What is Internet medicine?

Science and Profession

The Internet is a computer-based tool that is facilitating communication among vast numbers of individuals, groups, businesses, and governments. In addition to facilitating purely social and business-related ventures, the Internet is proving to be a valuable tool for improving the state of public health. This is because a new type of medical care and medical services has developed. These services, typically called telehealth, telemedicine, and e-medicine, use the Internet as a key tool in their dispensation, organization, and evaluation of health care services. Such services have taken the form of a variety of health care-related websites that provide services once available only through a face-to-face visit with a doctor or other health or social services professional. The websites are valuable in that they provide almost instantaneous information and other communications assistance to patients, their families, treatment professionals, trainers, trainees in the health care and social service professions, and medical researchers.

In terms of assisting patients, Internet-based medical approaches provide a variety of services to individual Internet users. First, they provide a wealth of information on different symptoms and medical conditions. They also allow for screening of such conditions to see if they warrant further attention from medical professionals and advice on how to handle minor health ailments and medical emergencies. They also help consumers to find medical advice, health care providers, self-help or support groups, and therapy over the Internet, all of which may or may not be supervised by medical professionals. Finally, they can give patients and their families information on different treatment options, including common procedures, the latest in alternative medicine, and even current clinical trials information.

Internet medicine can also be very helpful for family members of individuals having medical problems. Often, family members do not know how best to help their significant others in times of medical need. To meet this need, websites may post a wide variety of information that can help people understand the conditions, the requirements of treatment, the limits of treatment, and things they can do to be helpful to the ill family member. Additionally, websites sometimes offer lists of resources for family members.

Health care and social service providers also find the Internet beneficial for their work. For some, it might be as simple as using the Internet to schedule appointments, or to communicate test results, reminder information about treatment procedures, or appointment reminders via e-mail with clients. For others, it might involve using special websites to conduct assessments of clients for the purpose of tracking their treatment success or progress. Professionals may also use telemedicine in order to learn about new treatments and procedures, or to learn about new drugs and other pharmaceutical products. In addition, health care and social service providers may benefit their general practice by using the Internet to keep abreast of new clinical trials to test state-of-the-art treatments, changes in licensing laws affecting their practice, and the development of new health care databases for tracking, triage, and communication with insurance companies. Finally, some providers are actually using the Internet for health services delivery.

Health care providers in training and their trainers also benefit greatly from telemedicine. To trainees living in remote areas or those who might be highly mobile, such as those in the armed forces, the Internet provides immediate access to large online libraries, knowledgeable online teachers, and databases full of important medical information. Both long-established and new institutions interested in telemedicine increasingly are translating typical face-to-face training approaches into distance-based training programs utilizing the Internet. Encyclopedias, descriptions of techniques, pictures of what different conditions might look like both inside and outside the body, and even video of actual procedures are available online. Similarly, instruction in the use of such material is available online through training programs that lead to certificates of training and actual accredited degrees, ranging from bachelor’s to doctoral degrees and postdoctoral training. In addition to helping individuals who are at remote locations, such material also can be used to reach a larger number of trainees than might typically be able to observe or attend such training. The increased ability to teach, show procedures, or give supervision at a distance using pictorial, written, oral, and video information greatly facilitates continuing education and
improvement of general health care practice. It also helps to facilitate the evaluation of those practices and training sessions. Since all of the work takes place over the Internet, different aspects of the work can be monitored and evaluated electronically.

Much of the evaluation of this kind of information is done by researchers who are studying client, trainer, provider, or even health care system behavior and organization. This is done by evaluating information, also known as data, in individual sessions or visits to websites, as well as by examining data that are collected over time, across multiple visits. For instance, a person might first go to a website for information on a specific medical condition and then, at a later time or times, come back and look up different treatment approaches, or visit online discussion groups. What they do from time to time would be evaluated by researchers to see how individuals use the site, how long they stay on it, or what things they try searching for that may not yet be on the site. The process of watching behavior over time is called tracking. Tracking allows researchers to profile the users of websites to learn more about their behavior, usually for the purpose of predicting their behavior and response to treatment. The information gathered by creating tracking databases of what happens with Web site users can be used to improve services and to decrease long-term health care service, training, and administration costs on a continuing basis.

Because of all the data being collected on how individuals are using different websites or other Internet-based services, there has been some concern over the individual’s right to privacy and the protection of the information collected. For instance, some people have been concerned that if they are searching for information related to the human immunodeficiency virus (HIV) or substance use, they might be identified as being at risk for having that condition whether they do or not. Furthermore, many individuals do not want that information linked to their identities or medical records. On one hand, they may be wishing to avoid solicitation of business from sellers of medical services or products because of their association with the condition; they do not want their personal information sold for that purpose to the providers of such products or services. On the other hand, they may also wish to maintain privacy and keep their information confidential so as to avoid having any threat to their future insurability or their ability to get health care coverage. As an example, if a health care provider such as a health maintenance organization (HMO) tracked users’ information on a website and discovered, through the database, that someone who was now applying for coverage had certain medical conditions, that person might have a greater risk of being refused coverage if his or her time on the website was not completely anonymous. In sum, given these concerns, users of Internet medicine need to understand that there are differences between the terms privacy, confidentiality, and anonymity, as well as in the legal issues and protections one can exercise when using this type of medicine. Each website may be operating under different constraints, and so it is always important for users of these services to be sure they understand how the websites handle privacy. Finding out how a website protects or does not protect the privacy of its users is the only way users can determine how safe it is to reveal confidential information when they use a specific website.

Diagnostic and Treatment Techniques

One of the biggest opportunities offered by Internet medicine is that of increasing the ability of individuals to do self-screening for medical conditions to see if they need medical assistance. Likewise, the ability of service providers to do screening and assessment for a larger number of people is increased relative to what can be done in person. This is because the assessments can be administered via the computer, saving valuable provider time. Additionally, assessments can be completed online and sent to providers in advance for immediate evaluation. While it may be some time before conclusive diagnoses can be offered via online technology, such advances are not far off; the differences between online and in-person assessments are being studied.

Intervention via the Internet is also much improved because large quantities of information can be dispensed electronically, printed out by clients or their families, or distributed to large numbers of individuals. Such informational interventions can be important for facilitating proper compliance with medical prescription regimens, helping clients to avoid bad drug interactions, or providing reminders about other things needed to facilitate wellness. Informational interventions can also be used for primary prevention, or preventing problems from happening in the first place. By providing suggestions for problem prevention, much suffering could be spared and many health care dollars can be saved. This is especially true for teenagers and college-age populations, who are often savvy web users.

Treatment also takes place on the Internet via simultaneous online interactions such as in chat rooms, communicating via videoconferencing as in a normal conversation but using video cameras, and simple asynchronous e-mail between the client and the provider. Generally this type of treatment is a complement to face-to-face treatment. For instance, some HMOs use online support groups as additional treatment for persons already receiving therapy. Others are using programs such as self-guided online courses that clients can work through to benefit their health. In general, practitioners are permitted to do this so long as they are properly licensed. This usually requires being licensed by the state in which they are practicing and/or where the client is receiving the services.

Perspective and Prospects

The Internet continues to grow on a daily basis, with an increasing number of computer owners and websites taking advantage of its capabilities. Communications technologies are also improving constantly, allowing for almost instant individual communication of written, oral, and visual information at distances and speeds that were inconceivable in the past. As a result of these developments, as well as increases in health care costs and the potential economic and health benefits provided by Internet medicine, this specialty area is here to stay. Commitments by governments to examine such developments in health care underscore this likelihood. In 1998, for example, the Health Resources and Service Administration of the United States Department of Health and Human Services established the Office for the Advancement of Telehealth. This office is devoted to advancing the use of telehealth and Internet-based medicine to facilitate improvement in the state of public health and research on public health. The ability of such approaches to provide more services with streamlined administrative procedures and decreased costs holds much promise for improving the state of public health.

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