Using the Internet To Enhance Patient Care
Paul Kleeberg, M.D.
Revised: October 3rd, 2000
Objectives
Background
How do I use it?
Finding Information on the WebSearch EnginesJudging Quality
Metasearch Tools
Metasites
Medline
Allina Resources
Keeping Current
Patient Education
Communicating with Patients
Bookmarks that follow you
Making This Work
At the end of this talk, you should be able to:
Many people have written about the growth of the Internet and its importance to health care. Here are a few statistics:
According to a study released by WebSurveyMD.com (July 2000), the percentage of physicians interested in using the Internet for
Age did not appear to be a factor in the survey. Doctors who rated themselves highly “Internet-savvy” were even less interested in Internet-based healthcare activities. Most respondents said that they surf the Net for informational or educational purposes:
According to a study in late 1999 by the American Medical Association only 11% of physicians embrace the Internet as a patient education tool (Internet Health Care Magazine, September 2000)
_Finding what you need on the Web_
There are four general classes of tools that you can use to search for information on the web. These are search engines, meta-search tools, meta-indices, and Medline search tools. Each has its own strengths and weaknesses.
Search engines randomly index pages on the web. Though some say search engines give unsatisfactory results, I maintain that a well tuned search will give you excellent results in short order - faster than looking it up in a text in on your shelf.
To use a search engine you must understand how your results are arranged. With most search engines such as AltaVista results are arranged according to the number of times your search terms appear in the document. The more a term appears on a web page, the closer that page moves to the beginning of your search results.
With some search sites, not all your terms have to appear in the results. That rare medical term, though it may be the most important to you, might not be present in your first few results.
Google is a search engine that uses a unique method for ranking the results. It ranks them according to the number of other sites that link to the target document. In a sense it is using an unorthodox method of peer review by assuming that if a lot of sites link to the page, it must be good.
You will get better results if you keep these things in mind:
I recommend that you become familiar with the advanced techniques in one or two search engines and use them for your quick and dirty searches. Google is the search engine I use most frequently.
These tools are useful if you wish to canvas more of the Internet with your search. Since none of the search engines exhaustively index the web, it is sometimes valuable to blanket several sites at the same time to find that rare article. There are two different types of tools you can use to perform this type of search: A web site or an application that resides on your computer.
These sites can serve two purposes. One is to allow you to browse for information. Another is to allow you to perform a focused search.
My favorite metasites is Medical Matrix but a better known example of a metasite is Yahoo.
There are many tools which allow you to search the peer reviewed medical literature. My two favorites are PubMed provided for free by the National Library of Medicine and Ovid provided for free to any provider associated with an Allina facility. Once again it is best to become familiar with one of them so that you may refine your search techniques which will increase your efficiency.
Ovid is a robust MEDLINE search tool which will provide you with on-line access to full text of some medical journals. It will also indicate which of the journals reside in one of our libraries so the article can be easily retrieved. Instructions for requesting an Ovid password are available on the library’s web page.
PubMed allows you to save your search strategies allowing you to check them for recent updates. There are two methods for doing this. One method allows you to save your search strategy as a bookmark in your browser. This makes it very easy for you to scan recently published articles in areas of interest to you. Instructions explaining how to do this are available on-line. A newer method is to use the “Cubby” feature that recently became available. I have not tried it yet but I understand it is an easy method for saving and retrieving searches.
Just as one would evaluate a medical journal or any other article appearing in printed media, it is important to look at the publication (web site) the publication’s source of funding and the source of funding for the study. When evaluating websites, a quick glance of the site’s domain can tell you a great deal:
|
.com |
commercial site |
|
.edu |
educational institution |
|
.edu/~paul |
Paul’s web pages at the educational institution |
|
.gov |
Government site |
|
.org |
Non-profit organization |
|
.net |
A regional internet provider |
|
.us |
United States |
|
.au |
Australia |
|
.jp |
Japan |
|
.uk |
United Kingdom |
For more information about top level domains see the Internet Assigned Numbers Authority at http://www.iana.org/. You will find a listing of the top level domains for countries there as well.
A more thorough discussion of judging quality written by Allina Health System’s Medical Librarians can be found at http://fpen.org/train/web/evaluating-sites.html.
There are several valuable resources available to physicians from within the Allina Intranet. These resources can be accessed from either the clinic or the hospital:
There are several ways in which I use the Internet to help keep me informed of current medical events.
There is a great deal of information directed at patients on the Web. What is most important is finding information that you believe is reliable and consistent with your practice philosophy.
Allina Hospitals and Clinics maintain a health information website called Medformation.com. This web site provides access to local health information as well as easily printable handouts that you can give to your patients. The information is provided by Clinical Reference Systems and has been used by physician offices since the early eighties. It is also the same handout material in Logician, the automated medical record that is being installed in the Allina Clinics. Medica provides access to the Healthwise Knowledgebase from its web site
Specialty Societies frequently provide patient information handouts for their members on the medical society web site. Examples of these are the American Academy of Family Physicians, and the American Academy of Pediatrics. Many on-line drug stores will provide information for consumers about their medications. I have found these sites will often have this information soon after the drug is released. RxList is an example of a site I have found useful.
The U.S. Department of Health and Human Services maintains a listing of what they consider to be reliable consumer health and human services information. It is called Healthfinder (http://www.healthfinder.gov/). I refer to this site quite often when I am looking for reliable health information that I can trust is non-biased.
A resource that has recently been enhanced is MEDLINEplus (http://medlineplus.gov). Collected by the National Library of Medicine, the resources on this site appear outstanding. In addition to links to other medical resources on the web, there is a medical encyclopedia that includes information about diseases, nutrition, surgeries, symptoms and tests among other topics. Definitely worth a look.
A recent study by Cyber Dialog indicated that
This area is probably the most controversial. Patients wish to communicate with their physicians via the web however physicians are reluctant to undertake this. Most industries have found that augmenting their call centers with an interactive website can enhance customer service. It saves them money and frees their call centers to deal with other issues. Physicians do not see it this way. They see themselves as the target of most of these communications and are not willing to make interacting with computers and typing a part of their daily routine. Their days are already packed. Though many physicians entered the profession for altruistic reasons, the relentless increase on non-income-producing paperwork has made even the most generous of us become more cautious of “enhancements” which increase our busywork.
Patient-physician communication doesn’t need to be a burden on physicians. Just as with phone messages, many messages may be handled by your nurse or the front desk. In addition, when your patient types in the question, they are doing some of the work either you or your nurse would have to do. Electronic messages are easy to sort and organize. They can also be made part of the permanent record.
For those who choose to use electronic communications, there are dangers. E-mail is not secure and identities can be spoofed. Secure e-mail with encryption and signatures can guarantee security but it is cumbersome and there are too many “standards.” One solution is to use a website that facilitates secure communications and guarantees identities. An example of this is Healinx.com. This service allows for secure communication between physician and patient for messages, appointment scheduling and medication renewals. Their site has a demo available which is worth viewing.
Both the American Medical Informatics Association and the American Medical Association have taken positions in regard to electronic communications with patients.
_Bookmarks that follow you - MyHQ_
My job requires that I use multiple computers at multiple locations. Bringing my own personal bookmarks from one site to another is impossible. Often I depend on a search engine to find a website if I don’t remember the URL. A more elegant solution is to build a webpage with links to sites of interest to you but these are difficult to maintain and even more difficult to modify “on the fly.” Http://www.myhq.com is a website that allows you to build a page of personal bookmarks that will be available to you from anywhere in the Internet. Editing and rearranging them is quite simple. The page loads fast and is void of any advertising. I use this site to store the bookmarks I am most likely to need when I am away from my machine. As an example of a web page of bookmarks that link to many of the resources we have talked about her see http://www.myhq.com/public/l/o/logician/. There are other sites which allow you to build your own bookmarks, but I have yet to find one that works better than MyHQ.
The most important ingredients necessary to allow you to utilize Internet based resources in your daily routine are having a computer that:
Once these ingredients are in place, take the time to explore. Skills gained during unstructured exploration will make finding information easier when you are in a hurry.
For more information, contact:Paul Kleeberg, M.D. O o Paul@Allina.Com Allina Health System -+---+- Voice: 612-775-1338 1375 Willow Street |_o_| Family Practice & Minneapolis, MN 55403 USA / \|/ \ Information Services