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 "Experts 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
to this statement by accepting the invitation to write an explanation
of their position; many did not. Some respondents chose to indentify
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:
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
39% of internet experts agreed
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
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
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
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
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
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
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
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
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
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
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
Such systems will be vulnerable to abuse (hacking, security
and privacy invasions). - Bornali Halder, World Development
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
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
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
Consumer preferences for health care will likely cause the share
of GDP and the federal budget accounted for by healthcare to
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
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,
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,
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
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
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
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
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
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
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.