Telemedicine will certainly be an important part of medicine in the future; what’s uncertain is how quickly we will reach that promising future—and how enthusiastically physicians adopt it.
How will physicians cope with the rising visibility and importance of the Internet in the new millennium? This question is stimulating the development of huge multi-billion-dollar corporations all aimed at improving the quality of the physician-patient interaction through credentialed content, discussion forums, live one-on-one interactions, and a host of other interactive virtual tools. The ultimate objective is to provide a mechanism for the delivery of information and medical services that will be both superior and less expensive than traditional methods.
Despite the potential for the Internet to do all of the above, the actual integration of these tools into the medical practice environment has been less than stellar. More than 97% of medical offices still have paper-based medical records, few physicians have either the time or the hardware to access the Internet efficiently from their desktops in the course of the normal working day, and for those who attempt to seek answers to clinical questions during the patient consultation, the process is still markedly inefficient.
I have attempted to use the Internet for clinical review articles or other information that could be handed to a patient at the time of the office visit. Even with a good understanding of the available Internet-based resources, this information requires a search and review process that does not lend itself to the pressures of 10- to 15- minute consultations. Good quality clinical information is not currently available in a just-in-time format, in other words, at the point of care when you need it. However, we will see more resources being implemented in the future that will successfully meld the need and solution to one another.
The next question revolves around trust. With over 20 000 web sites providing medical information over the Internet, how does one find credible resources? Government-based web sites, specialty associations, and a variety of university related clinical resources are the obvious sources. In addition, organizations such as the Health on the Net Foundation (www.hon.ch) provide a set of principles call the HON Code. Web sites conforming to the HON Code are verified by the foundation and are provided a stamp of approval.
An opportunity exists for physicians to become an important source of online health information for patients, but physicians will need to become more comfortable with the Internet as a tool to supply quality health care. According to the Intel Health Initiative, “A survey conducted by FIND/SVP reveals that 77% of patients preferred to get online health information directly from their own physicians, but only 10% of doctors have a web page and most refuse to give out their e-mail address. While two-thirds of physicians say they believe that the net enhances their own access to practice-related information, only 12% actually refer patients to the Internet as an information resource.”
From a physician’s perspective, treating patients for medical conditions using a tool such as e-mail requires that the patient retrieve that message quickly. The medico-legal implications of providing advice to patients in a permanent format without a verification process to ensure the information is received and acted upon could be significant.
Security of information will continue to be an important issue. Embracing services such as e-mail and Internet-based electronic medical records requires that the information be as close as possible to 100% secure. We are constantly reminded about the vulnerability of the Internet as hackers find new methods to access and obstruct seemingly secure networks. A 1999 survey conducted by Healtheon found more than 34% of the respondents noting that security remains a primary concern in the use of e-mail or other interactive Internet services.
Telemedicine also has a great potential to impact the practice of medicine using the Internet as a low-cost mechanism to connect physicians with patients and physicians with colleagues both locally and internationally. However, despite significant potential, telemedicine has yet to impact the provision of health care in a noteworthy fashion. Perhaps the expectation has been too great to this point. Without low-cost, high-speed communication networks readily available to a wide range of institutions and physicians, and many physicians not fully utilizing the Internet in day-to-day practice, the place for telemedicine is yet to become established outside of specific networks in rural and remote areas.
Interestingly, most telemedicine is likely to be practised in a ‘‘store and forward’’ manner using e-mail. The logistics of real-time videoconferencing at the point of care are considerable and require an investment in hardware and network access. On the other hand, e-mail is almost ubiquitous. A physician could prepare a consultation referral, attach a digital image of an X-ray or clinical sign and send this via e-mail to a specialist or colleague for an opinion. This would create an enriched referral document that could be dealt with in the course of a normal day integrating well with the way in which a physician practises medicine.
The future holds unlimited potential. Physicians will either willingly and proactively adopt the Internet as a mechanism to enhance care and improve practice efficiency or will be dragged kicking and screaming into the Internet age by patients who will use this medium to research and manage their medical conditions with or without the endorsement of their physician.
1. Intel Corporation. Why Intel is involved in health: The Internet as a driving force for societal change. www.intel.com/intel/e-health/ internet.htm (2000; visited 17 April 2000).
2. Healtheon. Research shows 42 percent growth in physician use of Internet in last three months. www.healtheon.com/news/ pr_5_06a_99.html (6 May 1999; visited 17 April 2000).
Dr Brookstone is a family physician in Richmond, BC. He is also a founding partner of Worksmartdoc, an Internet-based practice management and consulting company.
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