Imagining the Internet Project

  Responses in reaction to the following statement were assembled from a select group of 1,286 Internet stakeholders in the fall 2004 Pew Internet & American Life Predictions Survey. The survey allowed respondents to select from the choices "agree," "disagree" or "I challenge" the predictive statement. Some respondents chose to expand on their answer by writing an explanation of their position; many did not. Some respondents chose to identify themselves with their answer; many did not. We share some - not all - of the responses here. Workplaces of respondents whose reactions are listed below are attributed here only for the purpose of indicating a level of internet expertise; the statements reflect personal viewpoints and do not represent their companies' or government agencies' policies or positions. Some answers have been edited in order to share more respondents' replies. Below is a selection of the many carefully considered responses to the following statement.
 
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Prediction on health system change
In 10 years, the increasing use of online medical resources will yield substantial improvement in many of the pervasive problems now facing healthcare - including rising health-care costs, poor customer service, the high prevalence of medical mistakes, malpractice concerns and lack of access to medical care for many Americans.

Compiled reactions from the 1,286 respondents:
  39% of internet experts agreed
  30% disagreed
  11% challenged the prediction
  19% did not respond


Online medical resources will not account for this. Health policy will be required. Technology is not a technology issue - it is a social issue - online technology will only codify current health policy that fragments care and underserves a significant minority of the American population. Real reform, including finance reform, is needed, which will result in cost-reduction, facilitated by online access. - Ted Eytan, MD, Group Health Cooperative

Online medical resources could certainly have a substantial impact on health care, particuarly in diagnosis, consultation, coordination. Certain types of mistakes could be lessened. But it is not likely to have a substantial impact on health costs, coverage, malpractice suits or access. Those needs require other avenues to remedy. - Benjamin M. Compaine, editor of "The Digital Divide: Facing a Crisis or Creating a Myth?" and coauthor of "Who Owns the Media?"

Not a chance. The financing mechanism guarantees higher costs. - Fred Hapgood, Output Ltd.

The internet could fill a huge vacuum in health care - the institutions are already weakened, the needs are critical, the demands are increasing - the time is ripe! - Christine Geith, University of Michigan

This may take more than ten years to accomplish, but it will happen. Much of our interaction with doctors involves talking to them - describing symptoms and events, etc. - and they give us advice, assurance, and guidance and prescriptions. That doesn't have to happen in a physical office. This will all start with standardized, digital medical records, easily accessibly by medical personnel. Then email exchanges between a doctor and patient, including routine prescriptions, scheduling, referrals and follow-up. Eventually, real-time video conferencing (like Apple's iChat) will permit "virtual" office visits, coupled in some cases with remote-sensing monitoring of vital functions such a blood pressure, pulse, temperature, etc. In the longer term, the internet will be able to keep more of the elderly out of nursing homes for a longer time: at-home patient care will be made possibly by remote monitoring ... If truly "big broadband" gets into enough homes, at the right price, it can enable enormous savings in health/nursing home costs for society as the baby boom generation ages. - Gary Bachula, Internet2

Access to medical information is a good thing and is already happening. But there are strong forces afoot to suppress information or access to non-FDA approved services. For example, there are bills in Congress to remove all vitamin supplements from the marketplace and make limited amounts of supplements available by prescription only. If this happens, people's medical choices will decrease and chronic illness will increase because people won't be able to maintain healthy preventative practices. - Peter Denning, Naval Postgraduate School, Monterey, Calif./columnist for Communications of the ACM

The entrenched silos of health care are huge, and the Internet alone cannot take this on, even as people get empowered with better medical knowledge. - Barry Wellman, University of Toronto

Too many people will use the Internet as fodder for becoming more demanding, more expensive health-care consumers. - Alexandra Samuel, Harvard University/Cairns Project (New York Law School)

I see a growth of misinformation on the Internet and the problem of people getting conflicting information regarding medical conditions not fully understood or on which physicians and scientists differ. People will be more informed about medical conditions but not necessarily better informed or better able to make decisions. Medicine is not a good place for autodidacts. - Stanley Chodorow, University of California at San Diego/Council on Library and Information Sciences

I agree with this. With increased access to relevant health information, better decisions will be made by health-care consumers and providers, there will be better access to relevant health care advice, and consumers will have access to greater peer support. - Gary Kreps, George Mason University/National Cancer Institute

I think this is essentially true, but I am not convinced that technology in healthcare will either decrease costs or increase access to care for the disadvantaged. I think technology will go a long way toward improving the care and the level of service that is delivered, and I have hopes for President Bush's EHR initiative. But I am not yet convinced, because of the costs of building and maintaining computerized networks and the software and devices needed to run on it, that the costs themselves will go anywhere but up. And as more people lose insurance, this will make care even more difficult to obtain, IT or no IT. - Kevin Featherly, news editor, Healthcare Informatics, McGraw-Hill Healthcare Publishing

This is very much a moving target. As medicine itself advances at an unprecedented speed, the demands on the system are likely to continue to outstrip their adequate provision. - A. Halavais, State University of New York at Buffalo

I do research in the field of online health, and I wish it were this simple. External barriers (such as legal/regulatory/reimbursement/organizational) still trump many efficiencies offered by the Internet. - Pamela Whitten, Michigan State University

The biggest challenge to health information is separating the reliable wheat from the uninformed or mercenary chaff. Too often, when I search on a disease, my first hits are sites that want to sell me a miracle cure. (Would it were so.) On the other hand, the biggest gain from the Internet is the abundance of health information I can access online. - Barry Wellman, University of Toronto

I expect improvements, but not necessarily dramatic ones here. The privacy issues will be a major obstacle until (and even after) widespread authentication exists. - Terry Pittman, America Online, Broadband Division

Improvements will be driven by HMOs and insurers. Improvements in customer service, access, and similar patient-centered concerns - to the extent they occur - will be fortunate byproducts rather than primary concerns. Some dramatic improvements that could readily be achieved - such as online consultations for common ailments with physicians who have not previously met the patient in person - will be forestalled or eliminated by physician-interest groups. - Lois Ambash, Metforix Inc.

Medical mistakes and malpractice will still happen. People will have access to more information to challenge decisions. The Internet will also allow better research of doctor records to prevent it. Certainly admin. Functions may be better dealt with online. Information is half the medical challenge and the Internet will help facilitate its dissemination more efficiently. - Jonathan Peizer, CTO, Open Society Institute

Online medical resources will have next to no effect on the delivery of adequate medical care to all. A political solution is required, and throwing technology at the population won't fix a fundamentally flawed system. - Rose Vines, freelance tech writer, Australian PC User and Sydney Morning Herald

So long as the poor, the old, and the minorities are less connected than the wealthy and educated, we cannot expect to dramatically influence the health system, whose highest users are from the same disadvantaged groups. - Tobey Dichter, Generations on Line

Tele-medicine is already having a significant impact on remote communities. Streamlined insurance processing, elimination of prescription mistakes, better and confidential accessibility to records including longer-term archiving (medical imaging, test results) are all on the way to improving health care - though there are still hurdles to overcome (e.g. getting the insurance companies to cooperate). - Ezra Miller, Ibex Consulting

I can see the Internet perhaps improving customer service and some rural access to medical expertise. But I can't see how this will lead to lower health-care costs, less medical mistakes or more medical care for Americans. These problems are systemic and not related to technology. They are political. - Mark Glaser, Online Journalism Review/Online Publishers Association

The Agency for Healthcare Research and Quality has put a lot of funding toward research in health information technology with the goal of improving patient safety. While technology is not a panacea for eliminating medical errors, it can automate some error-prone processes. Recent research shows that it can introduce previously unheard of errors, as well, so caution is warranted. Rising costs could be slowed and customer service improved by the efficiency of online medical resources. Access to health care through long distance consultations with specialists will increase as telemedicine becomes e-medicine. - Elizabeth W. Staton, University of Colorado at Denver Health Sciences Center

Most developed countries are aging fast. Having more online resources will help them but can't prevent the actual care that has to be given to a growing number of elderly and therefore costs will still rise. I do think the people will be better informed so the doctors have to give their best care possible before they 'shop' somewhere else. - Egon Verharen, innovation manager, SURFnet (Dutch Natl Ed & Research Network)

We are already finding the internet useful as a cheap way to distribute life-saving or promoting information and services to far-flung areas. Believe that there may be some (not a lot) of savings that can be put into other programs. - Centers for Disease Control and Prevention/National Center for Infectious Diseases

Such systems will be vulnerable to abuse (hacking, security and privacy invasions). - Bornali Halder, World Development Movement

This is far too optimistic. Some improvement will ensue, particularly in the areas of customer service, information sharing and eventually with remote surgery (i.e., one seasoned surgeon walking a remote, less-experienced surgeon through a procedure live). However, serious attention needs to be paid to privacy concerns now, or a backlash of mistrust could prevent people from going to doctors for fear of having their illness made public. - Peter W. Van Ness, Van Ness Group

It's not the ability for patients to look up information on their own that will revolutionize health care. It's the development of a single patient record that can be shared by all of a person's health care providers providing them with new context for suggesting options for treatment and prevention. It improves the cost, service and mistake factors, but would do nothing to provide health care for Americans who cannot afford it. That is a matter of political will, not technology. - Aaron Osterby, State of South Australia, Department of Health

The transformation of medicine is coming - the dire situation we have now will make it inevitable. It will be a tough paradigm shift to make, but new generations of medical practitioners will bring it with them. - John B. Mahaffie, Leading Futurists LLC

And the following are from predictors who chose to remain anonymous: [Workplaces of respondents whose reactions are listed below include Harvard Medical School, eHealth Institute, Geffen School of Medicine at UCLA, Weill Medical College/Cornell University, U.S. Administration on Aging, Gartner, The Aspen Institute, Microsoft, Harvard University, Proteus Foundation, Fred Hutchinson Cancer Research Center, Penn State University, South East England Development Agency, U.S. Congressional Budget Office, Carnegie Mellon, Discern LLC, RAND, University of California at Santa Barbara, University of Minnesota, University of Washington, Renaissance Health/Massachusetts General Hospital, Texas A&M University, Northwestern University, Merck, Center for Digital Government, Metafacts, People Who, Information Week, Hamline University of Law, Bowling Green State University, Ventureramp and others.]

Forget this. We have a conspiracy of all the bureuacrats who need their jobs. Hospitals need to push paper to get their cost structure up. Insurance, likewise. We are in a deadly embrace.

The next ten years will be marked by a series of disasters regarding the uses of ill-thought-through technologies (e-health, telemedicine), and insurance costs will be so high that government intervention will be needed. It will be common to have been injured by a failed IT-in-medicine system. There will be a strong counter-movement to humanize medicine.

Sadly, this field will continue to be a laggard.

Health care in the United States is likely to get progressively more expensive, less affordable, less available to those who need it, and more plagued with mistakes.

A series of structural changes in the insurance and health care industries must be made to break down the barriers to making such online resources truly useful. Whether or not the Congress and the interested industries have the courage to make those changes is another question.

Medical care costs are driven by the need to fund improvements in technology and these will continue to grow at 5-10% in excess of inflation. As a result, IT improvements may improve the standard of care and reduce mistakes but they are unlikely to tame the rise in costs. Also, rapidly rising costs are likely to leave excellent medical care the exclusive right of the wealthy.

May be wishful thinking, but I am hopeful this will be the biggest area of internet advance.

Medicine is the last big entity that has not completely adopted IT practices. Care will become more "virtual" ... and this will increase its availability, lower its cost, and if all goes well, limit hospitals/clinics to only times when they are really needed.

No, rising costs of health care are not going to be solved by more information; we might even see more rapidly rising costs as patients demand more and more expensive interventions they have encountered online.

Good records management will be the #1 improvement, though the internet and online is only a small part of that.

The healthcare industry has been traditionally and dishearteningly slow to invest the capital in technology development. Four percent vs. over 10% in retail environment.

Certainly customer service in health care will change. Costs will not decrease. Malpractice concerns need tort reform not online resources. Perception of access might change; actual access is a political issue.

But those problems will still be there.

Bad data will still yield bad results!

Lawyer-driven, risk-avoidance medicine will continue to prevail.

Disparities in access will probably increase without significant public investment, which is unlikely.

The benefits of any technological advances may be negated by timeless constants. While some surgical techniques may be improved or automated, and less-educated doctors may learn better treatment protocols online, the bulk of the work still comes down to doctors' ability to spend adequate time with patients and use the best medicines, technology and treatment at hand. The rise of malpractice has turned it into a less-lucrative profession, which may limit the numbers of new doctors certified each year.

Consumer preferences for health care will likely cause the share of GDP and the federal budget accounted for by healthcare to increase.

There will be a downside in more litigation, as ordinary people gain access to more knowledge about medical conditions, which makes them educated, but insufficiently expert. "A little knowledge is a dangerous thing."

Strong forces in medical and pharmaceutical and insurance sectors may affect this process more than Internet's capabilities. Complete or at least massive overhaul of health care infrastructure, including and reflecting Internet role, is necessary for this prediction to materialize.

Electronic medical treatment has been around for more than a decade. Without the investment of huge amounts for remote diagnostic equipment and video networks, it's unlikely that there would be much real change in care. More information is and will be available, but actual treatment is declining overall.

The increasing pressure to see more patients etc., will only continue. There is little use for more resources of information if no one has time to refer to them in the course of ordinary care. In addition, the rise in automation and self-serve options (such as we see in self checkout lanes at supermarkets) is training our society not to rely on service from other human beings. My sense is that it is likely that patients will increasingly use the internet to act as their own doctor, coming to their physician with not only complaints but "solutions," the quality of which will be suspect.

If better health information follows to patients, I can see these improvements being made. But will HMOs or other institutions control the information flow?

Healthcare may improve, but moving services online will certainly not reduce health-care costs or poor customer service, mistakes or malpractice claims.

The Internet will hardly be a silver bullet for personal-injury lawyers and the lawsuits - nor will simply overlaying a technology onto a legacy culture of poor service yield a sudden surge in warmth, compassion, and customer service. Technology is not a panacea for a broken culture.

Efficiency is another benefit of the internet, as is sharing of best-practices and record-keeping, comparative analysis, second opinions.

Only with government intervention and encouragement. The profit motive is too seductive for it to happen on its own.

Communication is a tiny proportion of the cost of medical treatment. How can reducing this tiny fraction of the cost (and that's, in essence, what the Internet is about) alter the big picture?

As an HR professional, this will only happen if the insurance companies (and especially BCBS) will invest money in their equipment, their programs, and their people. With dummies at the helm of the claims processing, it won't change, and customer service will be a challenging experience for consumers. Medical research will definitely be enhanced and virtual operations will help in rural areas, provided that they have the equipment to handle the newer technologies.

The Internet will make a large difference in the way that people access medical care. They will be much more likely to look up information on conditions and alternative care techniques. But it is hard to see how this will reduce cost, improve service or lead to significant reduction in malpractice.

I am not confident that the Internet will make a meaningful difference in the overall health care system - the problems there are deep-rooted and structural. However, there will be many individual success stories of the benefits of online health.

While the medical community has successfully resisted a major IT overhaul, I see it as inevitable, given the rising costs and changing demographics in the U.S.

This is possible, but not likely in all areas due to many legal problems, technology access problems, identity and privacy issues, regulations, etc.

While the Internet will continue to be a source of medical information, thus empowering patients more than ever, it can't do much for the U.S. health care system as a whole.

I think the major problems here are social, not technical. We can already do most of the things suggested here with current capabilities, but there is no evidence that the large-scale social changes that would be necessary to enable these improvements are going to be addressed any time soon. The problems seem to be getting worse, not better.

Other health problems may arise from the self-care, self-serve consumerist behaviors. Overall, I agree with the prediction although several sensational horror stories will emerge about poor self-service medical care choices.

Needs fundamentally new processes that harness the internet; internet alone is not enough.

A utopian viewpoint! Building such systems may turn out to be enormously expensive.

Technology itself is never the answer. Technology may enable these changes, if there is a will to do so.

The transition will be a very long and bumpy road. I personally am experiencing one of the bumps. There is no mechanism for removing medical records from potential use when they have been proven wrong. Records that claim I have multiple degenerative and fatal illnesses have been proven wrong through objective testing. Because the false records cannot legally be archived or removed from potential use in some way, they are used to deny me medical insurance and employment opportunities.

I don't think it will help with customer service! And it may only exacerbate the access problems for the poor. But the readily available information should certainly marginally improve care.

There will likely be increasing uses of alternatives although it is not clear how legal these will be. (e.g. buying medications from foreign sources not necessarily approved by the FDA.)

It will be very helpful, but not for the reasons listed above. The main advantage will be for peer-support and information sharing.

I think the problems of rising costs, poor customer service and the high prevalence of medical mistakes have more to do with the consolidation of the medical industry and the role of pharmaceutical companies and health insurance companies. I'm not sure how the internet will address that problem.

Healthcare costs will continue to increase driven by increased populations, increased population densities, a belief that illness (due to stress on the body's total system) can be solved, and that healthcare is like car mechanics (plug and replace). This is an arrogant belief.

This is the area in which I see the greatest potential impact of the Internet.

The increasing use of online resources will actually exacerbate most of these problems in the short term of the next decade, since medicine is still on the steep side of the adoption and learning curve in IT and use of the Internet in particular. The costs of the IT investment required by HIPAA alone will add measurably to health insurance premiums, today and for at least the next five years. Part of the problem is that, even though IT and online improvements in these areas are likely to be beneficial to the very great majority of consumers, the potential cost of nagging problems or spectacular single failures is devastatingly high. For example, if an online pharmaceutical database used by 1 million doctors links even .01% of them to a wrong web page that results in a serious drug interaction, what are the potential damages from those 100 errors? Incalculable. (Although I'm sure the insurance industry has already done the math...) Medicine online is inevitable and likely to have many benefits, but like teaching online, it also has limits and hidden costs.

Services not requiring physical interaction (e.g. lab & radiological analysis and some aspects of primary care and internal medicine) will be removed from medical centers and outsourced to large specialty contractors.

This is contrary to the trend of other predictions which suggest the Internet increases diversity of views and the selectiveness of seeking information. Medical quackery is alive and well on the Internet. The health care system has critical flaws unrelated to the information highway.

Healthcare is the one area where technology increases costs rather than decreases. Until drug companies and the healthcare system change their focus from handling symptoms of disease to curing disease we will not see major change to the problems within our healthcare system.

Most of the problems cannot be solved by the Internet, but by reorganization of institutions and ending of absurd U.S. economic model of health care.

The Web will continue to be a useful tool for information-gathering on health care problems that people then use in consulting with their doctors or seeking medical advice, but the evolution will stop there.

Technology will not fix the broken structure of the medical and insurance establishment.

The pharmaceutical and insurance and healthcare industry will feel so threatened that they will put up even more walls blocking access and use tactics that question electronic veracity. There will not be coordination; there will be no way to make corrections (see TSA's watch list, for instance).

People have the tools to improve their health already. Most chose McDonalds over the treadmill. The Internet will only give them access to data they will ignore.

Medical information will increase, but it will not eliminate human error, underfunding, and inadequate resources.

Technology is not a magic bullet for the problems facing healthcare. In fact, it has actually led to increases in costs and the extension of life beyond that which is truly humane. A true solution to the healthcare crisis is far more messy and more human than anyone is willing to admit. It will require concessions by attorneys, doctors, and pharmaceutical companies - concessions that I doubt will be fully worked out by 2014.

Both the rising healthcare costs and its result, the lack of access to medical care, are the results of health becoming a source of profit for investors who already have money. Nothing inherent in the Web fixes that. Ditto for poor customer service. There is a potential gain in the widening of access to medical specialties for those who have the money - digital records, easy transmittal of test results and MRIs for second opinions or consultations, etc. - but the increasing corporate seizure of what had traditionally been a private, in-person matter between physician and patient also brings with it denial of benefits, and thus of services, that act as a counterweight to those benefits for far too many Americans, and world citizens.

Legal Liability is the inhibitor to freedom of information in healthcare. It always has been. Read "The Great White Lie" by Bogdanich. It is so bad, people are not allowed the information to understand their illnesses much less to manage their health. The dividing line between doctors and patients is also liability. Doctors can't give information because of liability. BIG PHARMA cannot because it is marketing. We need to deliver information and choices inside of the point of care. People need tools to record their data, data visualization so they can understand trends and the implications of their choices. Disease State Management is a bureaucratic joke. If we are ever to empower people in their own care, we must bridge the learning/liability/information/telemetry gap in medicine. We should be empowered with the information to lower our health care costs by complying with care instructions and reducing our risk of health problems. It's simply a question of incentives for CORP, BIG PHARMA, Insurance, DOC, NURSE and PATIENT/consumer.

Dead wrong. The healthcare industry has been remarkably slow in adopting digital technologies already - and benefit from their resistance by making it more difficult for patients to understand and question billing, etc. The industry will continue to drag its feet for fear of giving up its lucrative control. Further, medical care is by its very nature hands-on and there can only be a limited impact by the Internet.


 

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