Hundreds of home pages-many of which amount to electronic marketing brochures-have marked healthcare's first tentative steps onto the World Wide Web.
Now, a few innovators are taking Internet technology to the front lines of patient care. For example:
Visiting nurses at Washington-based Medlantic Healthcare Group use laptop computers to send prescription requests for cancer patients to physicians, eliminating delays from trying to connect by phone.
Long Beach (Calif.) Community Hospital and Medical Center patients can register on-line, avoiding a wait at the facility or sometimes a special trip.
Patients about to undergo a computed tomography or magnetic resonance imaging procedure can alleviate their fears by visiting the radiology home page at Beth Israel Hospital in Boston. X-ray images, photos and text explain procedures and terminology, address safety and give background on staff.
Group Health Cooperative of Puget Sound, a Seattle-based staff-model HMO, has put a PC on the desk of each of its 1,000 physicians and uses the Internet to disseminate clinical guidelines instantly.
Florida physicians can fulfill continuing medical education and exams from their homes or offices using MedONE, a joint on-line service of the Florida Medical Association and Sprint.
This just skims the Internet's potential. The challenge is to find effective ways to improve care, lower costs and influence consumers' purchasing decisions on a large scale using Internet technology.
Two areas hold particular promise. One is private networks-dubbed intranets-which run on the Internet and move internal data seamlessly at a fraction of the cost of traditional computing systems. Intranets could be used to link all the pieces of health systems and managed-care organizations as well as to connect providers, employers and health plans in regional networks.
The second is the public Internet, which could help patients manage their own health and navigate the healthcare system. Some of the biggest names in healthcare are putting their heads together to assess the possibilities. Last week, Ernst & Young unveiled a 12-month study sponsored by technology companies to discover how healthcare can capitalize on the Internet.
The advisory board is co-chaired by information chiefs of Nashville, Tenn.-based Columbia/HCA Healthcare Corp. and Indianapolis-based Eli Lilly & Co. and includes officials of Aetna Health Plans, Cigna HealthCare, Harvard Pilgrim Health Care, the Mayo Foundation, Partners HealthCare System and U.S. Healthcare.
One tantalizing idea they'll explore is using the Internet to build community health information networks, which are regional networks of payers and providers that share clinical, financial and administrative data. CHIN development has been stalled by proprietary concerns, conflicting standards and the high cost of building an infrastructure from scratch, but Internet and intranet technology could address those problems with its universal reach.
Already, academic medical centers such as University of California Los Angeles Medical Center are starting to share information with health plans over the Internet, said Dan Nutkis, Ernst & Young's national director for healthcare emerging technologies. "The technology is somewhat amazing. It's extremely cost effective, and it has overcome barriers with connectivity," he said.
Technology companies peg healthcare as a key client, particularly for intranets. Intranets, already in use at some companies, link computers, software and databases with ease, enabling users to find data anywhere in the system. Electronic fire walls block access by the public, although security is still a concern among some users.
Along with a handful of health systems and managed-care organizations, the Department of Veterans Affairs is testing the use of an intranet to move medical records and images, perform administrative functions and send e-mail.
Intranets are considered a perfect match for industries trying to manage data at multiple locations. Mountain View, Calif.-based Sun Microsystems, a leading maker of Internet servers and developer of Java, an innovative Web programming language, claims intranets can save cost-conscious healthcare systems big money. Sun has targeted healthcare as one of its five major markets.
For instance, healthcare systems soon will be able to write simple applications called "applets" that will run everywhere in a system. An applet could, for instance, instantly remove a patient's name from multiple databases.
"Healthcare is a prime marketplace for that type of productivity tool," said Neil Knox, vice president and general manager of Sun's Internet and network products. Interactive technology with consumers is another promising area, but just how this might evolve is unclear.
Already, consumers, particularly those with chronic and unusual diseases, voraciously consume on-line medical data.
For example, at the neurology Web site of Massachusetts General Hospital in Boston, one recent visitor from overseas recognized his own symptoms as that of Gaucher's disease, a rare genetic disorder. He was able to download information and take it to a doctor for a diagnosis. Other patients have located physicians that specialize in their diseases and have contacted them directly to ask questions or seek treatment.
"The main benefit (of the Internet) right now is really patient empowerment," said John Lester, who also launched HospitalWeb, an on-line directory of hospital sites. "I think you'll see hospitals coming on-line with more educational information, if they listen to patients."
Some providers are steering patients to the better sites-a daunting task considering that more than 10% of the information on the Web relates to healthcare, according to an estimate by Reston, Va.-based St. Anthony Publishing, which rates healthcare Web sites (See chart, p. 50).
Some envision technology going even further, to help HMOs and at-risk providers monitor chronic disease, particularly diabetes.
Last month, Lilly launched an interactive site called Managing Your Diabetes. The eight-week pilot project contains about 200 pages of text and pictures with information on diet, exercise, medications and the importance of controlling the disease. Users may pose queries, which Lilly promises to answer within 48 hours.
A more advanced initiative will start next fall at Celebration Health, a futuristic hospital in the Walt Disney Co. town of Celebration, near Orlando, Fla. The idea is to monitor patients in "near time" and catch problems early.
For example, diabetics will send blood-sugar readings over the Internet to a health center computer, which will analyze them and give feedback. If a reading is out of range, the computer could tell the patient to alter self-care procedures or alert a nurse to call the patient.
The sponsors, Florida Hospital Medical Center in Orlando and two Lilly subsidiaries, expect to learn about managing disease and using computers to interact with patients. To expand access, computers might be given to some patients or visiting nurses might carry laptops. Patients who don't like the technology will be able to pick up the phone or click on a mouse to talk to a nurse. Eventually, patients will be able to talk and download information at the same time.
Des Cummings, president of Celebration Health, calls it "soft tech." "The technology is supposed to support the relationship rather than intrude," he said.
UCLA Medical Center also is partnering with GTE Corp. and Microsoft Corp. in a pilot project to bring healthcare data to some Southern California households through interactive television in the next two years.
Interactive technology, both for education and disease management, remains in a very early phase. "What needs to happen is far more interactivity and tailoring of messages that will be more relevant to the individual," said Tom Conant, director of behavior technologies at Wayne, Pa.-based Covalent Research Alliance Corp., which designs outcome-based measurement tools used in health management programs.
For that to happen, access must be expanded. Historically, Web users have been young, affluent and male-not exactly the biggest healthcare consumers. That demographic is broadening, though. For instance, computer ownership among those 55 and older, the age group least likely to access the Web, grew to 30% this year from 21% in mid-1994, according to a study by Intel Corp. and SeniorNet, an on-line service.
Technology companies are hustling to develop cheaper computers and high-speed cable-modems that speed the transfer of data. Notably, Oracle Systems Corp. last month unveiled a working model of a $500 "network computer" with no internal processor, designed to run only off the Internet.
Despite assurances from the computer industry, healthcare is waiting to see whether these "information appliances" really take off. Interactive television, when it arrives, could prove more palatable to the general public.
"If it's easy to use and you can prepackage the information, great. But I'm not sure we're there yet," said Rick Shoup, chief information officer of Waltham, Mass.-based Tufts Health Plan.
The network computer probably will be available within two years, but interactive television will take longer, Nutkis said. Basically, computers and TVs are likely to merge.
Long Beach Community Medical Center isn't waiting for the technology to evolve. Starting in May, the medical center plans to shuttle electronic medical records by way of an intranet.
Its Web site, which gets about 900 visits a day, links with HMOs, a physician referral service and the Long Beach Press-Telegram. The site is capable of enrolling users in two HMOs that contract with the medical center, but the HMOs aren't yet ready with their own technology.
On-line registration, which began in late February, aims to make a hospital visit "more like going to a hotel*.*.*.*.*Everything would be ready when you get there," said Janet Parodi, the medical center's president and chief executive officer.
Parodi believes a revolution is at hand. "The fact is, we're in a time where we have the technology to make remarkable improvements in the way we deliver healthcare. I think that's very exciting," she said.