You'd have to have been practicing medicine on the moon during the past several years not to notice the impact the Internet is having on patients. World Wide Web sites, such as drkoop.com, now provide the public with a wealth — some might say a deluge — of content and advice regarding health, disease and treatment. Our patients routinely bring this information to the examination room and ask us, their family doctors, to evaluate and comment on it. We also have been affected by the Internet's ability to provide easy, inexpensive access to valuable medical information, such as MEDLINE's literature searches, full-text journal articles and evidence-based guidelines.

But the eHealth revolution is about much more than online consumerism and information searching and retrieval. The most important aspect of eHealth for family physicians is its potential impact on the cost and ease of use of distributed software applications.

A better, cheaper model

Throughout the health care industry, software applications are being used to manage information flow within and between doctors' offices, insurance companies, hospitals, employers and the federal government. Software applications create, store and submit insurance claims; produce accounting reports; handle office scheduling and track patient referrals.

This functionality has come at a steep price. Both the software and the hardware to run these applications must be located at each user's site. Upgrading is routine and expensive, as preparations for Y2K clearly demonstrated. Communication between computers at different locations requires that all “client” sites interacting with one another operate with the exact same software programs, and exchanging data requires dedicated telephone lines. The result: high costs for software licenses, computers, network components, maintenance contracts and telephone lines.

All of this is about to change. The combination of several Internet and telecommunications technologies has created a new model for distribution of software, one that drastically lowers the cost for sharing data and information over widely distributed networks. Often referred to as “thin-client” technology, this easy-to-use and cost-effective model allows you to connect your desktop to software applications located anywhere in the world, in effect using the Internet as a “data utility” not unlike electricity. No software other than an operating system and Internet browser need reside on your desktop computer. You need not exchange CDs or floppy disks to load or update new software. You don't need hard drives for storage. Instead, a behind-the-scenes data center provides functionality, allowing you and your staff to focus on doing your jobs (which is a good thing, considering that software is supposed to be a helpful tool).

Suddenly, in the period of a few short years, the hoped-for-but-rarely-realized productivity gains from information technology appear to have had new life breathed into them, especially in health care.

The eHealth invasion

Here are a just a few emerging eHealth trends that are a direct result of this new model for computing.

Web-based practice management software. Imagine your office staff doing all your practice's billing, claims processing, eligibility verification and referral management via the Internet. Instead of paying thousands of dollars for software licenses for on-site software and the expensive hardware to run it, you can purchase Web-based applications on a monthly subscription or transaction-volume basis. You'll still need computers in the office, but very simple machines capable of running Netscape Navigator or Microsoft Internet Explorer will suffice. These changes could save the average computerized practice tens of thousands of dollars each year!

Combined practice management and electronic medical record applications. It has never made sense to separate the practice of medicine into two distinct software programs: one to perform business functions and the other to manage clinical information. Web-based application service providers known as ASPs (there's a new acronym born every day) will offer physician practices not only integrated business and clinical functionality via the Internet, but also scheduling programs, links into hospital databases and many other applications. All will be accessible on the desktop or, as it's coming to be called, the “Webtop.”

A patient's view of the medical record. Just as banks and insurance companies now permit customers to view their account information online, we'll begin to see health care organizations offer their customers online summaries of selected information. Patients will demand it, and new government regulations on privacy (the Health Insurance Portability and Accountability Act of 1996, or HIPAA) would give patients the right to examine their medical records and request corrections. Just as banks give customers the ability to view their balances or transfers via an encrypted Internet connection, Internet technologies make it possible for patient information to be shared securely.

Online interactive and convenience-driven patient services. Using secure Web sites, patients will be able to schedule their own appointments, input clinical and physiological data into their medical records and provide feedback on service quality to their doctors' offices.

Finally, security and confidentiality will become even more significant as eHealth proliferates. As thousands of new data stores containing patient-identifiable health records are created by online pharmacies, doctors' offices, hospitals and software vendors, the opportunities for unethical use of the information will grow exponentially. The government will require that strict, enforceable policies and procedures be in place in even the smallest health care organizations, including the solo physician's office. The amazingly broad reach of the HIPAA security requirements are a hint of regulations to come.

The real benefit

So, when you hear the term eHealth in the future, think beyond con-sumerism and e-commerce. The good news about eHealth is that the future offers a real opportunity for family physicians to increase productivity, lower information management costs, and, thus, decrease overhead. This ought to be welcome news to family physicians facing gradually shrinking reimbursements and practice revenues. If it simplifies data transmission between all parties, eHealth can make our patients' lives less complicated and help us re-establish trust in the doctor-patient relationship.