How Will the Internet Change Our Health System

NOTES

1. 
   “Americans Seek Health Information Online,” Reuters Health (5 August 1999).
   
2. 
   “The Net Imperative,” Economist (26 June 1999):5 11.
   
3. 
   For a superb discussion of these challenges, see J.D. Kleinke, “Release 0.0: Clinical Information Technology in the Real World,” Health Affairs (Nov/Dec 1998): 23 38.
   

4. 
   Ibid.
   
5. 
   For a skeptical analysis of the impact of computing on business productivity, see W. Gibbs, “Taking Computers to Task,” Scientific American (July 1997): 82 89.
   
6. 
   C.J. McDonald et al., "Canopy Computing: Using the Web in Clinical Practice," Journal of the American Medical Association (21 October 1998): 1325 1329. For a practical discussion of how physicians will use Internet technologies, see M. Ruffin, Digital Doctors (Tampa: American College of Physician Executives, 1999).
   
7. 
   J. Goldman, "Protecting Privacy to improve Health Care," Health Affairs (Nov/Dec 1998): 47 57.
   
8. 
   D. Bates et al., "Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors," Journal of the American Medical Association (21 October 1998): 1311 1316; and R. Raschke et al., "A Computer Alert System to Prevent Injury from Adverse Drug Events,"Journal of the American Medical Association (21 October 1998):1317 1320.
   
9. 
   "Americans Seek Health information Online.”
   
10. 
    P.R. Hubbs et al., "Medical information on the Internet," Journal of the American Medical Association (21 October 1998):1363.
    
11. 
    For a comprehensive if breathless look at the companies developing these sites, see S. Fitzgibbons and R. Lee, “The Health.net Industry: The Convergence of Healthcare and the Internet” (San Francisco: Hambrecht and Quist, January 1999).
    
12. 
    An early entrant is HealthGrades.com. See J. Morrissey, "Internet Company Rates Hospitals," Modern Healthcare (16 August 1999): 24. Thehealthpages.com invites consumers to rate their physicians along perceived quality dimensions. The mother lode of physician specific information, the National Practitioner Data Bank maintained by the U.S. Department of Health and Human Services, is presently inaccessible to consumers.
    
13. 
    See H. Rheingold, The Virtual Community (New York: Harper Collins, 1995).
    
14. 
    Howard Rheingold, information technology futurist, personal communication, fall 1998.
    
15. 
    U.S. Department of Commerce, Falling through the Net III (Washington: U.S. Department of Commerce, July 1999).
    
16. 
    Aetna/U.S. Healthcare had also an early and aggressive Internet presence (www.aetnaushc.com). The firm also collaborated with the Johns Hopkins University in creating a Web health portal (www.intellihealth.com).
    
17. 
    See J. Ray and J. Sydnor, "Disease Management: The Future of Managed Care" (New York: First Union Capital Markets, 12 April 1999). A pioneering, Web based, interactive disease management effort is CHESS (Comprehensive Health Enhancement Support System), developed by David Gustafson and colleagues at the University of Wisconsin.
    
18. 
    See J. F. Kasper, A.G. Mulley, and J. E. Wermberg, "Developing Shared Decisionmaking Programs to Improve the Quality of Health Care," Quality Review Bulletin (June 1992): 183 190. On the utilization impact, see E. Wagner et al., “The Effect of a Shared Decisionmaking Program on Rates of Surgery for Benign Prostatic Hyperplasia," Medical Care 33, no. 8 (1995): 765 770.
    
19. 
    The company that owns the rights to the Informed Choice process, Fairview Medical Services Corporation/Health Dialog, has negotiated a half dozen licensing agreements with health plans and is in discussion with many others.