Health Affairs Issue Examines eHealth
In conjunction with the California HealthCare Foundation, the November/December issue of Health Affairs focuses on the Internet's potential impact on health care providers, purchasers, suppliers and patients. According to Health Affairs founding editor John Iglehart, because Congress and the executive branch have not addressed the "countless health policy issues spawned by the greater availability of information networking and commercial opportunity" through the Internet, this issue of Health Affairs is designed to give "new perspectives" on eHealth through papers written by analysts and information technology practitioners (Iglehart, Health Affairs, Nov./Dec. 2000). The papers are divided into four sections: vision, business, quality and care, and perspectives on eHealth.
The following papers discuss the major issues "that seem most likely to define how well the health sector meets the challenges of the information age."
- Networking Health: Learning from Others, Taking the Lead. In this article, Edward Shortliffe, a professor in the Columbia University College of Physicians and Surgeons' Department of Medical Informatics, reviews the history of the Internet's development and its relationship to biomedical computing and the nation's health care system. He summarizes current research programs.
- Health Care Reform and the New Economy. In this paper, Paul Starr, a Princeton University sociology professor and founder of the Electronic Policy Network, advocates using information technology as the foundation for health care reform.
- Two Old Hands and the New New Thing. Health Affairs senior editor Rob Cunningham interviews former Speaker of the House Newt Gingrich (R) and Ira Magaziner, former senior adviser to the Clinton administration on electronic commerce. Both Gingrich and Magaziner agree that the health industry could be "greatly improved by Internet-enabled 'mass customization.'"
In the business section, four papers outline models, list potential problems and offer solutions for eHealth companies
- The Internet and Managed Care: A New Wave of Innovation. Jeff Goldsmith, president of Charlottesville, Va.-based Health Futures, focuses on the Internet's role in automating administrative and financial information for insurers.
- Vaporware.com: The Failed Promise of the Health Care Internet. J.D. Kleinke, president of the Denver, Colo.-based Health Strategies Network, discusses why the Internet "will not solve the administrative redundancies, economic inefficiencies or quality problems" that are hurting the current health care system.
- Financing the Health Care Internet. Jamie Robinson, professor of health economics at the University of California-Berkeley, writes that the initial venture capital backing and subsequent technology-sector stock crash of Internet health firms will lead to a "period of consolidation between eHealth and conventional firms."
- Beyond the Hype: A Taxonomy of E-Health Business Models. In this paper, Steve Parente, assistant professor at the University of Minnesota's Carlson School of Management, describes an eCommerce business model, its application to health care and why health policy experts should "monitor its development."
Two papers in the Quality and Care section discuss the "promise and pitfalls associated with online health care information."
- The Impact of the Internet on Quality Measurement. In this paper, David Bates, chief of the Division of General Medicine at Brigham and Women's Hospital, and Atul Gawande, a resident physician in the Department of Surgery at Brigham and Women's Hospital, discuss the Internet's impact on consumers' access to quality health measurements.
- Patients, Physicians, and the Internet. Jerome Kassirer, Tufts University School of Medicine professor and editor emeritus of the New England Journal of Medicine, writes that the Internet will alter the physician/patient relationship as doctors turn to Web sites and email to improve administrative and medical management services. Kassirer warns that "most physicians are unprepared, and many are resistant" to the change.
In a perspectives section, authors offer their opinions regarding some of eHealth's "burning questions."
- EHealth: Technologic Revolution Meets Regulatory Constraint. Bruce Fried, Gadi Weinriech and Gina Cavalier, attorneys at the Washington, D.C.-based firm Shaw Pittman, and Kathleen Lester, a privacy consultant for HHS, writes that an "Internet-driven health system poses new challenges for an area already thick with regulation."
- Self-Regulation: Who Needs It?. Mark Boulding, general counsel and executive vice-president of government and regulatory affairs for Medscape, writes that by "developing and enforcing a well-designed set of rules, eHealth codes of ethics can direct attention to the best-quality sites."
- Virtually Exposed: Privacy and E-Health. Janlori Goldman, director of the Health Privacy Project at Georgetown University's Institute for Health Care Research, and Zoe Hudson, senior policy analyst at the Project, write that privacy concerns are 'keeping consumers form reaping the full benefit of online health information."
- E-Health, HIPAA, and Beyond. John Lumpkin, director of the Illinois Department of Public Health and chairman of the National Committee on Vital and Health Statistics, discusses the central issues in designing a secure health information system.
Other eHealth related stories in Health Affairs include
- Old Before its Time: HIPAA and E-Health Policy. Health Affairs senior editor Rob Cunningham discusses the need to update HIPAA and the need for Congress to focus on the Internet's role in health care.
- Traversing the Digital Divide. Helen Burstin, director of the Center for Primary Care Research at HHS' Agency for Healthcare Research and Quality, discusses the possibility that the benefits of the computer in medicine could widen the gap between the rich and the poor in health care.
- Health Information, the Internet, and the Digital Divide. This paper points out that although more people are using the Internet, many for health information, a "digital divide" still remains, especially affecting lower-income African Americans. The analysis was conducted by Mollyann Brodie, vice president and director of public opinion and media research at the Henry J. Kaiser Family Foundation; Rebecca Flournoy, a research associate at KFF; Drew Altman, president and CEO of KFF; Robert Blendon, professor of health policy and political analysis at Harvard University's School of Public Health and John F. Kennedy School of Government; John Benson, managing director of the Harvard Opinion Research Program at the School of Public Health; and Marcus Rosenbaum, senior editor at National Public Radio.
http://ehealth.chcf.org/index.cfm?section=Policy and they will be available at www.healthaffairs.org.
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