Guidelines, the Internet, and Personal Health

Summary

Objectives: To summarize the insights gained in collaborative research in a Canadian Network of Centres of Excellence, devoted to the promotion of evidence-based practice, and to relate this experience to Internet support of health promotion and consumer health informatics.

Methods: A subjective review of insights is undertaken.

Results: Work directed the development of systems incorporating guidelines, care maps, etc., for use by professionals met with limited acceptance. Evidence-based tools for health care consumers are a desirable complement but require radically different content and delivery modes. In addition to evidence-based material offered by professionals, a wide array of Internet-based products and services provided by consumers for consumers emerged and proved a beneficial complement.

Conclusion: The consumer-driven products and services provided via the Internet are a potentially important and beneficial complement of traditional health services. They affect the health consumer-provider roles and require changes in healthcare practices.

Keywords

Evidence-based medicine - consumer participation - health promotion - Canada - Internet

¹ HEALNet and the work of many investigators inspire this account of the HEALNet experience. However, all observations and interpretations are strictly the personal view of the author.

• References

• 1 Hinohara S. The Past, Present and Future of IHEA. Methods Inf Med 2002; 41: 191-5.
• 2 Warner H, Toronto A, Veasey L, Stephenson R. A Mathematical Approach to Medical Diagnosis:Application to Congenital Heart Disease. In: Blum B. editor. Computer-Assisted Medical Decision Making. New York: Springer-Verlag; 1985. p. 143-58.
• 3 Ledley R, Lusted L. Reasoning Foundations of Medical Diagnosis. In: Blum B. editor. Computer-Assisted Medical Decision Making. New York: Springer-Verlag; 1985. p. 46-79.
• 4 Szolovits P. Artificial Intelligence in Medicine. Colorado: Westview Press, Inc.; 1982
• 5 Miller P. Exploring the Critiquing Approach: Sophisticated Practice-Based Feedback by Computer. In: Salamon R, Blum B, Jorgensen M. editors. Medinfo. 1986. Elsevier Science; 1986. p. 2-6.
• 6 Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine.. JAMAhttp://www.cche.net/principles/content_over.asp 1992 268 2420-5.
• 7 Sackett D, Haynes R, Guyatt G, Tugwell P. Clinical Epidemiology, a Basic Science for Clinical Medicine. 2nd ed. Boston: Little Brown & Co Inc.; 1991
• 8 ACP-ASIM – Product and Program Catalog – Evidence Based Medicine.. wysiwyg://35/http://www.acponline.org/catalog/journals/ebm.htm 2001(April 5).
• 9 Evidence-based Medicine, Clinical Practice Guidelines, Consumer Health Informatics.. http://www.acponline.org/catalog/journals/acpjc.htm 2001 (April 5).
• 10 ACP-ASIM – Product and Program Catalog – ACP Journal Club.. wysiwyg://29/http://www.acponline.org/catalog/journals/acpjc.htm 2001 (April 5).
• 11 Ministry of Supplies and Services Canada.. The Canadian Guide to Clinical Preventive Health Care – Canadian Task Force on the Periodic Health Examination. Ottawa, Canada: Canada Communication Group; 1994
• 12 HEAL Net – RELAIS: Putting Health Research to Work.. http://healnet.mcmaster.ca/ncedefault.htm 2000 2001 (April 5).
• 13 Networks of Centres of Excellence (NCE).. http://nce.nserc.ca 2001 (April 5).
• 14 Dickinson H. Evidence-based decisionmaking: an argumentative approach. Internat J Med Informatics 1998; 51 2-3 72-82.
• 15 Upshur R. Seven Characteristics of medical evidence. in Clinical Practice 2000; 6: 23-7.
• 16 Partnerships in Action – HEAL Net 1999 – 2000 Annual Report.. Hamilton, ON: McMaster University; 2000
• 17 Lau F, Penn A, Wilson D, Noseworthy T, Vincent D, Doze S. The diffusion of an evidence-based disease guidance system for managing stroke. Internat Med Informatics 1998; 51 2-3 107-16.
• 18 Edmonds M, Bauer M, Osborn S, Lutfiyya H, Mahon J, Doig G. et al. Using the vista 350 telephone to communicate the results of home monitoring of diabetes mellitus to a central database and to provide feedback. Internat Med Informatics 1998; 51 2-3 117-26.
• 19 Sackett D, Straus S. Finding and Applying Evidence During Clinical Rounds – The “Evidence Cart”. JAMA 1998; 280 (Suppl. 15) 1336-8.
• 20 Allen V, Arocha J, Patel V. Evaluating evidence against diagnostic hypotheses in clinical decision making by students, residents and physicians. Internat Med Informatics 1998; 51 2-3 91-106.
• 21 The National Guideline Clearinghouse™. Fact Sheet.. AHRQ Publication No. 00-0047, July 2000. Agency for Healthcare Research and Quality, Rockville, MD: http://www.ahrq.gov/clinic/ngcfact.htm
• 22 Crytryn K, Patel V. Reasoning about diabetes and its relationship to the use of telecommunication technology by patients and physicians. Internat Med Informatics 1998; 51 2-3 137-52.
• 23 Jadad A. Consumers and the Internet. In: http://www.jmir.org/1999/3suppl1/e3
• 24 Solomon M, McLeod R. Screening for Colorectal Cancer. In: The Canadian Guide to Clinical Preventive Health Care – The Canadian Task Force on the Periodic Health Examination. Ottawa, Canada: Canada Communication Group; 1994. p. 797-809.
• 25 Coward H, Hartick G. Perspectives on health and cultural pluralism: ethics in medical education. Clin Invest Med 2000; 23 (Suppl. 04) 261-5.
• 26 Weber D. Web Sites of Tomorrow: How the Internet will Transform Health Care. In.: Health Forum Journal; 1999
• 27 Tombs R. Use of Internet Resources for information on HIV/AIDS. Term Paper. Victoria, BC: University of Victoria, School of Health Information Science; 2000. July.
• 28 Are MDs falling behind as patient demand for health information grows?. 2000 2001 (April 5).
• 29 Wilson S. Impact of the Internet on Primary Care Staff in Glasgow. J Med Internet Research 1999; 1 (Suppl. 02) e7.
• 30 Wagner N. Commentary on medical education and training in the information age. Clin Invest Med 2000; 23 (Suppl. 04) 248-50.
• 31 Moehr J, Grant A. Medical informatics and medical education in Canada in the 21st century. Clin Invest Med 2000; 23 (Suppl. 04) 275-80.
• 32 IVF Connections.. http://www.ivfconnections.com 1999 -2000; 2001 (April 5).
• 33 Johnson C. The Role of the Internet in Disease Management. Term Paper. Victoria, BC: University of Victoria, School of Health Information Science; 2000