A Cyber Revolt In Health Care

Patients are finding new power through the Web

When 55-year-old Melinda Brown was told a year ago she had colon cancer that had spread to her liver and was inoperable, her daughter Jeanette reacted by going to the Internet. Jeanette wasn't looking for support groups. Instead she was hunting for cold, hard facts about the disease and treatment. During her lunch hour, Jeanette mouse-clicked her way across sites and read through thousands of entries served up by search engines when she typed in the word "cancer."

After a week of searching, she hit promising news--someone who survived a situation similar to her mother's through a new type of surgery, called cryosurgery, that uses nitrogylcerin to freeze cancerous tumors. Jeanette's doctor hadn't heard of the treatment, so the Washington (D.C.) family found a specialist. After two rounds of surgery, the tumor appears to be in remission. "The Net has so much more information than any one physician could ever know," says Jeanette, who is now in graduate school at New York University.

UNVARNISHED FACTS. There's a grassroots movement sweeping across the Web that could radically change the doctor-patient relationship. Patients finally are getting their hands on information that doctors didn't know about or simply wouldn't hand over in the past. And just as information and services on the Net have freed consumers from annoying haggling with car salesmen, it's giving patients unvarnished facts about their diseases. Armed with data they've found online in medical journals, databases, and consumer health sites, patients are walking into doctors' offices and asking about treatments and diseases some physicians may never have heard of or considered. "It's a fundamental shift of knowledge, and therefore power, from physicians to patients," says Jim Hudak, global managing partner for health at Andersen Consulting.

That newfound power puts health care on track to be the next big thing on the Net. Already, more than 17 million people in the U.S. have looked up medical care data online this year, up 35% from 1997, according to researcher Find/SVP. More broadly, a recent Intelliquest Inc. survey found that 30.8 million people, or 46% of online users, looked up information about a medical or personal problem.

Those numbers haven't gone unnoticed. Almost overnight, companies large and small are bolstering or launching services for consumers--providing personalized news, risk assessment services, insurance, and online drugstores. Since 1997, nearly $120 million in venture-capital funding has been sunk into Internet-related health-care companies, says researcher VentureOne Corp. And on Oct. 27, Intel Corp. will hold a Health Technology Day to raise the market's profile and unveil investments and partnerships the semiconductor giant is weaving together to speed adoption of online health care. For Intel, more consumers looking up information online means more computers--and chips--sold. "Health care isn't the primary reason people get online, but that will change," predicts Steven McGeady, director of Intel's Health Technology Initiative.

The Net may usher in an even more profound change. For years, there has been a push to bring health care into the computer age, giving patients more access to data and improving and tracking treatment. Until now, the health-care system has resisted--doctors' offices are the last great bastions of notepads and paper files. But the rippling effect of consumers using the Net could convert even the Luddites. "It's quite a challenge to introduce change, but we're doing it," says Anna-Lisa Silvestra, general manager of Kaiser-Permanente's national member technology group. "The main reason is our customers are asking for it."

Kaiser, like some health maintenance organizations, is dishing up promising services on the Web that move well beyond just offering electronic brochures about benefits. During the next 18 months, Kaiser, the largest nonprofit HMO, with 9.2 million patients, is rolling out a Web site that will let members register for office visits and send E-mail questions to nurses and pharmacists (and get responses within 24 hours). Next year, the HMO plans to test access to lab results and pharmaceutical refills online. Kaiser isn't the only one eyeing an online pharmacy. Established players such as Merck Medco and startups such as PlantRx also aim to be the Web's top drugstore.

While Kaiser is on the cutting edge, other HMOs haven't moved as fast, and impatient cybernauts are instead turning to consumer health sites. Topping the list are Mayo Clinic Health Oasis, BetterHealth, run by popular women's site iVillage.com, and DrKoop.com, a service launched in July and backed by former U.S. Surgeon General Dr. C. Everett Koop. The latter boasted 400,000 different visitors in September, while year-old Betterhealth drew 650,000 in August and Mayo had 800,000 users in August, up from 55,000 at the beginning of the year.

Consumer sites are just the tonic for those seeking a wide array of medical research and news, as well as links to databases that explain diseases and drugs in laymen's terms. Moreover, many offer online chats with physicians and nurses, personal medical pages with news alerts and customized data, and risk-assessment services that rate a person's health based on lifestyle and medical history--with information on how to improve it. Sites also are piling on to the E-commerce bandwagon, selling products that range from vitamins to health insurance.

"CYBERQUACKS." For all that, dispensing health care on the Net is not without its drawbacks. For one, many Web surfers worry about privacy when it comes to coughing up personal medical data. But the biggest obstacle could be the large amount of bad information. With an estimated 15,000 health sites, the amount of data that is just plain wrong or misleading hurts the credibility of the Web. So far, there have been piecemeal attempts to fix this, such as the one by the nonprofit Health on the Net Foundation that certifies and monitors sites. On Oct. 14, the Health & Human Services Dept. will launch a site (www.scipich.org) aimed at teaching consumers how to evaluate sites. "The opportunity for cyberquacks is out there," says Andersen's Hudak.

Longer term, the hope is the Web will go far beyond serving up medical data and will finally link together physicians, patients, and insurers like a massive electronic nervous system. The benefits are hard to ignore. About a third of the $1 trillion spent on health care in the U.S. is wasted on unnecessary and duplicated treatments, estimates Andersen. But connecting the different systems and offering electronic medical records has stalled, in part, because of how fragmented the health-care market is and the hodgepodge of computer systems used. Privacy concerns are another hindrance, since a problem with linking networks is ensuring the confidentiality of information, such as HIV-test results.

Headway is being made. Leading makers of technology for the health-care industry--such as Shared Medical Systems, HBO & Co., and IDX Systems--are creating Web versions of their products. "Our customers are pushing us very hard," says Mark Wheeler, chief technical architect at IDX.

Clearly, consumers are being heard. Startups already are stepping into the void left by hospitals and doctors who shun the Web. Dr. Koop and Seattle-based startup Lexant, for example, plan to offer personal health-care records that let consumers fill in their medical histories and, when possible, link electronically with labs or doctors' offices to add data about recent tests or visits. Consumers use a personal identification number or password to visit the site.

Julie Klapstein has already seen the benefits of Lexant's other services. The CEO of PhyCom Corp., a health-care software maker based in Kirkland, Wash., used Lexant's DoHealth service, which provides news and links to medical databases. This helped her pinpoint a condition that could have led to brittle bones. "It's consumerism in health care. It's people taking charge of their own health," says Klapstein.

In a piecemeal fashion, the Net is bringing health care into the 21st century. The adoption of Web technology is expected to pick up even more as companies finish grappling with the Year 2000 bug. "There is a huge opportunity to give clients a much higher level of service," says Eric Yablonka, chief information officer at Saint Raphael Healthcare System, a New Haven (Conn.) hospital that is installing Web software so physicians can look up patient data. With more such initiatives, the prognosis for health on the Net could be promising.

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