Cybermedicine, also known as e-health, involves the provision of health care services using the Internet for communication.
The growth of the Internet since the early 1990s, from a small network used in academia and government to a global infrastructure, has radically affected the delivery of health care. The health care industry has begun the complex process of linking previously disparate computer databases and patient-management applications together via the Internet. It is also adopting Internet-ready technologies, such as hand-held computers, Web cameras, decision-support and voice-recognition software, and wireless-transmission technology. The loftiest hope for cybermedicine is that it will create a fertile ground for patient-clinician partnerships as well as allow for more efficient management of health-related information. However, many issues of concern remain before the benefits of cybermedicine can be maximized while closely protecting the privacy and confidentiality rights of patient and clinician.
The strongest advocates of cybermedicine currently are consumers who use the Internet as a health-research tool. As of 2001, nearly one-third of the 250 million annual searches on the Medline Web site managed by the National Library of Medicine were conducted by patients and the general public. Thousands of public- and private- sector health Web sites exist; some target specific diseases such as prostate cancer, while others provide general health information. Some of these sites allow individuals to conduct disease screenings, or lifestyle and
The Internet is also increasingly used for telemedicine, which is cybermedicine involving the provision of care over the Internet. Patients with access to computers and the Internet may consult with their physicians on- line, receiving a diagnosis, treatment plan, and drug prescriptions for relatively simple disorders without face- to-face meetings. Computer-based decision-support software and videoconferencing technology are also used to provide telemedicine to chronically ill patients at home, and to help people with chronic diseases to self-monitor their conditions. People with diabetes, for example, may download data from a blood-glucose meter, record information about their medications, diet, and symptoms, and transmit these data to their health care providers. Teleradiology has been in operation for years but has vastly improved with the ability to transfer large amounts of data quickly. Genetics specialists are using telemedicine for genetic evaluations and services in rural areas. The future of telemedicine is projected to include long- distance robotic surgeries and quick tests of patients' DNA.
Remote surgery is an application of interest. Using a Web camera, a live transmission is sent from the operating room, where the patient is, to the office of a special- ist, in another location. The specialist guides the on-site surgeon through the procedure.
One of the fastest growing applications of cyber- medicine is in health business-support services. For example, WebMD, Medscape, and the American Medical Association's Medem are gradually moving traditional, office-based medical practices to the Web by offering on- line services for physicians, including the electronic transmission and storage of patient information, claims processing, billing procedures, and access to medical databases.
Since e-mail and other tools of cybermedicine are more impersonal than face-to-face communication, critics observe that cybermedicine may challenge the ability of patients and clinicians to make emotional connections, such as to foster trust; physicians may find it too easy to dehumanize patients, thereby lessening patients' involvement in decision making. As regards remote surgery, critics question what happens if the Internet service fails during a crucial transmission. Perhaps the major issue of concern is how to protect patient privacy/confidentiality over the Internet.
Proponents of cybermedicine point out that the ability to improve the flow of information between patients and clinicians gives significant potential to improve patient health. E-mail allows patients and clinicians to transmit detailed medical information and may increase opportunities for clinicians to provide social support to patients. Cybermedicine offers the potential to empower patients because patients may access the same on-line medical information as clinicians, thereby making the clinician-patient relationship potentially more democratic. Patients armed with accurate medical information may not be able to treat themselves, but they will be better informed and better able to assist in treatment decision making.
Another concern about cybermedicine is the difficulty of ensuring that Internet health content is both accurate and unbiased toward any product brands, thus maintaining the integrity of the line between e-health and e-commerce. To address this issue, many health-information Web sites are establishing ethical guidelines addressing issues such as commercial advertising, privacy, and accuracy of information. The American Telemedicine Association and the American Medical Informatics Association have established ethical and clinical guidelines for health care Web sites, health-related e-mail, and home-based telemedicine.
All indications suggest that cybermedicine practices will only increase. Health care practitioners should learn how to take advantage of this technology while recognizing its potential drawbacks, including concerns about individual patients' ability to assess symptoms and relate status effectively and clearly via the Internet. There is research suggesting that patients with chronic diseases such as diabetes or asthma and other chronic obstructive pulmonary disease (COPD) tend to underestimate the severity of their symptoms and to overestimate the degree of control that exists. Patients with breathing difficulties, for instance, cannot be adequately or accurately assessed without physical evaluation of the lungs and trachea and without in-office pulmonary-function tests. People with diabetes may find ways to modify results or underplay symptom reports via e-mail, so medications will not be changed.
Practitioners will also need to stay abreast of legal developments in cybermedicine. One legislative development expected to play a role in cybermedicine is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This act calls for protection of patient
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The American Health Information Management Association. 233 North Michigan Avenue, Suite 2150, Chicago, IL60601. (312) 233-1100. <http://www.ahima.org>.
American Medical Association. The Council on Ethical and Judicial Affairs. 515 North State Street, Chicago, IL60610. (312) 464-4823. <http://www.ama-assn.org/ama/pub/category/2498.html>.
American Medical Informatics Association. 4915 St. Elmo Avenue, Suite 401, Bethesda, MD 20814 (301) 657-1291. <http://www.amia.org>.
American Telemedicine Association. 910 Seventeenth Street NW, Suite 314, Washington, DC 20006. (202) 223-3333. <http://www.atmeda.org>.
ANA, American Nurses Association, 600 Maryland Avenue SW, Suite 100 West, Washington, DC 20024. (800) 274- 4ANA. <http://www.nursingworld.org>.
Center for Bioethics at the University of Pennsylvania, Suite 320, 3401 Market Street, Philadelphia, PA 19104-3308.(215) 898-7136. <http://bioethics.org>.
NSNA, National Student Nurses Association, 555 West 57th Street, New York, NY 10019. (212) 581-2211. <http://www.nsna.org>.
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