Special Report: Disease Management on the Web

The new frontier of disease management: The World Wide Web

Creativity is key in taking advantage of new information technology

Once little more than a curiosity, the World Wide Web has become an indispensable resource for health care professionals, experts say. Indeed, the Web offers a dizzying array of sites relevant to disease managers, including associations, government agencies, medical journals, and even hospitals and managed care organizations. Just as important, it represents a cost-effective way for your organization to further its disease management goals.

"It’s so exciting to see what can be done through the Internet that we used to think we had to spend thousands, even hundreds of thousands of dollars on," says Marcia Diane Ward, RN, CCM, market segment manager for IBM Healthcare Solutions in Atlanta. "Providers used to think they had to have these big systems. Then they realized that with Web browsing technology, they’re going to be able to tie in and access all kinds of guidelines and protocols."

In the past, Ward says, health care professionals assumed that expensive proprietary software systems were necessary to incorporate established clinical guidelines into a disease-specific plan of care. Now, Internet technology has emerged as an important resource for outcomes management.

"You can certainly use it as an outcomes tool and do a lot of your benchmarking with it," she says. (See related story on benchmarking Web sites, p. 145.) "If you’re a hospital network, or an integrated health care delivery system, part of selling your services is to be able to document. And it’s great not to have to go out there and say, ‘I’ve got to get this big software application, and it’s got to have all these things in it, and that’s going to cost all of this money.’ Because it’s available on the Internet."

Use the Web to improve patient education

Posting patient education materials on a general-access Web site can allow you to cut down on the time and expense involved in printing large quantities of such material, Ward says. It also allows you to update such information quickly and cheaply, without the need for additional printing and replacing of old material. Other resources you can offer members of your disease management program include on-line access to support groups and list-serves related to their diseases.

"Anything you can do to give the consumer an option to take responsibility for their health care and their education is going to be of great value," Ward says.

In addition to simply disseminating information to patients, however, you also can collect routine information from them without the need for office visits or follow-up telephone calls, says David Hutchinson, RN, an acute care nurse in pediatrics at the University of California Davis Medical Center in Sacramento and author of The Internet Workbook for Health Professionals. "Because the Internet right now is interactive, it’s fairly simple to set up forms that can take information and give it back," he says. "You can also have people check into a proprietary company site and then interact with the information or database that happens to be on the site. They can enter some information and get some answers back depending on what they’ve put in. So it doesn’t have to be static information." Some health plans have begun using the Internet not only to share information with consumers but among their own clinicians. (See related story on the University of Pennsylvania Hospital System, p. 143.)

Hutchinson notes that some organizations have set up electronic patient education "kiosks," where patients check in through the use of designated passwords. When a patient arrives at the site, he or she identifies him- or herself. A database then automatically pulls up the patient’s record and notes the length of time since the patient’s last visit. It also can automatically call up information specific to whatever chronic conditions the patient has. "In a managed care organization, different disease management programs or even individual physicians can put up guidelines that are tailored for their patients," Hutchinson says. "Or you could have something that applies across the board for all Kaiser patients with diabetes, for example."

Record medication information

Internet-accessible databases also can be used to record and update information such as changes in medication and a patient’s most recent acute exacerbation. "As long as you’re doing it with a fairly secure mechanism, so that you don’t have the dangers of it being leaked, then it sort of augments the typical methods of communication," Hutchinson says. Some organizations are already taking this approach a step further, performing telemedicine — the transfer of video or audio information between patients and clinicians at remote sites — over the Internet. (See "Telemedicine targets the chronically ill," Sept. 1997 DSM, pp. 111-113.)

The Web can also be used to market your disease management efforts effectively, says Ward. For example, by posting patient "success stories," you can illustrate instances in which a health plan member has benefited from a specific disease management intervention or program. "That’s pretty powerful because it gets into customer satisfaction," she says. "It tells other consumers that you’re not just in the business of medical therapy; you’re in the business of leading people to self-care and wellness, and that comes from responsibility and putting patients in touch with the right people and the right resources. In other words, instead of ‘Let us take care of you,’ the message is ‘Let us teach you to take care of yourself."

Despite the many benefits of establishing a presence on the Web, including education, marketing, data collection, and even sharing of clinical information, many health plans have resisted making full use of Internet technology, experts say. The main reason is their concerns over the security of confidential medical information.

That concern isn’t specific to health care. Visions of teen-aged delinquents planting computer viruses and hacking sensitive files for thrills have dissuaded many from transmitting their credit card numbers on-line to purchase consumer goods. Likewise, many health plans have resisted the notion of placing any but the most basic medical information on their proprietary Web sites. "Many worry about what would happen if sensitive information got out," Hutchinson says. "Like an HIV record, a file on infectious diseases, or someone’s psychiatric history. They think about what would happen if someone suddenly got a hold of names and positive and negative results — the implications that could have socially."

Don’t dwell on security issues

While Hutchinson won’t discount the dangers posed by computer hackers, he contends that fear over Internet security breaches has gotten out of hand. "I personally don’t think it’s that serious," he says. "There are secure mechanisms."

"I think we in the health care industry have overplayed and overemphasized the security issues, the idea of ‘Someone’s going to get into all of your medical information, and they’re going to persecute you and prosecute you," Ward says.

Hutchinson adds, however, that no mechanism is ever "100% secure." With computer hardware and software both continuing to develop at a rapid pace, "the people who are trying to hack in are pretty much on a par with the people who are trying to safeguard information," he says. "The average transaction, such as sending a credit card number over to buy something at an on-line store, is fairly secure. I would think that 100 or 1,000 or 100,000 times it would go. But you just don’t know when someone would have the ability to grab it as it flies across the net."

Even so, Hutchinson argues, the increasing use of the Internet by health care professionals is inevitable now, and the benefits of getting on-line far outweigh the risks. "The Internet is about access," he says. "It allows 24-hour, seven-day-a-week access straight to the home. The information you put there can be immediately automatically updated without great expense."

[For more information about Internet technology, contact: David Hutchinson, RN, University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 25817. Telephone: (916) 734-2011.

Marcia Diane Ward, RN, CCM, market segment manager, IBM Corporation, 3200 Windy Hill Road, WG14A, Atlanta, GA 30339. Telephone: (770) 835-8420.]