The Future of the Internet in Health Care: A Five-Year Forecast

Health care has discovered the Internet and the Internet has discovered health care! A rapidly growing number of Internet sites are dedicated to helping consumers find the information they need to make decisions about their health and health care. Patients are creating online communities that provide peer support, information on the latest research, and personal stories about their experiences. Health care professionals are using the Internet for research, to get access to the latest information in their field, to consult with their colleagues, and to keep in touch with their patients. Almost every health care business--from insurer to hospital to pharmaceutical company--has a Web site.

Why is the use of the Internet in health care growing so quickly? How sustainable is that growth? What kinds of health-related applications will develop over the next five years? How will the Internet affect health care delivery and health outcomes? In all the excitement about the Internet, there inevitably will be unrealistic expectations about its impact on the health care industry. This forecast sorts through the current hype to give a realistic assessment of the pace and direction of change for the next five years.

DRIVING FORCES

The major driving forces that are pushing the Internet into health and health care are strong and unstoppable; they ensure that the Internet increasingly will be integrated in our health care.

• 21st Century Health Care Consumers.  By 2005, more than half of U.S. consumers will have high household incomes, some college education, and access to a computer at home or at work. Health care consumers of the future will be more actively involved in making decisions about the health care they receive. They will expect high levels of choice, control, customer service, interaction with their health care providers, and access to information. They will use the Internet to help meet those expectations.
  
• Consumer Experiences with Other Industries. Internet Shopping and E-Mail.Consumers' experiences in other areas, particularly the responsiveness and choice they get from Internet shopping and the interaction they get using electronic mail, will shape the expectations they bring to health and health care. Parts of the health care industry will meet those expectations with online information and services and succeed. Others will not respond as well.
  
• The Characteristics of the Internet.  The Internet as a channel for health information and communications is well-suited to fulfill consumer expectations. It is inexpensive, easy to use, provides a diversity of health care information, and opens its users to a global network of people with common interests.
  
• Market Forces in Health Care.  Market forces have been at work in health care for a decade, in the form of managed care, employer purchasing coalitions, assertive government payors and regulators, and consumer organizations. Web technologies--intranets, extranets, and the Internet--will serve as a low-cost, rapidly deployable platform for disseminating information across vertically and horizontally integrated health care organizations. Managed care increases the diversity and urgency of information flow; more of that communication will move to the Internet. Competitive health care organizations will use the Web as a channel to promote their services.

BARRIERS

At the same time, a number of barriers will impede the development of the Internet in health and health care. They will not stop its use by any means, but the magnitude of these barriers ensures that Internet use will not be all-pervasive in health by 2005.

• Security Concerns. If there's one thing people are even more guarded about than their financial information, it's private information about their health. Even though technologies are in place to safeguard electronic health information, the perception of a lack of security will inhibit the use of the Internet for personal clinical information in the near term. Longer term, we will reach a combination of technological solutions, public policies, and cultural habits that allow health information to flow freely in the Internet.
  
• The Characteristics of the Internet. Just as there are characteristics of the Internet that will drive its use in health care, it also has several that will impede its diffusion. The rapid pace of change in the Internet will outstrip the ability of many health care organizations to keep pace. Weaknesses in Web browser and search engine technologies, including the inability to interact well with legacy databases and to find dynamic Web pages, will limit the appeal of the Internet to health care providers.
  
• The Mixed Quality of Information on the Internet. The flip side of the diversity of content that is available on the Internet is that a great deal of poor-quality information is currently available. That uneven quality will turn off some consumers and keep physicians from enthusiastically embracing the Internet.
  
• Physician Ambivalence. The poor quality of some health information on the Internet is not the only reason physicians will resist. Medical culture is extremely conservative and cautious, especially when it comes to new technologies. The Internet is one such technology that could alter the doctor-patient relationship.
  
• The Disarray of Health Care Information Systems. The legacy information systems of most health care players--insurers, hospitals, and physicians--are not ready to be used with on the Internet. Substantial restructuring and "housecleaning" must take place before the systems are ready for prime time.
  
• Lack of Resources for Web Development. Information systems departments in most health care organizations are not Web-oriented. They are underfunded and will be distracted, at least for the next 18 months, by the Year 2000 problem. Even when they are enthusiastic about the Web, health care organizations are competing with almost every other industry for scarce Web designers, technicians, and engineers.
  
• Too Many Standards. Health care has many standards for electronic communications and transactions. Too many, in fact. The parochial and vertically differentiated nature of standards in health care will inhibit the near-term development of electronic commerce in the industry and its move to the Internet.

FORECAST: LEADING-EDGE APPLICATIONS

Consumer uses of the Internet--to seek information about health and health care and to create communities and support groups--will move the fastest.

• Consumer Health Information Services. Consumers will seek information from the thousands of Web sites dedicated to health and health care. The number of health care Web sites will proliferate as established health care organizations, new Web-oriented health start-ups, and interested individuals put up their content. A number of approaches, including ratings services and trusted brands, will help consumers sort through the noise. Online purchases of both prescription drugs and over-the-counter items will increase during the forecast period.
  
• Online Support Groups for Patients and Caregivers. Online support groups for patients with a given disease and the people who care for them will continue to develop rapidly. Patients participating in the groups will feel more in control and, for many diseases, have better outcomes. There will be points of strain, however, between patients and some physicians who feel a loss of control over their patients' care.
  

Use of the Internet and electronic mail by health care professionals will proceed more slowly than consumer-oriented applications.

• Health Care Provider Information Services. Use of online information by health care professionals has become increasingly common. We don't forecast any breakthrough applications, although sites will develop that filter out most of the random content for them. Medical journals and, eventually, continuing medical education, will go to the Web.
  
• Provider-Patient E-Mail. In certain communities, consumer pressure will push physicians to overcome their fears of being overwhelmed with electronic messages, of breaches in security, and of liability. In most places, however, physicians will be reluctant to embrace e-mail with their patients. In time, despite the lack of reimbursement for e-mail communications, physicians will come to embrace it as they did the telephone in the early part of this century.

Finally, health care organizations will use the Internet as a replacement for or a complement to existing information systems, communications infrastructures, and transaction services.

• Communications Infrastructure and Transaction Services. The justification for using the Internet to transmit electronic insurance claims, conduct remote telemedicine consultations, and transmit data from clinical trials or for FDA filings will be largely economic. The Internet will replace other communications channels that are more costly or less capable. Large claims clearinghouses, which have taken a wait-and-see approach to the Web because of security concerns, will move rapidly to the Web once security regulations are clarified. Many other health care transactions, including eligibility, enrollment, and utilization review, will take longer to move to the Web.
  
• Electronic Medical Records. Health care providers are near the beginning of a slow transition to electronic patient records. One approach to overcoming the fragmented nature of existing electronic records is to use Web technologies as a "front end" to a range of clinical systems. In those applications, the Web browser displays in a common format (but usually not well-integrated) content from several information systems. We forecast that, although there will be a lot of activity in Web-based front ends, they won't be capable of providing the type of decision support that the eventual full electronic medical record will give to providers.

Ó 1999 Dean F. Sittig

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