July 15, 1999
Physicians are Using and Accepting the
The early returns suggest that physicians are adopting Internet
technologies! In this issue of our e-newsletter, we share
results of early surveys, explain why we expect these trends to
continue, and discuss implications for care management.
Three separate surveys show more doctors use and accept the
P\S\L Research led a study conducted in Spring/Summer 1998. Key
findings about physicians across the world include:
physicians across eleven North American, European, and Asian
countries own a computer and 44% of these physicians have
accessed the Internet. The predominant place of Internet
access is in the home.
physicians who have not yet accessed the Internet (56% of
physicians in the eleven countries surveyed), two-thirds intend
to do so soon. The overall result is that more than 80% of
physicians (90% in the US) are online or intend to be online in
the near future.
(95%) said they use the Internet to access disease information
an average of 14.7 times per month, 88% reported reading medical
journals online, and 86% said they use the Internet to obtain
Of the time
spent seeking any information on the Internet, experienced user
physicians overall report spending a full 50% of that time
seeking medical information.
In a finding
that is both surprising and indicative of the general trend
toward patient empowerment, 62% of net-connected physicians
reported suggesting to some of their patients that they, the
patients, could obtain medical information via the net. Almost
one-third of physicians reported that patients had brought to
them medical or health-related information they had found on the
strongly suggest that physicians may soon be obtaining online a
significant portion of the information they utilize to practice
findings from its latest
Internet Survey of Medicine in May 1999. Healtheon
has tracked 10,000 physicians for 3 years:
physicians surveyed are currently using the Internet. This is an
increase in regular online activity by doctors of 42% in the
last three months, and a jump of 875% from 1997.
More than 63% of the physicians surveyed use daily e-mail and
33% have used e-mail to communicate with patients.
Doctor-patient communications via e-mail has jumped 200% in the
last year and nearly 20% in the last three months; e-mail for
communications has increased by 33% in the last year.
The Health on the Net Foundation (HON) has conducted four surveys on
the Internet for Medical & Health Purposes. The First
Survey was conducted in Feb/Mar of 1997 and the Fourth Survey was
conducted in Mar/Apr of 1999. ©Health on the Net Foundation
Here are comparisons of a few key questions. The numbers reflect the
percentage of respondents who Strongly Agree/Agree with each
"Doctors in my country are
actively using the Internet."
"It is easy to find useful
medical/health information on the Internet."
"I have found useful medical/health information on the
"In the last 6 months have you sought medical/health
information for yourself?"
We find results from the last question particularly intriguing,
suggesting an increasing level of trust of the Internet...."If it's
good enough for me....then it has to be good enough for...."
(Commentary on the HON methodology: The questionnaires were
posted on the HON website, resulting in a non-random sample.
Respondents were not limited to physicians; 64% of respondents
identified themselves as healthcare professionals.)
Our summary: A large base of physicians, particularly in the
US, is using the Internet. Physician usage of the Internet is
increasing. Almost all physician users are using the Internet
for clinical information.
WHY IS THE INTERNET DIFFERENT
Physicians have been portrayed as
resistant to new technologies. However, THE INTERNET IS DIFFERENT!
There are a number of reasons why we expect physician usage and
acceptance of the Internet to continue to increase:
1) Quality of Content. Content on the Internet will only
continue to get better. The HON survey found that quality of
content on the Internet was perceived very positively even back in
2) Ease of Use. The HON survey shows dramatic gains in
perceived ease of use between 1997 and 1999. The Internet will
become even easier to use as time passes.
3) Low Cost (or NO Cost) Access to the Internet and
Applications. Many companies are experimenting with a variety of
approaches to get physicians on board.
Client/server based solutions in health care have been limited by
the need for physicians to invest up-front capital dollars to
purchase hardware and software. Physicians in particular have
been reluctant to make such investments, which can easily amount to
five or six figures.
This problem goes away through the use of subscription-based pricing
models, which will quickly become the standard for Internet
applications. This pay-as-you-go approach are making Internet
based technologies much more affordable for physicians.
If this isn't enough, there are numerous companies developing
business models that will GIVE AWAY Internet based services to
physicians. For example, Microsoft and DuPont have agreed to
underwrite 11 million months of WebMD subscriptions for physicians.
Abaton.com and Medix Resources have also been recruiting sponsors.
Why give it away to doctors? In the May 6 issue of our
e-newsletter, we pointed out that physicians direct over 70% of
medical costs through the "power of the doctor's pen".
Companies want to influence this direct medical spending. They
also want to develop physician loyalty to their Internet portal to
influence other physician spending (stocks, cars, vacations, etc.).
4) The Internet Will Turbocharge Clinical Information
Technology Applications. We see some companies developing
INCREMENTAL approaches to gathering clinical data, particularly
across different organizations and locations. The
all-or-nothing approach promoted by Electronic Medical Record (EMR)
vendors and integrated delivery systems has met with limited
success. The Punk/Zeigel
Healthcare Web Watch points out some of the difficulties.... "a
one-size-fits-all software model...it is difficult enough to
convince physicians to replace the highly efficient paper chart, let
alone actually pay for this technology....physicians (have) little
tolerance for technologies that require a lengthy learning curve"
Many organizations (particularly disease management companies) have
come to understand that useful clinical data can be collected
incrementally. For example, for heart failure patients, ONE
item of information -- a patient's daily weight -- is a reliable
predictor of imminent hospitalization. When a patient gains
weight, clinician intervention with medications can often prevent
excellent article by Francine R. Gaillour, MD, MBA
explains the incremental approach to the EMR and how the Internet
advances this approach.
5) Saving Time For Doctors. Browser based Internet
technologies are much more adaptable to individual physician
practice patterns. In contrast, earlier attempts required physicians
to adapt to the structure of the software.
Some companies are taking this a step further and developing
Internet approaches that bypass the doctor to save time for the
physician. For example, patient education can often be done by
"connected" nurses, case managers, or others. A note to
look twice to discern whether the motive is to save you time or to
cut you out of the loop.
6) No One Owns the Internet. Physicians mistrust
hospitals. Physicians distrust health plans. We hope you will
forgive our sweeping generalizations, but if you can't, write
Will physicians trust a corporate sponsor any more than they trust
their local hospital or health plan? Some will, some won't.
However, corporate sponsors won't have such a long history of
antagonistic relationships to overcome. A note to health plans
and hospitals: do you have a plan to deal with this?
FOR CARE MANAGEMENT
1) Good News! We believe physician involvement is
essential for optimal care management. The Internet is
beginning to deliver as the technology that brings doctors on board.
2) High Physician Acceptance of Clinical Applications.
Surprisingly, physicians are using the Internet for clinical
applications. (Take a second look at the survey results
3) Experimentation Abounds. We are seeing a variety of
approaches in structuring Internet-based clinical applications. In
contrast with past approaches, most are offering physicians carrots,
rather than sticks, for their involvement. The rigid
structures of client/server applications and the EMR are giving way
to flexible, browser based, work-flow friendly applications.
4) What's your organization's Internet strategy for
clinical and care management applications?
Other articles relating to physician usage
of the Internet:
AMA and Intel Road Show makes Physicians Internet Savvy
The October 21, 1998 issue of the
Journal of the American Medical Association
explored the way computers and the Internet are affecting medicine.
Futurist Frederik Pohl lists 5 "futuribles" - some of the
things he expects to have disappeared by the middle of the
2. Traffic jams
4. TV sets
"Disappearing Technologies", The Futurist (World Future
Society), February 1999 p. 30
STUDY TWICE - THERE WILL BE A QUIZ
Investment bankers Punk,
Zeigel and Company have published their first "Healthcare Web
Watch" report. You can download a copy. This meaty
report provides an information technology slant toward Internet
health opportunities. In particular, pages 39-43 discuss how
the Web is advancing clinical IT applications.
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,
LLC (http://www.bhtinfo.com). BHT provides consulting and
business development services relating to disease management, demand
management, and patient health information technologies.
You may copy, reprint or forward this newsletter to friends,
colleagues or customers, as long as the use is not for resale or
profit and the following copyright notice is included intact.
Copyright © 1999, Better Health Technologies, LLC. All rights