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 however, 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, and 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 presented symptoms and relied on paternalistic physicians to act in their best interests.

But there are problems with the new paradigm, just as there were with the one it replaced. Online health information can be incomplete, biased, lacking for proper context or flat-out inaccurate. And not everyone, especially those without a medical background, 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.

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Health Consumers Trust Traditional News over Social Media. A new poll shows that most people trust health and medical research information provided by traditional news sources more than that provided by social media and mobile devices.

Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.

The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.” 

One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.

Life of our patients is at stake—I am desperately asking you to contact

Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you
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Oh this is not good. Man mission critical systems should never be run in the cloud. Just because AWS is HIPPA certified doesn’t mean it won’t go down for 48+ hours in a row.

(+30 minutes since comment thread began) Well, it is supposed to be reliable…
Anyway, I am begging anyone from Amazon team to contact us directly. Thank you
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Go to your backups? Or make a big deal out of it on the forums maybe someone will take a look. In any case anecdotal empirical evidence has shown don’t bother with premium support its a freaking joke.
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Thanks for the comments, but we are really desparate. Amazon team – please contact us
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(+10 hours since comment thread began) Not restored. Not heard from Amazon. People out there – please take a look at our volumes! This not just some social network website issue, but a serious threat to peoples lives!
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Your only option at this point is Premium support. However, they’re just going to tell you to wait. Sorry.
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(+ 13 hours) There is some progress. 2 servers are operational and one still not working. Unfortunately, the one on which we have the most patients
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Aren’t you braking some compliance laws by not having a highly-available environment?
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You put a life critical system on virtual hosted servers? What the hell is wrong with you
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Not sure whether you’re plain incompetent or irresponsible. Anyway, you should be ashamed and prepare yourself with lots of money to pay for the lawyers. Would it be so difficult to have a contingency plan? another provider? or even another availability zone? Are you so fsklong dumb as to think that nothing could ever happen to a data center.
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(+ 15 hours) This is a home based system, not an intra hospital system. So the promised 99.95% uptime is fine. But this situation showed that the promised 99.95% = fiction… BTW. All three servers are working – hopefuly the situation will remain stable
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While I’m not going to suggest Amazon shouldn’t be ashamed of themselves.. I have to admit this is a pretty sickening tale. If I were running a system that could potentially lead to loss of human life. You’d better believe hot-spare data center would be in my mind.
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Your CTO will be a serious liability, and your board is going to crush your C*O staff very soon, if they’re awake. If you haven’t notified doctors and patients already, your liabilities just got worse. If you can’t roll over your IP routing, then you should not be in business. This should be going to a different server and duplicated by your own policies to ensure compliance with ALL regulatory requirements. You’re failing and you probably don’t even know how bad your company is failing. If I were you, I’d beg John Halamka to guide you out of this mess.
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“This not just some social network website issue, but a serious threat to peoples lives!” Which begs the question, why did you leave yourself — and your patients — open to this risk in the first place? I hope for your patients’ sake that you begin taking more seriously your IT planning. Since you apparently don’t have a fail-over — and are waiting for Amazon anyway — you might want to think about solving the weakness you built into your own system, i.e., start working on an alternative method of getting what you need. And if you can’t find a way to do that even now, I submit that you should never have launched your service at all.
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Not even your servers are redundant? One of your servers is offline, and there’s not a hot swapable replacement? for a life-critical system? Man, pray God nothing happens, because on contrary, the responsibles for this design are surely going to serve sometime on a nearby prison.
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If you were smart, you would have a distaster recovery plan for just this kind of thing. Judging from your lack of said preparations, you lot figured the cloud never goes down, and got greedy by not wanting to spend money on hot standby machines on a different infrastructure. Good going. Hope none of your cardiac patients croak because you’re going to get sued into next week…
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(+15 hours) As I wrote, this is not a life saving system.Which does not mean that patient’s life cannot be saved using it.That is all I have to say. Good luck to others
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Dude/Dudet. You put that patients lives are at stake in your title … Don’t try to back track. Just admit it was stupid and move on.
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Ah, so the title of this thread was a ruse? Either it isn’t so critical after all, and shame on you for trying to make it seem like it was, or else it is critical, and now you’re lying about it in order to not be shamed by others. Either way, shame on you.
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A perfect case study of what NOT TO DO. Why gamble when people’s LIVES are at stake!?
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We all do mistakes, but the important thing is learn from them. I’ll also have to review and change my policies. As for Amazon, it is a total shame that didn’t give ANY kind of assistance not even to this request. Regards
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Agreed. Sounds like he’s a startup. Failing over to other data centers is extremely expensive to set up and operate. Particularly if his data is write-heavy. No reason for everyone to go all self-righteous on him. In the end, the market will decide. if his patients die, he’ll be fired and/or his company will go out of business. Others will learn, the marketplace will move on.
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This is a Hoax. There are NO Patients in Danger. This was pure Hype from a Sick Person. Don’t fall for this BS. Use your Common Sense. Nobody in charge would allow this FruitCake to load any sort of critical monitoring systems up. You have been had. I respect your very real emotions, and your helpful and constructive responses to this fool, but he made all of this up, to get a Rise out of you. Next time, be more logical and think, before you answer crap like this.

Pizaazz Note: The long-term impact of the AWS outage on cloud computing is uncertain. It may be negligible. IDC estimates that corporate cloud computing will grow by more than 25% per year to $55.5 billion by 2014.

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Hair Loss Prevention Robot Approved by FDA. The Artas System, by Restoration Robotics, identifies and harvests permanent hair follicles which can then be implanted manually where needed.

HHS Launches Value-Based Purchasing Program. The program will reward hospitals for the quality of care they provide to Medicare beneficiaries. Measures to determine quality will focus on how closely hospitals follow best clinical practices and utilize health information technology.

Vermont Senate Approves Single-Payer Health Care. The state is on track to become the first one in the nation to offer a single-payer system and universal health coverage.

Wolters Kluwer in Deal to Acquire Lexi-Comp. Drug information provider Lexi-Comp is the latest of several WK acquisitions that have focused on providing decision support at the point-of-care. 
 
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Guantanamo Docs Neglected, Concealed Medical Evidence of Torture. The evidence includes bone fractures, lacerations, and symptoms of post- traumatic stress disorder, according to Physicians for Human Rights.

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Amazon’s Trouble Raises Cloud Computing Doubts. Problems with the cloud-based service are likely to prompt startups like Foursquare, Quora, Reddit and BigDoor to reconsider their reliance on such systems. 

How Harvard Medical Manages Students’ Mobile Applications. Of note, the most frequently downloaded clinical applications by the students were Dynamed, uCentral, VisualDx, Epocrates Essentials, and iRadiology.

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Rx for Secondary Prevention May Not Save Money. Statins and anti-hypertensives may, or may not be cost-effective in patients with known cardiovascular disease. We need studies to find out.

How Social Media Will Change Mental Health Care. The quality of care will improve in myriad ways, and the stigma and isolation of mental illness will lessen, according to a psychologist.

Drunk driving continues to be a serious problem. In 2009 for example, alcohol was a factor in more than 10,000 highway deaths. The same year, a stunning 10% of respondents to a survey of US adults said they had operated an automobile while drunk during the previous year. Nearly 6% said they had done it more than once.

So how would you feel about a car that can instantly detect whether a driver is drunk and prevent that person from starting the car?

You better make up your mind quickly, because scientists are close to perfecting this technology.

“We’re five to seven years away from being able to integrate this into cars,” Robert Strassburger, the VP for safety at the Alliance of Automobile Manufacturers told the Washington Post. The AAM, an automotive trade group, is on the development team for the new technology which is being spearheaded by the Automotive Coalition for Traffic Safety and National Highway Traffic Safety Administration.

The anticipated sensing device will look nothing like the breathalyzer machines currently used by police in the field. Instead, it will be comprised of tiny, passive, touch-sensitive sensors that are permanently affixed to a key fob or a starter button. The sensors can determine blood alcohol levels in seconds.

From a technical standpoint, the biggest challenge is to craft a sensor that analyses and responds to tactile information within about a third of a second. Current versions of the sensor take 20-30 seconds to do this. Team members are confident however, that advancements in solid-state electronics and infrared technology will help them achieve their goal.

After that lies the most nettlesome problem of all. Will car buyers purchase vehicles with these devices? Obviously, cost will be a concern, but more important will be the fears people have that the newly empowered vehicles will prevent them from driving home after enjoying a drink or two.

The device “establishes a situation where you are guilty until proven innocent every time you get into your car,” Sarah Longwell, who represents the American Beverage Institute told the Post. “Most Americans would say: ‘Absolutely not. I don’t drive drunk, and you’re not going to put that in my car.’”

Longwell added that her organization would support universal use of the devices if they were calibrated at 0.08–the legal drunk driving limit. She fears however, that the devices might be set lower than that. “Americans are 100% behind the fact that you shouldn’t drive drunk,” she stated. “But they’re not ready to give up the glass of wine with dinner, the beer at a ballgame or a champagne toast at a wedding.”