MULTIMEDIA PATIENT EDUCATION IN THE OFFICE: Going Where Few Patients Have Gone Before

A revolution has occurred in patients' access and use of the health care system. The managed care environment dominant in the United States during the past decade has resulted in new rules for how and when patients can access their health care providers. Patients and their physicians have become well versed in the complexities of accessing medical care that have been constructed in the name of medical economics. Aside from an often-reduced time to interact with patients, the physician office visit of today is, in many ways, indistinguishable from that of a decade ago, or even three decades ago. A medical history is taken, an exam is performed, an assessment is rendered, and a plan is implemented. Are patients happy? The reality and popularity of virtual medicine suggests otherwise. 12 Along with the revolution in management induced by managed health care, patients, visionary institutions, and businesses are driving a similar revolution in patient education and access to health care information. The societal and economic forces that are inducing changes in the physician-patient relationship demand a heightened awareness of healthcare options by medical providers and their patients. Increasingly, patients are aware of those options. In 1997, a survey revealed that 43% of the 40 million people who had accessed the Internet in the previous 12 months had used it to search for health-related information. 4 By 1999, this figure had grown to 60 million people accessing such information, according to a Harris poll. More than 25,000 health-related sites are maintained on the World Wide Web, originating from an amazing variety of individuals and organizations and representing a wide array of quality and approaches. 15 Sites have more than doubled in 2 years and continue to grow. An entire issue of the Journal of the American Medical Association was devoted not long ago to some of the issues that physicians and other health care providers must consider before their entry into the "virtual" health care world. 7 Among the concerns that were raised were issues of increased professional workload, payment for Internet consultative services, patient privacy, and ethical and appropropriate ways to use e-mail, Web sites, and telemedicine. No doubt, additional issues on the use of newer online technologies will continue to emerge. In fact, the drive towards patient self-education and control of their health is mirrored in society and business. Monumental changes in health care delivery are still underway. Large health care institutions, managed care and academic medical organizations, professional medical societies, governmental facilities, entrepreneurial businesses, and individuals with various motivations are all vying to be the definitive source of health care information for consumers on specific topics. Consider just two such examples, and amplify this effort by hundreds of other institutions and businesses investing millions of dollars in resources. The satellite subscription Health Channel was launched in 1999 by Baylor College of Medicine and Texas Children's Hospital in collaboration with General Electric Medical Systems (www.Healthchannelweb.com). The 24 hour-a-day programming offers discussions with medical professionals, films of live surgical procedures, news shows, and consumer health information. It also provides interactive opportunities with viewers during live shows. This is not be confused with a San Francisco Internet company called Health Channel, which claims it will provide the most complete source of continuing medical education (CME) on the Internet, and which also offers wide-ranging consumer medical information. 14 The effective design and implementation of such health care sites is an important subset of medical informatics, 8 and it holds the promise of positively influencing health care outcomes.