Key challenges of building strong Internet partnerships between health care providers and consumers

Heidelberg 19 September 1999The ways in which we structurise health information are crucial to the question of how we are to cope with overload. At McMaster University in Canada, Dr. Alejandro Jadad is Co-Director of the Cochrane Collaboration and Professor for Clinical Epidemiology and Biostatistics. As the first MedNet key-note speaker, he pictured the major challenges faced by patients as well as clinicians, using the Internet as a source of information in order to forge solid partnerships and optimize the level of health care. How can we reach for the ideal scenario of gaining access to the best available technology and information in a supportive environment with the most adequate user skills?


Dr. Jadad distinguishes between four types of information which are quantitative and qualitative research data, distribution of clinical data, anecdotal but powerful individual experiences, and tacit knowledge referred to as intuition. All this data is distributed at a global scale over the Internet. This massive overload constitutes a big problem for providers and consumers in health care. At the McMaster's Health Information Research Unit (HIRU), several projects are focusing these issues. As such, the GUIDE initiative was launched to gain a better understanding of the Internet's role on decisions based on evidence. The Health Evidence Application and Linkage Network (HEALNet) is concentrating on group's interviews and systematic reviews to transfer its research to the users.

As a matter of fact, various groups of decision-makers are using the Internet. On the other hand, a preliminary survey of results from research performed at McMaster, indicates that from a number of 407 patients 37% has access to the computer, but 19% of them doesn't know the Internet. Within the first group, 27% uses the Internet, out of which 74% looks for health information on the Web. Less than 10% shows the results to a physician. For Dr. Jadad there is obviously more collaboration needed between providers and patients. Clinicians should produce studies with their patients instead of on behalf of them. Input from clinicians as well as patients is necessary. Solutions lie in the creation of focus groups where patients are leading the discussions, and in databases with consumer input. The clinical decisions should be based on personal patient experience, randomised controlled trials (RCT), systematic reviews, and evidence-based guidelines.

The future generation will dispose of wearable computers and interactive television to provide health care information. Interactive systems will assist people to collaborate. Fast access to information anytime, anywhere, will be offered by satellites and airplanes equipped with solar cells. At present, we already experience that verbal communication is far more important than written information. The Internet gradually moves away from the written word. We should equally take into account that 25% of the population within the United States is functionally illiterate whereas another quarter is marginally illiterate. Consequently, health information will have to be presented in less conventional ways. In this regard, Dr. Jadad stresses that the Internet has caused an electronic text revolution. The Web can do a lot more than just present written text.

Currently, we are finding ourselves in a transitional period in which we move from text-based data to a different, interactive way of communicating. Soon, multi-sensoral experiences will be possible in a multi-media environment. In the factors that affect decisions, information is just one component. We also have to deal with strong values and preferences. This calls for a right balance between virtual and face-to-face interactions in which we urgently need to re-assess the roles of humans but of machines as well, as Ray Kurzweil has predicted earlier on. Most important of all, the access to information should be made equitable for all of us. The gaps between populations are widening in the developing countries in which information is only one of many, many needs. For countries in full development, the creation of virtual halls and of telecommunication centres might provide an answer.

According to Dr. Jadad's belief, the Internet forms an opportunity to improve health care but also holds in store unparalleled threats. It is only through the establishment of strong global partnerships that we will be able to meet the tremendous challenges thrust upon us in the fast changing world of the Internet and global telecommunication. More details about the activities of the health information support staff at McMaster's University are hosted at the Health Information Research Unit Web site.

Leslie Versweyveld

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