The Age of the ePatient: Not Quite There Yet

July 25th, 2011 | Sources: Commentary

The Internet has transformed every aspect of health care. Online communities provide new forms of support for people with a thousand different medical conditions. Email has streamlined communication between stakeholders in the system. Electronic medical records and social networking sites hold a wealth of data that can be leveraged to study the effects of various treatments.

The most significant advance by far though, has been the ease with which people can access information about their health. As many as 74% of all people search for information about their symptoms and treatments online. Many of these information-empowered people now see physicians as guides to and interpreters of this information, a far cry from the era in which passive patients simply recounted their symptoms and relied on paternalistic physicians to act in their best interests.

There are problems with the new paradigm, just as there were with the one it replaced. In particular, online health information can be incomplete, biased, lacking for proper context or flat-out inaccurate…and not everyone can sort through these deficiencies in a way that assures they are properly informed.

A recent study by Alexander van Deursen and Jan van Dijk of the University of Twente has quantified these problems. The scientists used performance tests to assess health-related Internet search and other online skills in a representative sample of the people in the Netherlands.

Their tests focused on four types of skills:
Operational-These included basic internet skills like opening a health website, saving a PDF file and adding a website to a list of “favorites.”
Formal-These included navigating health-related menus and websites, and surfing a list of websites.
Finding Information-These included accessing specific information regarding medical conditions and answering specific questions like whether it is appropriate to begin a treatment after being infected with a particular germ.
Strategic-These included extracting information from different sources and making decisions based on the information. For example, “find out whether it is wise to give a 3-year-old boy Vitamin A and D.”

On average, study subjects successfully completed only 73% of the operational skill tasks and 73% of the formal skill tasks. They completed only 50% of the finding information tasks. An abysmal 35% used their findings strategically.

Only 28% of the subjects successfully completed all operational skills tasks, 39% completed all formal skills tasks, 13% successfully completed all information skills tasks, and 20% completed all the strategic skill tasks. There was substantial variation in the time required to complete any particular task successfully.

According to the scientists, age and educational level were strong predictors of success with operational and formal Internet skills. In the latter case, years of Internet experience was also somewhat predictive. When it came to information finding and strategic internet skills, educational level was the most important predictor of success.

What Should We Make of This?
The study, if it can be generalized, suggests that a surprisingly large fraction of the general population lacks basic Internet skills needed to keep pace with the explosion of online health information and services. Many more, including a surprisingly large number of younger folks, have problems finding information on the Internet and using it appropriately. In the latter group for example, subjects often failed to recognize that key information was missing, that the information they encountered was biased, and that claims made on certain sites were not based on scientific evidence. More pernicious problems included a tendency to focus on finding information quickly rather than information that answers specific questions. Frequently for example, subjects visited only the top-listed links (which are often sponsored) derived from a search.

What Should We Do?
First, we need to recognize there is a problem. I am just as bullish about the potential of the Internet as the next guy, but this potential will only be reached if we implement policies and procedures that improve Internet skills for the general population. Adult education and computer classes should be made available to teach operational and formal Internet skills, especially for older folks. Similar training in information finding and strategic Internet skills are required for people of all ages. It is dangerous and often flat-out wrong to assume that, just because the Internet has become ubiquitous, people know how to use it properly.

As for the age of the empowered e-patient, this study suggests that millions of people, perhaps tens or hundreds of millions, aren’t quite there yet. Even today, medical professionals must act as curators of credible information. They shouldn’t assume their patients can identify and use evidence-based information from the Internet. Minimally, their job is to steer patients away from the sponsored sites and ones touting miracle cures, and towards the ones which are reliable and free from bias.



  1. tmana | 26/07/11

    One of the key skills of junior-high and high school English, Social Studies, and Science classes used to be the ability to evaluate text for reliability and bias, to search for corroborating or refuting evidence, and to present the results of that analysis in a cogent manner.

    I fear that in this era of “teaching to the test”, these lessons may have fallen by the wayside.

  2. Dominic | 17/09/11


    I run health websites and I have searched through competition for research. Unfortunately the Internet for most people is driven by search engine function, which in itself is driven by good SEO.

    For patients targeting a specific topic it is the marketer with the best SEO which gets to the top of Google. Unfortunately these sites can be full of marketing info and non-medical based facts promoting an affiliate product.

    Tmana is very correct in their comments. But for some reason school kids seem to loose that ability to check and to corroborate. Just look at Yahoo Answers for a clear indication of how lost and how reduced in the ability of research a lot of kids are.

    And then you have medical professionals who have so many different ideas on even one particular subject that once a site is found to be “reputable” you have many different opinions on what it could be and how to treat it.

    Also I would be extremely reserved in promoting full web medical analysis because sometimes what the patient thinks they have, they actually do not. And because you can not see it, and can not show all signs and symptoms, diagnosis can be misjudged.

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