Many physicians want to use computers, and especially the Internet, to enhance their practices. But with new technologies being developed constantly, it's difficult for them to keep up with what's available.
So it's not surprising that when San Francisco-based e-health network Medem offered free template-based Web sites to physicians at the AMA's annual House of Delegates meeting in June, one-third of the 700 attendees immediately signed up.
"A Web site serves as an augmentation to your practice," says Melvin Stern, M.D., a pediatrician in Highland, Md., who set up his site through Medem in June. "Within the first week and a half, we already had positive comments from patients about the hyperlinks to articles" on such topics as breastfeeding, appendicitis and immunizations.
Stern's site, which he said was "a piece of cake" to create using the template, includes articles written by the American Academy of Pediatrics, medical news, and information about his practice. "Patients need reinforcement on simple things such as potty training, dietary issues and even how to respond to fever.
With the Web site, they can take a look at that there (instead of calling the office)."
Medem was founded in October 1999 by the AMA and the American Academy of Ophthamology; the American Academy of Pediatrics; the American College of Allergy, Asthma and Immunology; the American College of Obstetricians and Gynecologists; the American Psychiatric Association; and the American Society of Plastic Surgeons. New members continue to join, and Web sites are free to physicians who are members of Medem-affiliated organizations.
Surveys show that physicians are using technology more and more. They are taking courses from local colleges, learning computer skills from their children and during conferences, using online tutorials and even asking their peers for help.
Increasingly, they are looking for training from healthcare organizations, professional associations and medical societies, though much of this type of support is still being developed.
"There isn't a central place to start looking for computer training education," says Charles Jaffe, M.D., an allergist and immunologist at Scripps Health in San Diego. Jaffe is owner of an informatics consultancy called InforMed in Del Mar, Calif., and chair of clinical information systems for the American Medical Informatics Association. Jaffe says Stanford holds a "superb" weeklong program twice each summer, but there are only 20 slots for each session and he says they fill up six to eight months in advance. He also recommends the two weeklong summer programs offered by the National Library of Medicine, but those also are difficult to get into.
Jaffe himself teaches 40 or so classes annually nationwide, often for medical societies or hospitals where he lectures or helps with hands-on computer instruction.
Andrew Barbash, M.D., director of clinical information systems for Mid-Atlantic Permanente Medical Group in Rockville, Md., agrees that physicians want more computer skills. "Now that physicians know what technology can do for them, they are becoming very demanding. They want tools that are extremely efficient, and that is one of the challenges in the medical informatics area."
At Oakland, Calif.-based Kaiser Permanente, all employees, including physicians, are offered an eight-hour computer training class when first hired. The course covers the functionality of the electronic medical record, and the basics of Windows are taught if doctors require it.
As Barbash and his staff create or update programs, such as electronic medical records software, physicians are directed to instructions posted online in PowerPoint format. "It's very effective, because they can learn the software on their own time and they don't need intensive training." He also offers online instruction at various days and times, so physicians can plan their schedule around the training.
"Distance learning on the Web is the only practical way of getting people together," Barbash says.
DoctorQuality.com, an Internet-based healthcare company in Philadelphia, is offering year-long fellowships focusing on Internet-based applications in improving healthcare quality, disseminating information to purchasers and other clinicians, and technology-based strategies for implementing best-practice medicine.
"Technology is a very strong quality improvement tool for empowering patients in their healthcare and sharing information, so not everything is stored in the doctor's office or hospital," says David Shulkin, M.D., CEO of DoctorQuality.com. "Physicians who don't have an understanding of the Internet and how information is used are really going to be missing a significant opportunity." Shulkin expects to enroll one fellow this fall and one more next year. Fellows receive a $30,000 annual stipend and will be eligible for stock options in DoctorQuality.com.
The AMA offers a popular one-day, hands-on Internet Health Road Show that allows participants to learn why patients access the Web, what tools are available to physicians and the latest cutting-edge Internet healthcare technology. Hundreds of physicians have participated during the AMA's annual and interim meetings during the past two years.
The Association of Medical Directors of Information Systems holds an annual computer symposium focusing on clinical decision support, disease management and other applied medical informatics. AMDIS also publishes Informatics Review, a free online journal covering information technology issues.
"In the last three years, there's been significant interest from physicians to become more knowledgeable and have access to information technology," says AMDIS executive director Richard Rydell. "A lot of it is driven by their patients, who have access to the Internet and get a lot of information. Physicians need to know what their patients are capable of accessing."
Physicians must also anticipate future technologies.
"The Internet is invading every facet of the physician's professional life," says Peter Grant, an attorney and partner with Davis Wright Tremaine in Seattle, who helped coordinate the eHealth Colloquium, a weeklong course for clinicians and healthcare executives being held this month at Harvard. The program addresses everything from the basics of the Internet to "Internet Strategies to Enhance Quality and Avoid Medical Errors."
Grant notes that already patients show physicians articles they've downloaded from the Internet and demand specific prescriptions based on direct-to-consumer advertising. Soon, he predicts, physicians will have to decide whether to make e-mail correspondence with patients a part of their practice. "They'll have questions about confidentiality, liability and whether it's saving or adding time to their workload."
Physicians also will need to determine the feasibility of supply ordering, claims processing and hospital connectivity through the Internet. And many will wonder about the need for handheld devices, digital cameras for sending patients' pictures and x-rays, and other gadgets. "So much is happening so quickly, it's discombobulating. The majority of doctors have not really caught up with the technology."
When David Voran, M.D., chief medical information officer at the 14-hospital integrated delivery network Health Midwest in Kansas City, Mo., teaches classes to system physicians, he focuses on the basics. Physicians want to know what type of hardware and software they need, how much it will cost and how to protect data.
But he says many physicians underuse the technology that's already in their offices. For example, they use word processors only as glorified typewriters and not for the mail-merge and template functions they allow. Assess existing technology before buying new equipment, he advocates.
But Voran also looks to the future. "More physicians will embrace technology when the third-party payers open their systems to physicians in return for access to physician office systems, streamlining the billing process and turnaround time. So when the day is done, my transactions are transmitted to the insurance company and I receive payment that day, like the way a credit card transaction is handled."
Despite all this technological growth, "the ideal system and the killer application are still not there in medicine," says William Bria, M.D., the medical director of clinical information systems at the University of Michigan Medical Center.
Bria, who also is assistant professor of internal medicine and a pulmonary critical care specialist at the University of Michigan, says healthcare technology needs standardization before it will be successful and embraced industrywide. But he emphasizes that "the PC era is gone, and now we're onto the Web."
And he notes that physicians want as much function as possible in as small a device as possible, especially through a gadget that's portable.
Ultimately, everyone agrees that computer-savvy physicians will have a competitive edge. "The physicians who learn how to use technology can practice better quality care and have better efficiencies," says Kaiser's Barbash.
Robin F. DeMattia is a freelance editor and writer based in Fauquier County, Va.