Chicago Sun Times


Net health boom gets patients more involved

   March 12, 2000

   BY BECKY BEUPRE STAFF REPORTER

   The Internet is revolutionizing health care as millions of patients
   turn to the Web to research their symptoms, diseases, doctors and
   drugs, bringing an unprecedented level of knowledge and power to their
   own care.

   Net-savvy patients are e-mailing their doctors, ordering prescriptions
   online, making appointments over the Web, participating in Internet
   support groups and sifting through medical studies that once only
   doctors could access easily.

   Already, physicians are becoming accustomed to a new breed of patient:
   one who is armed with information and eager to play a role in what may
   be the most fundamental change in the doctor-patient relationship
   since managed care became common more than 10 years ago.

   "The old system of the patient being a passive entity--that model is .
   . . going out," said Dr. Tony Lu, medical director of integrative
   medicine for Loyola University Health System. "The new model is the
   patient is actively involved in the care."

   That was the case for Jude Crouch, 50, of Oak Park. When he was
   diagnosed with diabetes more than two years ago, he rushed online and
   read about medications, diet and blood-sugar monitoring.

   "I got virtually all my information on the Internet," he said.

   Without being asked, he started charting his glucose levels and
   presented the data to his doctor.

   "I was much more able to discuss things with him," Crouch said.

   Crouch also became the self-appointed facilitator of an online message
   board, alt.support.diabetes, where he exchanges information with other
   sufferers.

   Without the Internet, "I certainly wouldn't have the control right
   now," Crouch said. "I wouldn't be focused on it."

   Patients who have researched their conditions are more likely to take
   their medication, express opinions about their care and demand more
   from their insurance companies, doctors say.

   "I believe the Internet is the salvation of health care in America,"
   said Dr. Michael Roizen, a medical professor who practices internal
   medicine at the University of Chicago Hospitals. "It's giving power to
   the patient and taking it away from [managed care]."

   Of an estimated 72 million adults who used the Internet in December,
   more than 34 million searched for health information, according to the
   Internet analysts Cyber Dialogue. That number is expected to grow to
   40 million by this summer.

   Medical sites number in the tens of thousands--and the major ones
   battle for their share of traffic through advertising and marketing
   blitzes.

   "There's a fast effort to get registered users at the beginning," said
   Mark Bard, health practice director at Cyber Dialogue.

   Signs of e-health are popping up all over the Chicago area.

   Several major hospitals have begun allowing patients to make
   appointments online.

   A doctor at Northwestern Memorial Hospital in January became the first
   physician in the country to write an electronic prescription.

   People such as Rogers Park resident Nerissa Levey, who has had kidney
   disease since 1972, are turning to the Internet for support. Levey
   regularly logs on to Internet message boards so she can exchange words
   of encouragement with fellow kidney disease sufferers.

   "They understood me," she said.

   About 65 percent of people who search the Internet for information on
   specific diseases are looking for treatment options, according to a
   study by Cyber Dialogue. Nearly a quarter are trying to find out if
   they should see a doctor, and about one-fifth want to connect with
   others who have the same issues.

   Women are slightly more likely than men to search for health
   information, the data show.

   For Carolyn Placko, of Chicago's Northwest Side, the Internet offered
   an extra sigh of relief after a whirlwind hospital stay last year that
   included a diagnosis of ovarian cancer, surgery and aggressive
   chemotherapy treatment.

   Her doctor had given her excellent odds, saying he had a 100 percent
   cure rate for cases such as hers. But she had her doubts.

   "I went on to the Internet to find out if he was just blowing smoke,"
   she said. What she read suggested he wasn't.

   "The information I was getting validated what my doctor had told me,"
   she said. "I think I said a little prayer of gratitude that I ended up
   with this doctor."

   John Berglind of Naperville uses e-mail to help manage his diabetes.

   Three to five times a day, Berglind, co-owner and vice president of an
   information technology consulting firm in Chicago, pricks his finger
   to test the glucose levels in his blood. The device he uses, which is
   smaller than a Palm Pilot, plugs into his computer and uploads the
   blood sugar data to a spreadsheet.

   Every three months, he e-mails the results to his endocrinologist.

   "I would have to go to my endocrinologist once a quarter if I wasn't
   doing this," Berglind said. Instead, he goes once every nine months,
   or sooner if the doctor sees a pattern he doesn't like.

   Between visits, the doctor uses e-mailed data to suggest adjustments
   to Berglind's diet. And Berglind, who doesn't need to take insulin,
   finds the electronic system easier than the handwritten logbooks he
   had when he was first diagnosed in 1997.

   "Not only do I think it saves me a lot of time," he said, "it helps me
   do it."

   Patients such as Berglind stand to benefit the most from e-health,
   which eventually may reduce health care costs by cutting down on
   unnecessary doctor visits, Cyber Dialogue's Bard said.

   "It's going to be revolutionary first and foremost for these chronic
   conditions," Bard said.

   In addition to e-mailing updates to doctors in between appointments,
   patients can sign up for automatic prescription refill reminders, read
   the latest research and, essentially, become experts on their
   diseases.

   "It's an educated consumer, and, at the end of the day, it's a higher
   quality of health care," Bard said.

   But as with any revolution, there are obstacles to overcome.

   Despite the high interest among patients, doctors have been relatively
   slow to embrace the Internet.

   About 48 percent of online users would like to communicate with their
   doctors' offices via e-mail, but only 3 percent currently do,
   according to a Cyber Dialogue study released in October. And nearly
   three-fourths of those who access health information on the Internet
   say they would be more likely to trust a Web site recommended by their
   doctor or pharmacist. But only 4 percent say such recommendations
   currently are having an impact on which sites they use.

   Still, physicians' use of the Internet is improving, according to an
   American Medical Association study released in December. About 37
   percent of doctors surveyed said they used the Web, nearly double the
   20 percent who used it in 1997. Not surprisingly, those who use the
   Web tend to be somewhat younger, the study showed.

   The avalanche of online information thundering toward patients has
   raised a few concerns among time-pressed doctors, even those who
   express enthusiasm for e-health.

   "We're not particularly interested in a patient bringing in 135 pages
   and saying, `Would you please read that,' " said Dr. Richard Corlin,
   speaker of the American Medical Association's house of delegates.

   But he said those instances are still relatively few and, for the most
   part, are outweighed by the benefits.

   Others worry about misinformation and misinterpretation.

   "Just because they have all this information in their hand doesn't
   mean they're more knowledgeable," Lu said. "Sometimes, they're more
   confused."

   But Lu encourages patients to do the research--and to consult him when
   they need guidance.

   "They bring it to me, and I'll sort through it and say this thing
   looks like it's well-proven, this looks like it doesn't make sense."

   There's also a concern that some patients might forgo a necessary
   doctor visit, choosing instead to treat themselves based on their
   Internet research.

   "The physician's opinion is still very important," said Dr. Ricardo
   Martinez, senior vice president for health affairs at WebMD, one of
   the leading Internet health sites. "Will there be some patients who
   think they're junior doctors? Yes. But do we have patients like that
   now? Yes."

   Technological barriers--primarily the need for a more secure and
   reliable Internet--also have held back the tidal wave of e-health,
   according to a report released late last month by the National
   Research Council.

   "The Internet has not penetrated many areas of health and health care
   that promise even more significant transformations than we have seen
   to date," said Edward Shortliffe, head of Columbia University's
   department of medical informatics and chairman of the group that wrote
   the report "Networking Health: Prescriptions for the Internet."

   Improved Internet quality and speed could lead to more widespread use
   of live video for remote medical consultations.

   And once security issues are adequately addressed, it may become
   common for patients to have electronic medical records that can be
   accessed in out-of-town emergency rooms when they become sick on
   vacation--or traded among doctors for faster and more accurate
   treatment.

   Right now, only a handful of hospitals use the Internet to locate
   health information about emergency-room patients, Shortliffe said.

   Many are grappling with how to make this information available
   remotely without compromising confidentiality.

   "As we all know, health information can be extremely personal and
   sensitive," Shortliffe said. "So, systems designed to transmit patient
   medical records across the Internet or to allow remote access to a
   patient's medical record must have strong, built-in security
   protections."

   Still, experts said they have high hopes for the future of e-health.

   "The impact is obvious at the present time," the AMA's Corlin said.
   "And [it] is growing and will become substantial."


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