Revolution Health Group, the year-old company started by America Online co-founder Steve Case, yesterday unveiled a preview of its free health Web site and debuted a concierge-style consumer service.......The institutionalization of intermediation for the supply of health information to patients and the general public is perhaps the fundamental issue of health planning. Since Abraham Flexner almost 100 years ago recognized that the European model of medical education made sense to replace the dysfunctional anarchy in the United States, but was not ideal for China, developing nations have struggled with questions of the relative roles of paramedicals, traditional practitioners, and doctors in diagnosis, prescription, and treatment of patients. The problem has not disappeared in developed nations, although affluence may reduce the urgency of its solution.
RevolutionHealth.com joins a list of contenders seeking to become the leading online provider of health-related information. The nine-year old WebMD is by far the dominant player, with 35 million unique visitors per month and about $170 million in annual revenue......
Other competitors include HealthCentral Network of Arlington, a collection of condition-specific sites that has 7 million unique visitors per month, and Waterfront Media of New York, publisher of EverydayHealth.com, which has 5 million unique visitors per month.
The ICT revolution has provided new opportunities for such intermediation, ranging from the use of mass media for the dissemination of public health messages, to the use of email for communication between doctor and patient, to telemedicine, to direct online websites providing information that allow self-diagnosis by individuals such as those mentioned above.
Clearly as ICT becomes more sophisticated and affordable, and connectivity increases, online services will continue to become more important.
The patient interface should obviously be tailored to the needs of the patient. Thus, it should be in the patient's native language. It should be accessible to patients with disabilities, and the facets of the website dealing with each specific disability especially accessible to those suffering from that disability. Patients come with different levels of education, and different cultural expectations, indeed, different cultural definitions of diseases. The appropriate interface will depend on the health needs of that patient, which depend not only on the age and gender of the person. But the website should also be tailored to the likelihood of various presenting conditions, and thus on the epidemiological situation of the community from which the user comes. Thus, the online websites mentioned above, which all have been designed to serve U.S. clients, are unlikely to serve well users from developing nations.
There are also disease specific websites, for example those of the American Diabetes Association or the National Kidney Foundation. The ADA is a non-profit organization, largely supported by diabetics, while the NKF focuses on the 20 million Americans with chronic Kidney disease. They provide user friendly interface and lots of information, and perhaps are reasonably accessible to English speaking persons from all countries. But both are targeted to the North American community, and both are unlikely to serve well the needs of those in developing nations where diabetes is an increasing problem, and kidney diseases are widespread.
Indeed these websites are funded by the sale of advertising, and their advertisers are not especially interested in having their adds seen by people who can not buy their products -- such as those too poor in their marketing area or those affluent enough but not in their marketing area. In the United States, the National Institutes of Health and National Library of Medicine provide a public service with MedlinePlus, but I am not sure fully complements the online services provided by commercial firms. Of course, my health maintenance organization, one of the largest, also provides services through its online presence for its members. I wonder whether there is a gap? Indeed, I wonder whether the proverbial reluctance of the U.S. government to compete with private industry (especially in the field of medicine) does not compound the problem in the United States.)
Surprisingly neither the World Health Organization nor the Pan American Health Organization seems to have a website comparable to MedlinePlus but targeted to the poor majority in the regions they serve, nor have I been able to find a program in either organization to advise national governments on the development of such websites. While there are commercial consulting firms that offer the service of design of health and medical websites, it seems unlikely that they would have the health planning and intercultural capabilities to design medical websites serving increasingly connected poor populations in poor countries.
I personally would like to see work to extend user friendly health and medical websites to less affluent patients and communities. Access to the Internet is increasingly available even in poor communities, albeit often through computer kiosks or other shared facilities, but I suspect that in many such communities the provision of online health information would be very welcome, and be perceived as worth paying for. Where is the donor supporting the development of a generalizable approach to the development of such content for poor people?
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