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All bets are on: physicians are using and accepting the Internet!

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.

Survey results:

Three separate surveys show more doctors use and accept the Internet:

1.  P\S\L Research led a study conducted in Spring/Summer 1998. Key findings about physicians across the world include:

• 80% of 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
• Among 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
• Almost all (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 drug information
• 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 Internet
• These findings strongly suggest that physicians may soon be obtaining online a significant portion of the information they utilize to practice medicine

2.  Healtheon released findings from its latest Internet Survey of Medicine in May 1999. Healtheon has tracked 10,000 physicians for 3 years:

• 85% of 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 professional communications has increased by 33% in the last year

3.  The Health on the Net Foundation (HON) has conducted four surveys on Use of 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

• Here are comparisons of a few key questions. The numbers reflect the percentage of respondents who strongly agree or agree with each statement:

• 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 for physicians?

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 1997
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 turbo charge 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" (p8)

• 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 hospitalization. An 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 doctors: 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: http://www.house.gov/house/MemberWWW.html

• 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?

Implications 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 above.)
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.

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

Copyright © 1999, Better Health Technologies, LLC. All rights reserved.