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The Rise Of
Consumerism -- Impact of the Internet
Information technologies
have fueled another societal trend that will continue to have
an impact on the health care workforce. The flag bearer of
this trend is the Internet, which brings information access
and interpersonal communication on an unprecedented scale
to hundreds of millions of persons worldwide.
According to the
U.S. Department of Commerce, as of September 2001, 143 million
Americans, or about 54 percent of the population, were using
the Internet, and new users were adopting the technology at
a rate of more than two million per month.
The continued insinuation
of computer and network use into the fabric of society is
assured by observations that 90 percent of US children between
the ages of five and seventeen now use computers at home and
at school.
A 1997 survey of
Internet users found that 65 percent had sought health information
at least once, and more than a third used the Internet to
find health information regularly.
The sight of a
patient sitting in the waiting room reading printouts from
health-related Web sites in preparation for presenting them
to the doctor has become common in health care settings, a
practice that some practitioners encourage and others dread.
The rise of consumerism
in health care moves toward positioning the patient as the
final authority for choosing among diagnostic and treatment
alternatives and the health professional, to a role akin to
"tech support" for purposes of explanation of alternatives
and interpretation of medical terms and concepts.
Effects On The
Health Care Workforce
For the foreseeable
future, the "graying of America" that will usher
the postwar baby boomers into their retirement years will
increase the need for health services, both traditional and
novel. This demand should fuel growth of all health professions,
including physicians, nurses, and allied health professions.
The forces of ubiquitous
communication and computing technologies and access to information
do not appear at this point to be sufficient to cause the
extinction of any current type of health professional.
Among health professionals
there will certainly be winners and losers, however, and the
emergence of new categories of jobs. As health practitioners
serve as advisers and teachers, their communication and teaching
skills will be highly valued by empowered and knowledgeable
consumers; failure to communicate effectively will be likely
to place a health care provider at an economic disadvantage.
New Occupations
Obtaining and synthesizing
information from electronic sources are time-consuming tasks,
which explains in part why physicians and other health professionals
underuse the information sources now available to them. More
than thirty years ago a modification of the traditional role
of the reference librarian, called the "clinical librarian,"
brought an information access specialist into the hospital
wards as part of the medical care team, to identify questions
related to the care of individual patients for which additional
information was needed and to find that information from printed
or online sources.
Personal health
advocates and advisers
While physicians
and other health professionals may not wish to avail themselves
of expert help in finding relevant information, it can be
predicted that some of the lay public will. Personal health
advocate and personal health adviser services targeted at
providing tailored education for an individual's unique combination
of health problems and concerns are an obvious commercial
opportunity for an educated populace connected by a global
Internet.
These intermediaries,
who would not themselves provide health care services but
would help others to understand their medical conditions and
also negotiate the complexities of selecting and using appropriate
health care services, could eventually have their own basis
for credentialing and licensure if viewed by state medical
boards as a form of medical practice.
Continuing Education
The thorniest problem
arising from the explosion of medical knowledge and its implications
for medical decision making is the retraining of the existing
health care workforce. In most practice settings, licensed
health professionals can simply avoid information technologies
if they so choose.
Physicians, nurses,
and other professionals who do not use online sources to get
up-to-date information are practicing within a professional
standard of care that will need to change as the complexity
of clinical decision making escalates. In the coming era of
"personal genomics," where one's own DNA sequence
is used to select the correct drug from among hundreds of
alternatives, computers will be essential intellectual amplifiers
for health professionals.
The systematic
correlation of treatments delivered with health outcomes,
an utterly obvious step for continuous quality improvement
that is largely missing from today's health care environment,
other than in research studies, requires the use of standardized
electronic medical records. And effective electronic medical
records require the direct participation of health care providers
in their creation, maintenance, and interpretation.
The health professional
who refuses to use a computer is a justifiably endangered
species in this emerging environment, but new methods are
needed to add competency in information management and technology
use for mid-career professionals.
This goes beyond
simple computer literacy and includes knowledge of the principles
of information retrieval, clinical epidemiology, biostatistics,
and how to critically appraise the published literature. Since
the best teachers are role models, an opportunity will exist
for a new specialty within the health care workforce of technology
and information science educators, who are themselves health
professionals with extensive expertise and experience in the
application of these knowledge management tools to health
services delivery.
Existing short
courses and degree programs for already licensed health professionals
are harbingers of a more systematic approach to the retraining
of mid-career professionals.
The growth of biomedical
knowledge and the ubiquitous availability of computer-based
information access and knowledge management tools will expand
the types of jobs in the health care workforce and provide
new business opportunities for support industries.
No current category
of health professional appears to face extinction, but pressure
will mount to abandon the current model of autonomous practitioners
depending upon their personal memory and experience to deliver
optimal care.
Empowered consumers
and a glut of health information available via the Internet
will lead to continued growth of nontraditional and alternative
health products and services and to a remodeling of the relationship
between providers and patients.
| In
health care as much as or more than in other human endeavors,
knowledge is power, and the redistribution of access to
knowledge will mean an inevitable redistribution of power
over the decisions that affect the delivery of health
care and the makeup of the health care workforce. |
Health
Affairs September / October 2002
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