An Introduction to Cyberspace for Medical Professionals BY Sheldon Chang, MSPT Physical Therapist

In Burlington, MA, a Community Health Information Network developed for the Harvard Community Health Plan's patients integrated a patient education system with patient records and an electronic evaluation system that allows for patients to recognize important symptoms from trivial ones. The system could also dispense simple care instructions and aid in setting up an appointment for a real examination by a physician [11]. Patients who have access to disease state information will be better able to recognize appropriate times to check in with their doctors.

Especially in the instance of capitated healthcare systems, using the Internet to decrease inappropriate referrals is seen as a way to minimize unnecessary costs. [31] Simpler versions of the Burlington, MA system may be developed for smaller facilities lacking impressive computer resources. A secure website would work. A general health questionnaire could be taken on-line as the initial point of contact as a pre-screening checklist to improve the accuracy of referrals.

At a time when reimbursement schemes are forcing clinicians to cut short the length of patient visits, computers and the Internet may enhance and make up for some of the quality lost in the patient-provider relationship. [31] Computer based education should not be avoided in fear of encouraging a distancing intervention in healthcare. Computer based education can be a cost effective way of covering what couldn't be covered in the office visit. [31] At the most basic level, computer programs can be used to generate "customized" education booklets pieced together by selecting the appropriate options. At more advanced levels, interactive programs exist that allow the patient to take a more active part in learning about his or her disorder.

Educating patients about health issues through the Internet is an expanding practice. Electronic patient education modules can be obtained commercially, as freeware, or self-authored and made available for patients to access through a clinic or hospital web site. The Virtual Hospital from the University of Iowa, an early leader in on-line patient education approach maintains a large library of multimedia patient education modules organized by health care discipline or organ system. Patients may pick from any of the choices and read instructional material and view illustrations. Patients who want learn more about their conditions may jump over into the multimedia textbooks section set aside for providers where keyword searching may help them better find the information they're looking for.

With the unlimited content of the digital approach, proving the validity of the promoted image becomes either an added burden or an opportunity. As more and more people "become digital" selling image alone will no longer be enough to capture an information savvy consumer.

The Internet is full of patient education "for the taking," so to speak. More and more healthcare organizations are realizing the value of putting patient information on-line. Columbia Healthcare Corporation's "Health Manual" is a cornucopia of detailed electronic patient handouts and answers to frequently asked questions. For a modest fee, some places like the already mentioned "Healthgate" will allow healthcare clients access to professionally prepared information on a wide range of subjects. As more and more official information resources such as Healthgate and Columbia's patient education websites appear, the less likely patients will be easily mislead by hype and fiction. Also for the healthcare provider stumped with the task of providing a patient with information about rare conditions, quick and useful answers may finally be at hand on the Internet.

Though the Internet as a source of patient education has improved greatly, it is still an unproven and immature path toward better patient care, but may hold the most promise of all the computer based approaches. On the other hand, with continuing developments of multi-platform computer applications such as Java applications or Adobe Acrobat documents, downloadable patient education programs and electronic books may have more practical application in the future.

The Find/SVP study found that there was a heavy interest among on-line health information consumers to have access to their doctors through e-mail. [14] Concerns have been raised by some about the privacy and security concerns with conveying medical information through e-mail. Although the practical risks to privacy are probably minimal, patients should be informed about the potential implications of using e-mail to communicate if e-mail is to be used in patient-provider interactions. Encryption devices could also be used as a safeguard.

Overall, answering a question through e-mail takes only a fraction of the time it takes for support staff and provider to handle a telephone call. [17] E-mail can be used as a time-efficient method of following up on office visits, issuing appointment reminders, and consulting on existing conditions to name a few uses. [17, 31] E-mail offers a number of real advantages over the telephone. It is not merely a gimmick to coax patient compliance.

One of the greatest advantages of electronic mail is that it is not as invasive as the telephone into daily routines and can be answered and read whenever convenient. In telephone consultations, if both parties are not ready to talk at the same time, consultation cannot take place. E-mail eliminates phone tag, allows the provider time to review records, and also offers the patient a physical source of information. [31] In the event that the patient forgets what was "said", the physical record of consultation can be read over and over again. Through e-mail consultation, the provider may also give a few words of advice and point the patient to teaching modules set up on the clinic or hospital's web site or at an outside source rather than enter lengthy discussions about the patient's problems.

Also, as telemedicine becomes a more familiar practice and third party payers begin to reimburse distant medical consult, some providers may find themselves following up and caring for patients through a computer. "Ask the Doctor" type of chat services and websites are already drawing many visitors and participants. Although most of the interactions on such services are merely question and answer sessions and not involved enough to be true professional medical consultations, they may be a sign of things to come.