reliable providers of information for the public. The Web site is coordinated by the Office of Disease Prevention and Health Promotion, which also oversees the HHS Healthy People initiative.

Consumers' Use of Internet-Based Health Information Services for Decisionmaking

More than 50 percent of Americans with Internet access have turned to Web sites to find health or medical information that they use to make decisions about their health.

  • 48 percent of these health seekers say the advice they found on the Web has improved the way they take care of themselves.
  • 55 percent say access to the Internet has improved the way they get medical and health information.
  • 92 percent of health seekers say the information they found during their last online search was useful; 81 percent said they learned something new.
  • 47 percent of those who sought health information for themselves during their last online search say the material affected their decisions about treatments and care; half of these health seekers say the information influenced the way they eat and exercise.
  • 36 percent of those who sought health information for someone else during their last online search say the material affected their decisions on behalf of that loved one.

Source: Fox S and Rainie L. November 2000. The online health care revolution: How the Web helps Americans take better care of themselves. Washington, DC: Pew Internet and American Life Project.

The development of quality criteria for health Web sites is an emerging area that may bring improvements in the reliability of online health information and services. Healthy People 2010 has set a national objective to increase the number of health Web sites that disclose critical elements of operations so that users can assess the quality of the site. Private and nonprofit organizations have developed codes of ethics and standards that will be used to accredit health Web sites. For example, URAC, an accreditation body for healthcare organizations, has developed a set of quality standards for health Web sites. 23 Organizations may apply to URAC to have their Web sites reviewed and accredited. If applied broadly and enforced consistently, quality criteria for health Web sites may provide measurable improvements that will help consumers identify the most appropriate Web resources for their needs.

Improving individuals' ability to self-manage chronic conditions: With the help of a multimedia home information center, a 50-year-old mother, Mrs. M., manages her family's health. She receives automatic alerts and e-mails from her own doctors and her daughter's, and she also receives health information tailored to her specifications. For example, the last time her daughter had an asthma attack, Mrs. M. was able to e-mail information about her daughter's condition to the physician, receive advice within 2 hours, and avoid a trip to the emergency room. Because Mrs. M. is an authorized user for her dad's personal health information manager, she and her father, who lives far away and has emphysema, are simultaneously alerted when the air quality index in his community shows high levels of pollution. Her father also has a voice-activated medication reminder service that he accesses from the information appliance in his kitchen. The reminder service tells him which pills to take when, and he confirms that he has taken the pills as directed. His daughter also can see whether he is taking his medications correctly. The medication reminder service also tracks the need for refills and automatically sends a refill request as needed to the mail order prescription service.

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