Where People go to look for Medical Information on the WWW

Everyone is doing it. Patients do it, physicians do it, and family members do it.



For the current generation (Millenials, Gen-X) the use of the internet and familiarity with search is a sine-qua-non. They have used it in school, most likely beginning in elementary school. It has become an educational staple, much like learning your ABC and/or multiplication tables.

One of the key ingredients is to  know where to search for what. A simple Google search will result in thousands of results, which is not much help in the long run. Google's search engine optimization is not built for research. It is a marketing tool based on several algorithms to  analyze who watches what, and if they return.

The PEW Internet Project evaluated internet usage in depth, by illnesss, chronic disability, age, other demographics

Health Fact Sheet

Highlights of the Pew Internet Project’s research related to health and health care.

A key ingredient is the ease of access to this information:

90% of U.S. adults own a cell phone; 58% of U.S. adults own a smartphone (January 2014 survey). For more, see: Mobile Technology Fact Sheet

87% of U.S. adults use the internet (January 2014 survey). For more, see: Internet User Demographics

Online health information:

72% of internet users say they looked online for health information within the past year.

• This is based on a September 2012 survey, the first time we asked people to think only about their online health activities in the past 12 months. For historical perspective, see: Health Topics and Who Doesn’t Gather Health Information Online?

77% of online health seekers say they began their last session at a search engine such as Google, Bing, or Yahoo. Another 13% say they began at a site that specializes in health information, like WebMD. Just 2% say they started their research at a more general site like Wikipedia and an additional 1% say they started at a social network site like Facebook.

The most commonly-researched topics are specific diseases or conditions; treatments or procedures; and doctors or other health professionals.

Half of online health information research is on behalf of someone else – information access by proxy.

26% of online health seekers say they have been asked to pay for access to something they wanted to see online (just 2% say they did so).

Clinicians remain a central resource:

When asked to think about the last time they had a serious health issue and to whom they turned for help, either online or offline:

• 70% of U.S. adults got information, care, or support from a doctor or other health care professional.
• 60% of adults got information or support from friends and family.
• 24% of adults got information or support from others who have the same health condition.

People turn to different sources for different kinds of information:

When people have technical questions related to a health issue, professionals hold sway. When a situation involves more personal issues of how to cope with a health issue or get quick relief, then non-professionals are preferred:

Technology Revolution

Three major technology revolutions have occurred during the period the Pew Research Center has been studying digital technology – and yet more are on the horizon.

Broadband

First, the rise of the internet changed the way that people got information and shared it with each other, affecting everything from users’ basic social relationships to the way that they work, learn, and take care of themselves. The speed of internet connectivity picked up considerably with the rise of broadband connections. As people adopted those higher-speed, always-on connections, they became different internet users: They spent more time online, performed more activities, watched more video, and themselves become content creators.

Second, mobile connectivity through cell phones, 

and, smartphones and tablet computers, made any time-anywhere access to information a reality for the vast majority of Americans. Mobile devices have changed the way people think about how and when they can communicate and gather information by making just-in-time and real-time encounters possible. They have also affected the way people allocate their time and attention.

                                                               Social

Third, the rise of social media and social networking has affected the way that people think about their friends, acquaintances, and even strangers. People have always have social networks of family and friends that helped them. The new reality is that as people create social networks in technology spaces, those networks are often bigger and more diverse than in the past. Social media allow people to plug into those networks more readily and more broadly – making them persistent and pervasive in ways that were unimaginable in the past. One of the major impacts was that the traditional boundaries between private and public, between home and work, between being a consumer of information and producer of it were blurred.

Health Care Social Media is a in social media. The use of hashtags allows anyone to search on twitter for specific diseases, treatments, and more including twitter postings from scientific meetings, ie #AMA2015, or #AAFP2015. This allows any twitter user to receive tweets from the specific meeting, filtered out from the twitter stream.

This last category  has potential to be the most important. Facebook pages, Google plus pages offer a visible and easily accessed methodology to 'llke" "follow" or + topics of interest. Many of these sites come directly from a hospital and/or clinic. 

Static web pages are fixed in content. A web page coupled with an active daily or weekly social media posting using hashtags as a search modality gives both user and patient an active inter-action.

These formidable changes have not been limited to healthcare. Health professionals were lagging in interest possibly due to the issues of privacy and confidentiality.  HIPAA clearly defines the limits of information in regard to personal identification placed in a public space, accessible to anyone. 

Access to these high speed resoures remains limited however in many rural and some suburban areas due to the unavailability of modern broadband resources. The development of high speed 4G, and LTE cellular networks is also lacking in some areas. Profitability and a business model for those regions remains a paramount barrier.

Who is not using modern technology to access health information?

mHealth----More Necessary Regulations

Much of the big news in health IT this year came out of the Office of the National Coordinator for Health IT. ONC -- along with CMS -- is in charge of overseeing the widespread adoption of EHRs through the meaningful use program. After years in the works, the first phase of that program is wrapping up right now.

The past several years were almost frantic for HIT and ONC, with meaningful use standards, interoperability standards, incentive funding and a succession of creative and dynamic national coordinators, each with their own focus on what needed to be accomplished.

Unlike other Executive departments, Medicine has been fortunate to have a clear path, relatively clear goals, and minimal political divisiveness......all to the benefit of our patients.

mHealth has had an explosive growth in mobile applications for iOS and Android.  The hardware form factors are multiple with stiff competition and new hardware offerings almost monthly.

Growth and competition are plentiful and numerous manufacturers (Nokia, Windows, Google, Motorola,iPhone) in smartphone or pc tablet form.  In many cases EHR vendors have rapidly developed a mobile app portal.  The acceptance rate has been high for those who are tech savy.  Despite the potential vulnerability to a security breech and all that HIPAA stands by on the sidelines ready to pounce with a hefty penalty. The plain truth is that these applications and hardware offer so much to efficiency a way needs to be found quickly to certify HIPAA compliance for each application and device.

Not withstanding this urgent need there have been several attempts to regulate this market. FDA, FTC, FCC,  and HHS have all been mentioned. Suffice it to say that regulatory agencies are pressed to stay current with new hardware and devices.

Why, How and Which  Mobile Health applications need regulation?

In an article (blog post) in June 20012 I discussed  Five Reasons Why Digital Health Technologies Need FDA Oversight   Now the FDA is in the process of forming a mobile health division to study, certify and authenticate applications.  A new workgroup in HHS has been formed,

According to mobiHealthNews;

"The workgroup’s efforts will likely end up affecting the regulation of mobile health and health IT. According to HHS, FDASIA requires Sibelius, with the ONC and the FCC, to “develop a report that contains a proposed strategy and recommendations on an appropriate, risk-based regulatory framework for health IT, including medical mobile applications, that promotes innovation, protects patient safety, and avoids regulatory duplication.”  The new workgroup’s input will feed into that report.

According to Brian Ahier,

"As a general matter FDA regulates all medical devices and FCC regulates devices that utilize electromagnetic spectrum - i.e. broadcast devices. So with regard to mobile health devices - sensors, applications, systems - FDA regulates any given device as a medical device while FCC regulates the device as a communications device. 

Recognizing the potentially overlapping jurisdiction in digital health, in 2010 the agencies entered into a Memorandum of Understanding "to promote collaboration and ultimately to improve the efficiency of the regulatory processes applicable to broadband and wireless enabled medical devices."

Last month FCC announced its mobile body area network (MBAN) proposal, which would allocate electromagnetic spectrum for personal medical devices (see link below). The allocated spectrum would be used to form a personal wireless network, within which data from numerous body sensors could be aggregated and transmitted in real time."

Representative Marsha Blackburn (R-TN) and others introduced The Software Act.which will act to build a cohesive multi-agency over view of mHealth.