December 13, 2000
PHYSICIANS AND THE INTERNET
In the past several months numerous
studies and analyses have examined physician adoption of Internet
technology and tools.
With a dash of perspective tossed in, this essay synthesizes some
major findings, conclusions, and wisdom from recent research.
1) READ THE FINE PRINT - STUDIES
DIFFER ABOUT CURRENT MEASUREMENTS OF PHYSICIAN ADOPTION OF THE
How many physicians are online?
37%? 98%? ....somewhere in between?
Whatever answer you pick, you will find "scientific" evidence
supporting your guestimate in this provoking
article in American Medical News.
"There are three types of people in
this world: Those who can count, and those who can't." Seen on a
2) STUDIES DO NOT DIFFER -- PHYSICIAN
USAGE OF THE INTERNET CONTINUES TO INCREASE
The studies disagree about the
specifics of current physician adoption of Internet technologies and
tools. The studies DO NOT differ about the direction of change:
physicians are adopting Internet technologies, slowly and surely.
From the executive summary of
a recent study by Cyber Dialogue/Deloitte Research:
Just as a large percentage of
physicians do not feel the Internet is essential to their practice
today, an even larger group of physicians (71%) is confident that
they will increase their reliance on the Internet in five years.
press release summarizing research by Gomez.com:
Physicians consider themselves open
to new technologies. Despite physicians' reputations (which precedes
them), 57% say they are "very open" to adopting new technologies for
their medical practice, with 35% responding they are "somewhat
open." ....Over 70% of online doctors plan to use wireless
applications for work-related tasks in three years.
3) UNTIL NOW, THE PRIMARY BENEFITS OF GETTING PHYSICIANS ONLINE HAVE
ACCRUED TO SOMEONE OTHER THAN THE DOCTORS
Who benefits most from getting
doctors online? Payors, hospitals, eHealth companies, pharma
companies? One thing is fairly clear....it's hasn't been the docs
...and we wonder why physicians have not been early adopters?
4) CRITICAL SUCCESS FACTORS TO
ENCOURAGE PHYSICIAN ADOPTION ARE BECOMING APPARENT
A Forrester report entitled
"Why Doctors Hate the Net" suggests a practical check-list:
Before using a net tool, doctors will
ask six questions:
1) Does it save time?
2) Is it free?
3) Does it work as advertised?
4) Does it bear a trusted quality stamp?
5) Does it strengthen my power position?
6) Does it help with a mandate I can't refuse?
Cyber Dialogue/Deloitte Research narrowed their list to three:
integrating technology into
workflow at the patient point-of-care,
demonstrating how online
technologies and services will help them practice medicine more
efficiently and effectively.
5) BARRIERS TO PHYSICIAN USAGE OF THE
INTERNET ARE MORE ABOUT MONEY THAN ABOUT ANYTHING ELSE
The technology isn't perfect, but
that's the least of it. The Cyber Dialogue/Deloitte Research study
cuts to the chase:
The main obstacles to adoption are
purely economic. Physicians already feel financially squeezed in an
era dominated by managed care; adoption of online services adds to
their financial burdens in a number of distinct ways: 1) the
up-front and out-of-pocket costs of information system (hardware and
software) investment; 2) monetary opportunity (time) costs of
learning and using a new system; 3) potential financial risks
related to increased liability with EMRs and e-mail; and finally, 4)
the risk of "getting burned" from making a "bad" information system
6) SOME PROMISING RESULTS ARE BEING
For example, two recent studies of
electronic prescribing/drug reference devices show:
Allscripts (e-Prescribing Study)
The aggregate impact of utilizing
TouchScript for prescribing will vary by plan, ranging from $0.75
to $3.20 savings per TouchScript prescription
Savings come from two areas: 1)
increased prescribing of generic medications, and 2) enhanced
formulary compliance of physicians
The savings are realized by
providing real time information at the point of care as a part of
the prescribing process.
50 percent (of physicians)
indicated that the ePocrates qRx(tm) handheld clinical drug
reference guide helped them avoid one or more adverse drug events
Over 90% of clinicians surveyed
reported that it took them 20 seconds or less to find information
using ePocrates qRx
(Read the fine print on these
7) KEEP AN EYE OUT FOR POSSIBLE
The Forrester Report lists some of
the most promising applications:
Medical information sites for
Wireless reference, ordering and
EMR (Electronic Medical Records)
Physician patient email
Telehealth in the patient's home
Expert systems for
"HEALTH e-PEOPLE: THE ONLINE CONSUMER EXPERIENCE"
The California HealthCare Foundation
has published a Five-Year Forecast entitled
"Health e-People: The Online Consumer Experience."
This insightful five-year forecast looks at three groups of online
1) the Well, (60% of consumers)
2) the Newly Diagnosed (5%)
3) the Chronically Ill and their caregivers (35%).
The report explores their use of the
Internet for health-oriented content, community, commerce, and care.
Highlights from the executive summary:
In the long run, delivery of online
care will have the most significant impacts on e-health consumers.
Whereas care applications will have the highest payoff, however,
they will also take the longest to develop. Opportunities exist in
disease management and monitoring, support for compliance with
treatment regimens, electronic consults and house calls,
psychological and psychosocial services, Internet-delivered
diagnostics, online clinical trials, and personal medical records.
In the next five years, online
health-related products and services will develop in two stages.
After a shakeout by business leaving a few survivors in each
e-health niche, the nearer-term e-health environment (between now
and the end of 2002) will be market driven, with ability to show a
return on investment coloring continued venture capital support. The
longer-term, and more significant, shift online (from 2003 through
2005) will result from an accumulation of health care data and an
agreement on information standards that will make apparent the
advantage of an online platform for business.
WHAT'S WRONG WITH
150 people killed by allegedly
faulty tires = front page headlines for six weeks
98,000 people killed by medical
errors = has anyone noticed?
According to a recent study by the
Kaiser Family Foundation, the short answer appears to be "Yes - the
issue of medical errors has reached the public consciousness." Read
the "National Survey
on Americans as Health Care Consumers: An Update on the Role of
The Pew Internet & American Life
Project has published
Online Health Care Revolution: How the Web Helps Americans Take
Better Care of Themselves".
The report describes "health
seekers", the fifty-two million American adults, or 55% of those
with Internet access, who have used the Web to get health or medical
information. A great many health seekers say the resources they find
on the Web have a direct effect on the decisions they make about
their health care and on their interactions with doctors.
E-Health: The Next Wave
November 2000 issue of Health Affairs contains multiple articles
from world renowned authors analyzing various aspects of e-health.
RED HERRING'S TOP
TEN TRENDS 2001
Red Herring magazine has published
its annual listing of
Top 10 Trends -- Technology and Business:
1) Computing: Distributed computing redefines computer networks,
underpinning innovation, company formation, and investments.
2) Intellectual property: Protecting it will be increasingly
3) Venture capital: A shakeout forces a return to venture capital
4) Public markets: The rise of electronic communication networks (ECNs)
will push traditional exchanges to consolidate into a single
electronic trading network.
5) Wireless: Bluetooth nears maturity, creating significant startup
6) Communications: Carriers shift from voice and data transmission
to new high-bandwidth services.
7) International: Wireless commerce in Japan will be a model for the
rest of the world.
8) Government: The Internet falls under the regulation of
9) Energy: Fuel cells will reduce our reliance on oil and allow
businesses and homeowners to produce electricity independently.
10) Biotech: Functional genomics makes drug discovery cheaper and
faster, reinvigorating all of biotech.
3 REPORTS ON
HEALTH CARE ASPs
The California HealthCare Foundation
and First Consulting Group (FCG) have sponsored two reports
discussing health care application service providers (ASPs).
The first report is
"ASPs: An Executive Report: Are Application Service Providers Ready
for Prime Time". This report discusses:
How did ASPs evolve?
Differences between ASPs and
timeshare or outsourced IT offerings.
When are ASPs advantageous?
What are different types of ASPs?
Today's ASP market/what to ask an
The second report is
"Community Clinics: Are Application Service Providers Right for Your
Clinic?". Topics include:
Alternative acquisition methods -
the lay of the land.
ASP vendors and applications.
How to evaluate an ASP offering.
Conclusion: proceed with caution.
A third report on ASPs (by FCG) is
available for those who are still curious or confused.
"Application Service Providers: Unveiling the Mystery for Health
iMcKESSON STUDY -
CONSUMERS WANT COMBINATION OF HIGH TECH/HIGH TOUCH PERSONALIZED
iMcKesson has sponsored an
"Healthcare Satisfaction Study"
(scroll 3/4 down the page to see the links to the Executive Summary
and Full Report) Some of the study's conclusions:
Consumers want a range of options
for accessing their doctors and nurses, including face to face,
online and telephone
Consumers want physicians to use
the communication option that makes the most sense
Consumers across all age,
geographic and income groups want more sophisticated
Internet-based tools to manage their healthcare
Consumers are beginning to factor
the availability of multiple communication options into their
physician and health plan selection decisions
Disclosure -- No BHT clients are
mentioned in this issue.
E-CareManagement News is an
e-newsletter that tracks a major change in health care and managed
care—the paradigm shift from “managing cost” to “managing care”.
This e-newsletter is brought to you by Better Health Technologies,
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management, and patient health information technologies.
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