Studies find physicians and patients still balk at thought of Internet medicine

Studies find physicians and patients still balk at thought of Internet medicine

Vendors struggle to validate e-health model

A number of studies tracking Internet use in the healthcare sector have been released in the past month, and for the most part they reach the same conclusion: that despite the numerous advantages e-health appears to offer over conventional medical practices, patients and providers continue to be wary of moving their relationship out of the examining room and onto the World Wide Web.

These findings come at a time when concerns over patient privacy, security, and the Internet have become both big business and a political hot potato (HNN 7/12/00, 6/14/00). E-health vendors argue that the Internet is the key to transforming healthcare delivery in the U.S. by empowering patients and providers alike in a managed-care environment. This strategy has not fared as well as some investors would like, however, with consumer-oriented sites such as drkoop.com, Healtheon/WebMD, and Mediconsult.com reporting disastrous financial results for the first two quarters of this year (see briefs, p. 5).

In fact, the more recent trend among dot-coms is to focus on the physician market, and several vendors are now touting “personal health records” as the next big thing in facilitating electronic patient-provider interaction and drawing traffic to their Web sites (see related story, page 8). Even so, established companies such as MedicaLogic/Medscape that have been selling into the physician market for some time are struggling to show a profit; the EMR firm expects to report a $0.69/share loss for the second quarter.

And despite the growing number of lawmakers that are jumping on the e-health privacy bandwagon (HNN 7/12/00, 6/14/00), patients and providers aren’t exactly responding with enthusiasm. According to a survey of 257 family practitioners, general practitioners, and internists, MDs have little interest in Internet-based medical applications and are skeptical of the Internet’s potential benefit to healthcare. Only 27% of those participating in the online WebSurveyMD.com study conducted by Ziment, a New York-based healthcare research organization, believe the Internet will save the health system money in the next five years, and less than half feel it will improve physician-patient communication.

In addition, fewer than a third of those surveyed expressed significant interest in using the Internet for communicating with patients, consulting with colleagues, participating in clinical trials, or filing patient insurance claims. And contrary to many vendors’ contention that Internet-based healthcare products and applications will really take off when the next generation of physicians comes into the marketplace, the Ziment survey found that age did not appear to be a factor. In fact, interest in using the Internet for clinical applications was even lower among those physicians who consider themselves extremely Internet-savvy.

“The online healthcare industry is expected to expand to nearly $400 billion in the next five years, but greater physician buy-in is necessary for it to live up to its potential,” said Howard Ziment, managing director of WebSurveyMD.com. “Some of the developing Internet-based technologies and services targeted to physicians may fail unless physician needs and interests are more clearly understood.”

In fact, tailoring these products and services to better meet physician needs is critical to achieving success in online healthcare, according to Dr. George Lundberg, editor in chief of Medscape, an informational Web portal acquired last year by EMR vendor MedicaLogic, and adjunct professor of health policy at Harvard.

“Most physicians and hospitals are resistant to change unless it can be shown that it is very helpful and very easy, and up to now, many computer applications in healthcare have not been that,” Lundberg said. “Doctors will not use things that waste their time and will not help them, and that is why we think the Internet will change everything.”

But for this to happen on a broad scale, patients need to buy in as well. Unfortunately, another recent study finds that, despite several recent laws designed to address concerns over privacy, this issue continues to be a barrier to consumer acceptance of e-health products and services. Conducted by Cyber Dialogue, a New York-based consumer research firm, the study finds that successful development of online healthcare will depend on companies adequately handling consumers’ concerns about privacy, ethics, and security issues.

Among the 37 million people online who do not use online health information services, Cyber Dialogue’s Health Practice group found that 6.3 million are staying away primarily because of privacy and security concerns. In particular, they are concerned that insurers could use private personal health data to limit or affect their insurance coverage or that employers could use it to limit job opportunities.

“Consumers have recognized that their privacy may be at stake in an online healthcare environment that has merged editorial content with advertising, commercial sponsorships, and e-commerce,” said Carolyn Gratzer, senior analyst for Cyber Dialogue. “The very aspects of Internet-driven healthcare that hold the most promise for improving care delivery are the same aspects that raise the most concern among the public.”

For example, Gratzer says, even if access to online medical record keeping is restricted to an individual and his or her physician, it is viewed as the greatest threat to individual privacy. The Cyber Dialogue report, which is based in part on a survey sponsored by the California HealthCare Foundation and the Internet Healthcare Coalition, also found that consumers are uncertain whether personal health data are protected by law and confused about who should regulate Internet health information.

Echoing this theme, the Association of American Physicians and Surgeons (AAPS) has issued an alert warning patients of the security dangers they face when using health-oriented Web sites.

The AAPS report cites the same California HealthCare Foundation report used by Cyber Dialogue, which also analyzed the privacy policies and practices of 21 popular health-related Web sites, including WebMD, drkoop.com, ivillage, and AltaVista. The report concludes that anonymity on the Web is a myth, and that many Web sites are willing participants in furnishing and selling information to third parties.

“This industry is cashing in on trafficking in people’s personal medical records,” said Jane Orient, a physician and executive director of the AAPS. “They’ll do everything they can to pry, cajole, or coax information from consumers to make money for their stockholders.”