" And the times, they are a-changin' "

1. " And the times, they are a-changin' " Dylan

3. Bard of CyberDialogue Maturation of eHealth “5 Cs” eContent eCommerce eCare eCommunity eConnectivity

4. Automated Journalism Storage Editor Author Referee Print Electronic Reader

5. Medical On-Line Services Full text of : • JAMA, NEJM, BMJ, Lancet, Annals Int Medicine, Archives Js, others • Textbooks Medline from NLM

6. Medical On-line Services Advantages • Timely, High Quality/Quantity Disadvantages • Difficult to search • Expensive

7. Medical CD-ROM • Single journals • Collections by topic/publisher • Reference Materials • Interactive approaches

8. Medical CD-ROM Advantages • Low cost players and disks • Effective for teaching • “Multimedia” capability Disadvantages • Slow response time • Information not timely

9. The Internet the future in the present

10. The Internet the most important advance in human communication since the printing press

11. Medical Internet • Web of Networks • Millions of participants • Research databases • Interactive and personal • Widely searchable • Massive information source

12. Medical Internet Advantages • Worldwide, Voluminous, Personal Disadvantages • Unregulatable, variable quality, poor security

13. Determinants of Human BehaviorA Hierarchy Personal Morality Societal Ethics Public Law

14. Morality A quality or fact of conforming to or deriving from right ideas of human conduct; goodness and uprightness of behavior

15. Ethics Principles of conduct governing an individual or profession; the ideals of character manifested by a people

16. Law A rule or mode of conduct or action that is formally recognized as binding by a supreme controlling authority and is made obligatory by a sanction

17. The Essence of Professionalism is Self-Governance One of the defining features of a professional is "the voluntary self-imposition of higher than ordinary standards"........"When faced with a difficult decision, the true professional will efface his own self-interests" Pellegrino

18. Principles of Medical Ethics AMA-CEJA I. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.

19. Doing the right thing for individual patients and populations of patients Medical Ethics

20. Seek Truth and Report It Minimize Harm Act Independently Be Accountable Society of Professional Journalists Code of Ethics -1996

21. The US Chamber of Commerce 15 Principles of Business Conduct - 1924 11. …bad faith…fraud…bribery…public wrong 12. Controversies…voluntary agreement or impartial arbitration 13. …moral obligations of individuals… 14. Lawful cooperation…is commended 15. Business should render restrictive legislation unnecessary

22. The International Committee of Medical Journal Editors (The Vancouver Group) Ann Intern Med, BMJ, CMAJ, Dutch Med J, Index Medicus, JAMA, J Danish Med Assoc, Lancet, MJA, NEJM, NZMJ, J Norw Med Assoc, West J Med > 600 journals have agreed to participate 1999

23. CME activity –Jan 1999 to Dec 2000

24. Ethics statement or “seal” 15% Brand name identification 9% Presence of leading experts 44% Not certain how to judge 32% How survey responders judge the ethics of a medical web site

25. eHealth Code of Ethics May 2000 1. Candor 2. Honesty 3. Quality 4. Informed Consent 5. Privacy 6. Professionalism in Online Healthcare 7. Responsible Partnering 8. Accountability

26. HI Ethics 1. Privacy Policies 2. Enhanced Privacy Protection for Health-Related Personal Information 3. Safeguarding Consumer Privacy in Relationships with Third Parties 4. Disclosure of Ownership and Financial Sponsorship 5. Identifying Advertising and Health Information Content Sponsored by Third Parties 6. Promotional Offers, Rebates, and Free Items or Services 7. Quality of Health Information Content

27. Between 20 000 and 2 000 000 Health/Medical Sites on the Internet Health Searchers Porno Searchers >

28. US Adults Seeking Health Info on the WWW June 1998 54 million June 1999 69 million June 2000 98 million November 2000 106 million Harris Interactive

29. On Line Health Information 97 Million US Adult Users Search engine or portal 52% Directly to health site 24% General site with health info 14% Average 3.3 visits a month Harris Interactive 2001

30. > 50% for specific illness or diagnosis 46% after new Rx/treatment Only 20% before seeing their physicians CyberDialogue Patients Visiting Health Sites 2000

31. On line Health Users 15% of MDs recommend specific sites Vitamins and nutritional supplements are bought Prescription drugs not bought on line

32. On line Health Users More women than men Typically older, married, Caucasian & college-educated Arrive at Doctor with print-out Leave with lower opinion of Doctor

33. US MDs accessingthe Internet 1995 3% 1996 15% 1997 32% 1998 60% 1999 80% 2000 89% 2001 93%

34. US MD Internet Use Overall 85% Medical information and news 71% Access guidelines and protocols 50% HealthTech 2001

35. MDs Use Internet 3 Hours/Week to: Research clinical matters 90% Read journal articles 78% Contact colleagues 61% Complete CME 45% Attend conferences 31% BCG 2001

36. Average time on-line on Medical sites 2-3 hours/week Have looked for/at: Disease Information 94% Medical Association News 85% Medical Sites 74% University sites 67% Online CME 45% Canadian Physicians

37. Medical Portals most used: Medical Associations 26% Medscape 11 % MEDLINE 6 % WebMD 6% Pubmed 2% University sites 2% Canadian Physicians

38. Expect their Internet use to increase next 12 months Accessing Disease Info 70% On Line CME 58% Access Drug Info 33 % Canadian Physicians

39. Agreed with the statement: The Internet is changing the way I practice medicine 43% I take fewer medical journals because the information is on the Internet 37% Canadian Physicians

40. What do Physicians Do?

41. Physicians and Information Seeking Gathering Interpreting Feedback Observing Assimilating Dispensing Monitoring

42. Where is the Internet Applicable? 1. Anywhere the telephone/fax machine is used 2. As a library 3. To replace hand-delivered notes 4. To replace letters/brochures/certificates/lab results 5. Orders and results 6. Verbal communications 7. Whenever distance separates individuals or copies are needed for others

43. Physicians’ “Essential” Internet Applications Clinical Diagnostic reporting Electronic medical records Administrative Claims processing Eligibility authorizations Referral authorizations IT systems support HealthTech 2001

44. Great for an established patient-physician relationship E-mail Medicine

45. Verboten for initial or sole patient-physician interaction E-mail Medicine

46. Values of e-mail Medicine Maintain continuity of care Facilitate information flow Increase meaningful communication Reduce unnecessary appointments Increase patient responsibility Mechanic 2001 BMJ

47. 34 million want to Only 3 million have done so 5 million have visited any physician web site CyberDialogue Patients Contacting Physicians Electronically 2000

48. Electronic Alerts from Physicians - 84% Lab Results on line - 83% Personalized Medical Information - 80% Charts to Monitor Chronic Conditions - 69% Will Select Physician Based on Internet Services - 43% -Harris Interactive 2000 What Consumers Want

49. Concerned that e-mail will impact their busy schedules Only experimental methods of payment Potential loss of “high-touch” relationships Consider nurse or physician assistant triage Physician Fear and Resistance

50. MDs Use : E-mail with patients 26% EMR 22% Electronic prescribing 11% Remote monitoring 5% BCG 2001