Physician Internet Medical Information Seeking and Online Continuing Education Use Patterns. Casebeer L, Bennett N, Kristofco R, et al. J Contin Educ Health Prof. 2002;22:33-43.

Nearly all physicians report access to the Internet through home or at work for personal or professional goals. It has been unclear, however, what online sources physicians find helpful for their professional development. Recently, the number of online continuing education (CE) providers has increased. This study was designed to examine the behaviors of physicians regarding their search for medical information and the relevance to continuing education providers who develop the online activities. A survey instrument of multiple-choice questions was faxed to nearly 324,000 US physicians of all specialties. A total of 2,200 survey questionnaires were returned and utilized. Demographic information such as gender, specialty, location of practice, years since graduation, and years having used the Internet were obtained. The survey included questions related to variables that physicians deemed important when seeking medical information, how frequently they accessed online CE, how frequently they utilized the Internet and whether it was for personal or professional use, and what motivated them to seek medical information on the Internet. It was determined that there are differences in Internet use by gender, location of practice, and specialty, but not with age or Internet experience since graduation. Most physicians use the Internet to supplement their traditional learning activities of reading journals and attendance at local meetings. The majority of physicians indicated that they search the Internet for specific patient management problems. The problems of using the Internet for seeking medical information include the extensive, yet nonspecific, amount of information for the topic at hand and little time to browse. Physicians indicated that online CE must be immediate, relevant, credible, and easy to use. The results of this study suggest that online CE providers reconstruct their roles by helping physicians locate, rather than develop, materials by providing links to association updates, breaking news, and specific-patient management. This new idea, however, poses difficulty for assigning CE credit. Although the Internet is an excellent way to deliver educational information, it creates a challenge for CE providers to provide credible, relevant, and accessible content.

OneTouch Technologies is unveiling the OneTouch System, an electronic data-recording system for inputting resident information at bedside, improving resident care and operational efficiency. At press time OneTouch Technologies was planning to conduct pilot tests with several major long-term care chains.

The OneTouch System includes a computer microchip (iButton) embedded on both a resident’s identification wristband and on the caregiver’s name badge. In addition, the caregiver uses a customized Personal Digital Assistant (PDA) and wand to read the iButtons and record the pertinent resident information.

On the PDA, the OneTouch System provides a preformatted clinical checklist/menu of observations to be made and procedures to be performed and recorded. This enables the caregiver to simply touch an icon on the screen to record preconfigured information without computer keystrokes and in minimal time.

As a rheumatologist, I see some patients as frequently as once a week at the Arthritis Institute of Long Island[R]. A single patient encounter, consisting of office notes, X-ray reports, lab results, flow sheets and correspondence, can generate 10 to 15 pieces of paper. One patient can easily have 500 pieces of paper added to her medical chart every year.

On average, the practice generated 1,000 and 2,000 pieces of paper per week, and I spent two to three hours a day dictating notes for transcription. I am a solo practitioner, yet I had 21 full-time and part-time employees because of the nature of my practice.

EMR With Document Imaging

In April 2003, I purchased Charting Plus, an electronic medical record (EMR) computer system by MediNotes Corp., to minimize dictation time and decrease my dependence on transcription. The EMR had integration capabilities with a medical records document management system, IMPACT.MD, developed by Advanced Imaging Concepts. Part of the reason I purchased the EMR was the price value, along with the ability to purchase IMPACT.MD as part of the system. We installed the EMR in May 2003.

We use other software products, too. PhonePad is used for intraoffice electronic phone messaging, and SnagIt captures the telephone printout from PhonePad in a TIF format, which gets directly imported into the system and becomes part of the patient’s record. ZetaFax provides computer faxing capabilities and integrates with Charting Plus and IMPACT.MD, allowing us to fax directly from either program. I can speak with another a physician about a patient’s lab tests and fax him the lab tests from my computer while we talk.

We no longer mail laboratory test results or office visit notes to physicians, but fax them directly from IMPACT.MD, which saves us considerably on postage. A copy of the fax is automatically saved into the patient’s medical record for documentation purposes. Incoming faxes are electronically received by ZetaFax, imported into the document management program, then electronically filed into the patient’s chart.

IN A SMALL town, they say, everyone knows your business. A county judge in Iowa is pushing that tendency to an extreme by requisitioning medical information from a local women’s health clinic.

The trouble in Storm Lake, a town of about 10,000 in Buena Vista County, started in late May when an abandoned newborn, possibly born prematurely, was left for dead in a local recycling center. With the police department at a loss for leads, County Attorney Phil Havens sought access to the names and address of every woman who took a pregnancy test at the town’s Planned Parenthood clinic during a nine-month period. Once authorities had the names, they would check that each woman gave birth to a living infant; when this wasn’t possible, they’d question the mothers.

After some legal back and forth between Planned Parenthood and the courts, Judge Frank Nelson ordered the clinic to hand over the information by August 17 or risk being charged with contempt. Jill June, the president of Planned Parenthood of Greater Iowa, refuses to compromise her patients’ privacy. “What they’ve asked us to do is wrong;’ she says. “It violates the laws of Iowa, it violates the confidentiality and trust these women place in us. As much as we’d like to help with the investigation, we simply cannot cooperate.”

Havens, the county attorney, who did not return calls for comment, argues that pregnancy test information is not protected by doctor-patient privilege laws because the test could be performed and interpreted by non-medical personnel. But Judge Nelson took a slightly different tack, according to Randall Wilson, legal director of the local American Civil Liberties Union. In response to Planned Parenthood’s assertion of doctor-patient privilege, “he cited a case suggesting that privilege only applies when you’re in court.”

Wilson is concerned about the precedent that would be set if the judge’s order stands. “It would say that anytime officials want to go on a fishing expedition in medical records, on a hunch or just because under the law of percentages it might sometimes result in finding evidence, they can;’ he says. “It would basically wipe out any expectation of privacy in medical records.”

June doesn’t plan to allow that to happen. “It is our intention to pursue every legal avenue available to us, no matter how long it takes or what it costs,” she says.

Patients can review some of the best overall medical reporting from the XV International Conference on AIDS (Bangkok, Thailand, July 11-16, 2004) This material is written primarily for medical professionals but it is freely available to anyone. Patients can skip around to find the information they need.

Scroll down and click “LAUNCH,” for either “Part 1: Antiretroviral Therapy: Current Regimens, Novel Strategies, Resistance, and New Agents,” or for “Part II: Pharmacology, Metabolic Complications, Hepatitis Coinfection, and Opportunistic Diseases.” Then click “Begin Module” (which should appear in a new window). You will need to click again on the image on the right-hand side of the window. Then slides should start to display, with an audio explanation for most of them. Note that you do not need to watch the whole program, but can start anywhere by selecting the slide you want by name, in the margin on the left.

A good dial-up Internet connection works quite well for these slide and audio presentations, although a high-speed connection may avoid some delays. You do not need to have PowerPoint software to use these modules and see the slides displayed. (They use Macromedia Flash, and work on almost all common browsers without the need to download any additional software.) The site also allows instructors to download PowerPoint slides to customize and use in their own lectures, and of course PowerPoint software is required for doing this.

As the Internet changes the face of business at an exceedingly rapid pace, the rising popularity of online shopping, Internet conferencing and business communications, news services, and financial management is putting more information and services at the fingertips of businesses and consumers than ever before. The healthcare community is gradually increasing its own reliance on the World Wide Web as well. Quest Diagnostics (Teterboro, NJ) recently announced a partnership with Caresoft Inc. (Sunnyvale, CA) that will make some test results available online to both physicians and patients. In addition to test results, the service will provide background information about the test to the patient as well as explain how it might be used by a care provider to make health management decisions.

“Consumers are increasingly managing their own health just as they have been doing with personal finances,” says Gary Samuels, a spokesperson for Quest. “We firmly believe that this trend will only grow stronger because consumers’ interest in easy access to health information continues to grow. Wherever possible, we’d like to provide or facilitate that access. The relationship with Caresoft enables us to provide not only access to test results but also information that gives a broader context for understanding what those results might mean to the patient.”

Patients will be able to access their results and other information at www.thedailyapple.com Caresoft’s consumer health information Web site. Although the results-reporting service is not yet available, the Lab Center–the site location where results may be accessed after security protocols have been satisfied–is expected to be launched in March of 2000.

Samuels adds that patients will not be allowed access to test information until it has been made available to their primary care provider and that some results, such as those for pregnancy and HIV tests, will not be made available online. “The doctor should be the primary source of that kind of information,” he says, “especially when there are complicated and sensitive issues involved.”

So-net M3, a Sony Communication Network affiliate, has announced the results of a survey on the provision of medical information that was conducted via the Internet from September 27 to October 3. The survey asked questions to 113,000 doctors who are members of m3.com, So-net M3’s portal site for medical professionals. There were 5,575 valid responses.Of the respondents, 96.1% recognized that the Internet will play a more important role in providing medical information while only 3.7% considered that its importance will stay the same. When asked about the benefits of obtaining information online, 93.4% cited that they can access useful information whenever they want to. Also, 53.5% said that information will be of help in deciding on therapies and drug prescriptions.

Further, when asked about the benefits brought by the company’s information service MR-Kun, 64.9% mentioned that it is convenient since they can constantly get the latest medical information. However, 55.1% would like to obtain information from a wide range of companies.

Doctors rarely make house calls these days, but in today’s dot-com world, they do make virtual visits. Nearly 100,000 health-related Web sites offer treatments for all maladies imaginable, though the U.S. Federal Trade Commission found that at least 1,200 of the sites promote dubious remedies. So whom can you trust?

The answer may be The Merck Manual of Medical Information Home Edition, a medical reference guide now available as a free public service online. The manual, at www.merckhomeedition.com, contains the same medical information found in its hardback cousin, the Merck Manual of Diagnosis and Therapy, which doctors have relied on for more than a century. All the information is physician-reviewed and is written in plain language.

Also in the works for the online manual are a pronunciation guide, as well as downloadable videos of medical procedures.

An important initiative at the U.S. Navy Medical Information Management Center (NMIMC) in Bethesda, MD, has been to empower its healthcare community by pioneering the virtual organization. This entails securely sharing a substantial amount of medical information, such as medical benefits, newsletters and e-mails, with more than 100,000 users worldwide, across every, conceivable technological environment.

Due to the size, cost and complexity involved in this project, NMIMC had to look beyond traditional VPN and secure extranet solutions. “Security was an absolute priority and every solution we looked at was reliable in this aspect,” says Lt. Rick Nickerson, head of security at NMIMC. “The real difficulty was to find a secure remote-access solution that could effectively work for this many remote users with unpredictable PC configurations. These users are generally not very technical and have minimal or no technical support.”

NMIMC manages a large volume of medical information–used to plan, coordinate and provide cost-effective information management throughout the world for Navy personnel and their families. Information is accessed through a variety of means, including e-mail, files, Web applications, terminal applications and traditional client-server applications. Recent efforts have been made to centralize, standardize and simplify access to more of this data using standalone or centralized Web servers.

The federal bank, thrift institution, and credit union regulatory agencies issued on June 6, 2005, interim final rules under the Fair Credit Reporting Act (FCRA) that create exceptions to the statutory prohibition against obtaining or using medical information in connection with credit eligibility determinations. The interim final rules also address the sharing of medically related information among affiliates.

The effective date for these rules is nine months after the date of publication in the Federal Register, which was on June 10, 2005.

Section 411 of the Fair and Accurate Credit Transactions Act of 2003 (FACT Act) amended the FCRA to provide that a creditor may not obtain or use medical information in connection with any determination of a consumer’s eligibility, or continued eligibility, for credit except as permitted by regulations or the FACT Act. However, the FACT Act also requires the agencies to prescribe regulations that permit creditors to obtain and use medical information for credit eligibility purposes when necessary and appropriate to protect legitimate operational, transactional, risk, consumer, and other needs. A proposed rule was published for comment on April 28, 2004.

The interim final rules create exceptions to the general statutory prohibition on obtaining and using medical information. The provisions are similar to those contained in the proposed rule and include exceptions for the use of medical information that is also financial information typically considered in credit underwriting. As authorized by the FACT Act, the agencies have expanded the scope of the rules so that the exceptions will apply to all creditors, not just to creditors ordinarily regulated by one of the agencies.