Some Internet & Healthcare Challenges An introduction Dr Daniel DÉSIR General Secretary Belgian Hospital Association
History of Internet (1) 1962 - Advanced Research Project Agency (ARPA) builds a small network (ARPANET) to promote the sharing of super-computers amongst US researchers. 1969 - ARPANET connects 4 universities : Stanford, UCLA, UC Santa Barbara, and U of Utah 1970 - E mail most popular application of ARPANET 1973 - ARPANET goes international (London and Norway) 1982 - The term 'Internet' used for the first time. 1982 - TCP/IP, common language of Internet computers 1985 - E-mail part of life at many universities 1988 - "Internet Worm" temporarily disables 6,000 of the 60,000 Internet hosts.
History of Internet (2) 1991 – Birth of the World Wide Web 1991 - Tim Berners-Lee (CERN) : hypertext markup language (html) 1992 - More than 1,000,000 hosts are part of the Internet. 1994 – Netscape Corp. Pizza Hut accepts Net orders. 1996 - Nearly 10 million hosts online. 2000 - 6 billions of electronic messages yearly 2001 - 111 millions hosts and 1 billion pages available.
Internet users (2001) (millions of users)
« Fairy tales » billionnairs Yahoo ! (Stanford - 1995) : Yet Another Hierarchical Officious Oracle ! • 1 million USD became once 10 billions USD • 100 billions USD max market capitalization (2000) • 8 billions USD today • Revenues 2000 : 1,11 billions USD • Net income 2000 : 70 millions USD • 120 millions users monthly worldwide
WWW in the year 2000 :English language imperialism is vanishing 327 millions users with : • 160 millions English users (49 %) • 167 millions non English users (51 %)
Internet & Healthcare • About 100 000 medical and health sites • 40 millions visitors each year • several thousands of focused associations • 1st reason to surf (more than stock exchange entertainment or weather forecast) • « the good, the bad and the ugly » : • free & validated scientific information • no quality label(s) • unregulated quackery
Internet & Healthcare Some (meta) search engines : • NorthernLight • Altavista • Metacrawler • Fast (alltheweb.com) • Google • Yahoo • Lycos • MedHunt Références : http://hopitalerasme.org/
Internet & Healthcare Some Web sites on general topics : • PubMed (NIH - Bethesda) • British Medical Journal • New England Journal of Medicine • Health On the Net Foundation (Genève) • Medscape • Agency for Healthcare Policy and Research (USA) • Centers for Diseases Control and Prevention (USA) • World Health Organization • Ministries of Health (France, UK, Canada) • CHU de ROUEN (French)
Healthcare : Who is surfing ?
Healthcare : What are lay surfers looking for ?
Internet & Healthcare Main characteristics : • dominating consensus to avoid any kind of regulation • no meta-editor, no control of content • no authority, no peer review • health = youth, beauty, fitness • priority : trade (and not public health) • ubiquitous US imperialism (hardware, software, routers, browsers, search engines, data banks, ...)
Internet, Health and Trade To sell : • « Beauty - Body -Fitness » products • diets and vitamins • prescription drugs • insurance • books on « health » and « medicine » • travels and congresses
Patients & Internet • distance between North-American and European realities • agreement to avoid anonymous encounters (patients-providers) and overflow (flood) • skills, open mind, education, equipment and availability of physicians ? • Is it ethically mandatory to answer to electronic requests of your own patients ?
Notification about early-release articles New England of Medicine : • frequent early-release papers since 1999 • > 70 000 members of the E mailing list • > 50 000 subscribers for the E Journal • 125 000 visitors of the Web site each week Campion EW, NEJM 341 : 2085, 1999
Quality of health and medical information on the Web ? Criteria ? Actors ? Tools ?
Internet e-Health ethical guidelines • Candor - Honesty • Quality - Professionalism • Privacy - Informed consent • Responsible partnering • Accountability • Disclosure of authorship / interests
+ universities reknowned scientific journals hospitals public agencies groups of experts thematic organisations - individual practicionners individual experts leagues of consumers associations of patients sponsored associations commercial and advertising Web sites Internet : Credibility of sources ? Credibility = « capacity to inspire a belief » Credible = « providing acceptable grounds to be believed »
Quackery sites on the Web General Characteristics : • Any site used to market herbs or dietary supplements, typically including : • (a) lack of full disclosure of relevant facts, • (b) promotion or sale of products that lack a rational use, and/or • (c) failure to provide advice indicating who should not use the products. • Any site used to market or promote homeopathic products. No such products have been proven effective. • Any site that generally promotes "alternative" methods.There are more than a thousand worthless "alternative" methods. • Any site that promotes "nontoxic," "natural," "holistic," or "miraculous" treatments. Source : http://www.quackwatch.com/
Quackery on the Web Common false statements about nutrition : • Everyone should take vitamins • Vitamins are effective against stress. • Taking vitamins makes people more energetic. • Losing weight is easy. • Special diets can cure cancer. Source : http://www.quackwatch.com/
Quackery on the Web Other widespread false statements : • fluoride supplements are dangerous • immunizations are dangerous • Mercury-amalgam filings make people sick Source : http://www.quackwatch.com/
Usefulness of a hospital Web site ? • passive information - business card <http://www.hospitals.be/> • active information retrieval • active interaction (data, parameters, protocols, appointments, consultations et al.)
Review by Price-Waterhouse(march 2000) 85 Belgian hospitals (Flanders and Brussels) : • 33 sites Web sites (39 %) • providing general information (42 %), illustrated by pictures and photos (33 %) • Less than 25 % of sites regularly updated (several not updated since july 1998)
Internet in Belgium ? For surfers / patients / lay people : • cost of telecommunications (telephone to cable) • distrust in electronic shopping, banking, ... • slow and obsolete equipments • few providers of information in a small local market • cultural and socio-economic gaps ? • Training ? Poorly available
Internet : slow pace in Belgium ? In Belgian hospitals : • IT priority to Y2K and « Euro » challenges • Web « communication » is not a priority • willingness to discard advertisement practices • distrust with regard to e-insecurity • fear of « me-too » and fashion effects • « a lipstick on a bulldog face ? » • cultural obstacles ? (« a tool for teenagers ») • confusion ? IT / communication
Web Site of Hôpital Érasme (Brussels) http://intranet/ http://hopitalerasme.org/ http://www.ulb.ac.be/erasme/ 3 500 pages - 1 full-time operator Editorial board - 10 members
Web site Erasme : 1999 / 2000 n visitors / month : 853 to 3 755 n countries visitors : 27 to 51 % visitors (erasmians) : 66 to 36 % % visitors (Belgians) : 89 to 66 %
E mail - Intranet 1 400 connected PC (Intranet) : • Professional use ? • Who is actually reading the messages ? • Who is really mastering the tools ? • Who is abusing ? What kind of abuse ? • Are there « Webholics - On-lineholics » ?
Electronic mailFour principles : 4 "D"s • Dump • Delegate • Do • Delay
Electronic mail • No naive trust in self-learning capabilities • intensely - but roughly - used tool (attached files, links, html ?) • under-utilized equipment • mail not read (> 50 % ?) • exasperating spam • ubiquitous need of training, help desk and maintenance teams • vulnerability in front of budget cuts
Visions of the future ... • "I think there is a world market for may be five computers." Thomas Watson, chairman of IBM, 1943 • "There is no reason anyone would want a computer in their home." Ken Olson, founder of Digital Equipment Corp.,1977 • "640K ought to be enough for anybody." Bill Gates, Microsoft, 1981
Experts ? Not all predictions of experts are true ! Not all predictions of experts that are true will impact you !