A consortium of Canada's major telephone companies is bankrolling a commercial service that roams cyberspace, searching for healthcare-related information on the Internet.
At the same time, Kaiser Permanente, one of the largest HMOs in the U.S., is testing videoconferencing techniques that allow its staff to monitor patients' blood pressure, pulses and other vital signs as well as examine visible symptoms.
Both projects share the consulting services of Tom Ferguson, an Austin, Texas-based physician who is one of the architects of the self-care movement in the U.S. He is advising MediaLinx Interactive of Toronto, a Bell Canada subsidiary, on its "Healthy Way" World Wide Web site as well as training staff for the on-line pilot project at Kaiser's Santa Clara, Calif., facility.
A senior associate at Harvard Medical School's Center for Clinical Computing, Ferguson is the author of several books on healthcare and a frequent speaker at healthcare industry conferences. He was recently appointed to Santa Barbara, Calif.-based Tenet Healthcare Corp.'s Internet advisory board.
MediaLinx is spearheading the project for the consortium of Canada's telephone companies, the major one being Bell Canada. Officials of the subsidiary declined to reveal how much the consortium, called Stentor, is spending on the effort.
Spreading information. While Healthy Way is pitched mainly to consumers, it's also accessible to physicians, nurses, medical researchers, caregivers, public health officials and healthcare workers. The menu includes articles on diseases, anatomy, healthy eating and living, keeping fit, family life, sex, disabilities, mental health, alternative medicine and addictions.
"There is an expanding universe of good information available from Internet sites, which physicians can use in their relationships with patients," Ferguson says. Instead of having patients languish in a physician's reception room waiting for a chance to ask questions, "it would often be possible to transact the same information remotely, by e-mail, rather than in a clinical situation," he adds.
Because the Internet is not considered a totally reliable source of information, MediaLinx hired Infinet Communications of Toronto to review and rank healthcare-related information on Web sites, for content, quality of information and graphics, timeliness and other attributes. Infinet so far has reviewed about 4,500 of the 7,000 healthcare sites.
Ferguson sees other possibilities for electronic communication. Patients could be taught to monitor their own blood pressure or use urine-testing kits, for example, and then e-mail the results to their physicians. Patients discharged from hospitals who need some monitoring could also maintain e-mail contact.
Paul A.W. Gamble, a consultant to the MediaLinx health group and director of the health service school at Ryerson Polytechnic University in Toronto, contends consumers gain little from the information in printed material stacked up in physician and hospital reception areas.
"There is a far stronger response to more specific, customized information, greater retention and probably actual use on the Internet," Gamble says.
That clearly doesn't preclude a diagnosis by a physician, and there is a disclaimer about endorsing any treatment or medication therapies discussed on the Web sites.
But Internet communication is "an excellent support tool that allows you to gather information on a diagnosis, for example, and, as an informed consumer, to ask a physician what it means, possible complications, what to expect and other things you would like to know," Gamble says.
Professional use. The expectation is healthcare professionals will use the Internet more intensively in time, particularly if they recognize the value of dealing with better-informed patients.
However, there is a long way to go before that happens. A recent survey underwritten by a consortium of companies interested in information technology showed only a slight majority of healthcare organizations have designated the Internet as a top priority during the next three years (March 10, p. 52).
Nonetheless, as Gamble foresees Internet information exchanges between healthcare institutions, more operating room videoconferencing and remote consultation.
"There is a tremendous revolution going on in healthcare," Gamble says. "We're just beginning that transition as a society to health information in much the same way as we did with banking and financial information."
Cutting edge. That revolution will be hastened by the kind of groundbreaking projects Kaiser has rolled out in California. It already has a system that handles appointment scheduling, prescription refills and a telephone medical advice program, which is being integrated into what will be a far more elaborate Web site.
There are about 5 million Kaiser enrollees in California and another 2.5 million in the rest of the U.S. Tim Kieschnick, technology development manager for the HMO's "interactive technologies initiative" at its Oakland, Calif., headquarters, says Kaiser is testing "a combination of CD-ROMs, interactive television and the Internet to provide personalized, confidential healthcare services to Kaiser enrollees.
"We're looking at Kaiser On-Line as a comprehensive infrastructure that will support many different applications," Kieschnick adds. "Another project is Telehome Health, in which 100 patients released from hospital have been provided with videoconferencing capability so they can exchange medical data with a home health nurse.
"The nurse will be able to see them in their homes on the screen and be able to judge how well a patient can walk across a room, for example, or have them hold up wounds to the camera and have them use stethoscopes to monitor their heartbeat," Kieschnick says.
Other types of interaction will be added to facilitate access to educational materials and group "bulletin boards" with other patients in similar medical situations.
There are, ultimately, cost savings to be realized from this, although it is too early to gauge what they might amount to. "If we can determine, through better access to healthcare providers, whether someone should return to hospital for emergency treatment because of complications, for example, that's good for patients and saves cost for the hospital,"
The Kaiser initiative, he adds, includes raising the level of basic healthcare information on publicly accessed Web sites and information about Kaiser's services and physicians.
Kaiser executives declined to say how much the organization is spending on the project. The first phase of the program began last October, and the final phase-when access is available to all California enrollees and a few outside the state-is scheduled for completion in early 1998.
Warson is a Toronto-based freelance writer.