Many of us already go online to seek healthcare, and not just to Google symptoms. Online support groups, healthcare systems that allow for online communication between patients and doctors, and other innovations are making the web a crucial part of car. Ahead of our panel asking doctors and bloggers to discuss the dangers and opportunities of online care, we asked UCLA’s Molly Coye, Kaiser’s Kate Christensen, and UC Davis’ Peter Yellowlees to tell us what online healthcare will look like in five years.
Building trust and easing pain online
What do we really expect from online healthcare? In the first wave of online services, we used the internet to find sources of information. In the second wave, online communications replaced some of the most tedious parts of healthcare – allowing us to send information to the doctor’s office, make appointments, refill prescriptions, and avoid endless missed calls by emailing our doctors. At the same time, some health providers started using telephone and then Internet-enabled devices to monitor our blood pressure, weight, and other indicators of our health. These functions make our lives easier and (at least in theory) should make healthcare less expensive. When Kaiser Permanente offered members the chance to email with their doctors, for example, the need for clinic visits was reduced by 25%.
But the most promising aspect of online healthcare is emerging as consumers and patients and physicians discover the power of the Internet to foster relationships. Relationships of trust, learning, support and mutual benefit are the long-term platform for successfully managing our way through the potholes and bumps of parenthood, the advent of chronic conditions and those rare acute crises that galvanize our entire network.
The idea that relationships – especially networks as communities – can support individuals to change their lives is not new. When Kate Lorig asked groups of arthritic patients to meet in groups – without a provider present – in order to talk about managing their pain and disability, she found that their pain and disability decreased and their need for pain medication stayed lower than expected for several years after they participated in the group. That was in the 1990s. Today, this approach has been reformulated for the web, and groups of patients are advising and supporting each other and forming their own communities in order to manage their health. The National Health Service in the UK and large health systems in the US have adopted Lorig’s program. And patients, or consumers, have found their own platforms: on PatientsLikeMe, individuals are sharing their health data, exchanging information about diagnoses and treatments, and forming online support groups without any sponsorship by health providers.
–Molly Joel Coye, MD, MPH, is Chief Innovation Officer of the UCLA Health System.
The Internet can make us healthier
As an old-school Internet user, with children in their 20s, I see a clear trend between those older folks with health issues who are deeply engaged in using the Internet from their computers for health matters, and those young ‘uns who live on their mobile phones. That trend and the distinctions it creates will accelerate over the next 5 years. According to a recent California HealthCare Foundation Survey, “40% of respondents with two or more chronic conditions that use PHRs [online Personal Health Records] did something to improve their health vs. 24% of others interviewed.”
About 44% of registered users of the Kaiser Permanente Web site kp.org, and its ‘My Health Manager’ Personal Health Record, are over 50. This makes sense, because they have greater health care needs than most younger people. They use it to make appointments, request refills, research conditions, check their test results, and email their doctors. In five years, us AARPers will participate in even more health interactions with Web visits, online chat or email with providers, prescribed WII Fit exercises, online health coaching, and digital monitoring of activity and biometrics like blood pressure and blood sugar. All of these capabilities are in use now, but have not yet become mainstream and are not yet integrated together into a coherent experience. When the technology is cheap and ubiquitous, platform agnostic, and integrated and the incentives for all are aligned, it will be commonplace to see digital monitoring in the homes of older Americans, as well as in the homes of younger people with hypertension or diabetes. (The fitness enthusiasts are already tracking their pulse rates and mets burned any way they can). In five years, we will also be seeing more integration between the information I track in my home and the information my doctor tracks for me. This will give rise to new opportunities as doctors are able to see data about patients’ real lifestyles (if they’re willing to share) and how they integrate with in-the-moment problems.
Members of my kids’ generation use their mobile phones mostly for texting (using a phone to talk on is so lame!) and Internet searches and transactions, like music downloads. Online health for them will look like text reminders and notifications, with a Web cam visit, digital photo or video upload when needed. They will expect to be able to complete transactions on their phones, like making appointments or requesting refills, with a high degree of usability. There will have to be an app for that, for most anything they want to do. In addition, there will be opportunities to integrate the data from all of the disparate sources and transactions in a unified whole, and once this is commonplace, we’ll wonder how we ever got along without it.
–Kate Christensen, MD, is Medical Director of the Internet Services Group for Kaiser Permanente.
The tipping point for online care
Online healthcare is becoming more accepted by both patients and doctors and is, I believe, at a tipping point in 2010. The remarkable changes in internet based technologies are allowing us to rapidly implement new clinical practices that support patient focused and individualized care. By 2015 online communication between patients and doctors and the routine use of multimedia information will be the norm.
Patients will still be seen in person but our improved capacity to communicate electronically is, as CM Christensen, JH Grossman, and J Hwang put it, “a disruptive innovation” that will revolutionize healthcare delivery. Providers will be routinely using new technologies, such as email, telemedicine, electronic records, social networks, and wireless mobile applications with patients. This will make healthcare more affordable, accessible and efficient.
These changes will be supplemented and strengthened by the availability of multimedia data. Electronic clinical information will be more freely available than today for both patients and doctors to review, comment on, pass to others for second opinions, and compare with clinical databases and disease registries. This data will be in multiple electronic formats–numeric, text-based, audio, digitized still pictures, video, radiologic, genomic and 3D streams. It will include data emanating from multiple medical monitoring and diagnostic devices as well as from ubiquitously available consumer devices such as cell phones. Patients and physicians will have to learn to navigate a “sea” of data, using new techniques to evaluate and analyze the relative importance of specific data points and elements of clinical information.
These two changes will mean that by 2015 the relationship that many patients have with their doctors will have expanded beyond the in-person interaction of today, and will increasingly occur literally anytime, anywhere in both online and in person environments.
-Peter Yellowlees, MD, is Director of the Health Informatics Graduate Program at UC Davis and author of Your Health in the Information Age – How You and Your Doctor Can Use the Internet to Work Together.
*Photos courtesy the contributors. Photo of desktop courtesy Chris Jagers.