e-Healthcare: A new service for older consumers. (Computer Quarterly Update).

The rise and recent precipitous fall of many dot.com consumer-focused businesses, including healthcare-related Web sites, should not be viewed as a long-term setback for Internet use in healthcare. On the contrary, electronic Internet applications are already proving to be extremely valuable for healthcare organizations by improving efficiency in many administrative functions, such as claims submissions, eligibility determinations, provider referrals, purchasing of medical supplies and equipment, and administrative communications. While these uses will continue to grow in the future, the greatest significance and power of the Internet will likely be in enabling patients, providers and payers to communicate to better manage and improve health-related conditions. The challenge ahead is to move from the provision of health information online (available from many Web sites), to using the Internet for improving or maintaining resident health.

Some of the major areas include: health risk assessment and reduction, wellness programs, disease management for chronic conditions, pharmaceutical management and providing information to assist consumers in selecting healthcare services and providers. A resident's independence and aging in place will be enhanced by all these services, in ways which I will explain:

Health risk profiles and wellness interventions based on medical evidence. More than 100 million Americans have chronic health conditions such as obesity, stress, depression, tobacco use, high blood pressure, high cholesterol and too little exercise. In addition, many conditions such as cancer, diabetes, asthma and chronic obstructive pulmonary disease (COPD), arthritis, hypertension, circulatory and cardiac conditions, and neurological conditions increase in prevalence and severity with age and often require increasingly expensive medical management. While it was formerly believed that wellness and health management interventions required at least three to five years to produce results, recent research is suggesting that some types of health improvement and cost reductions can occur in less than one year. Using the Internet to identify, communicate and manage these interventions provides an important tool to reinforce consumer knowledge, compliance and level of effort.

Disease management using the Internet. Disease management programs are usually directed toward specific chronic conditions that can be managed by patient adherence to certain procedures, protocols and/or pharmaceuticals. The Internet can provide important tools to assist health self-management, such as information, compliance reminders, evaluation of results and identification of new conditions. Examples of chronic conditions that are known to respond well to patient self-management include diabetes, asthma, congestive heart failure, COPD, arthritis, back problems and certain behavior problems. Since people with chronic conditions are already very active in using the Internet to obtain healthcare information, it is very likely that this tool will become one of the most effective medical management and treatment technologies for the older population of the future.

Pharmaceutical treatment and self-management. The Internet can be, and is, used by health plans (such as health maintenance organizations) and insurers to monitor pharmacy use by providers, but a much more significant use is to assure patient compliance with pharmaceutical treatment and schedules. It is known that between one-third and one half of patients do not comply with prescribed medication regimens, and that online monitoring and reminder programs can assist patients in meeting medication administration requirements.

Consumer information and health management. Consumers continue to express the desire to obtain understandable information on the quality of health plans and providers but, unfortunately, often do not know how to use information from "report cards," quality rankings or compliance surveys, often because they do not know how to interpret many standard quality indicators or are uncertain about the accuracy of indicators and rankings provided directly by health plans or treating professionals. Few independent ranking services exist, and consumers tend not to be familiar with them. In addition, many quality measurements are based on cross-sectional or annual data that, while important, do not indicate the ongoing quality of care, patient satisfaction or patient health status, all of which are the types of information that many consumers are seeking. These problems notwithstanding, the Internet will continue to provide an increasingly more informed consumer audience with health and healthcare information and provid er evaluation data.

In general, while these approaches are very new and research has not yet been completed to prove their effectiveness, it appears that providing residents with healthcare information and management tools online can produce improved health quality, more active lifestyles and more cost-effective healthcare management. Thus, use of e-healthcare tools should be encouraged in independent and assisted living settings and also adopted, as appropriate, by nursing home providers.

Malcolm H. Morrison, PhD, is president and CEO of Morrison Informatics, Inc., an information technology and data analysis consulting firm specializing in Long-term care and post-acute care.