Although the internet has only been around for a relatively short period of time, its influence on both clinicians and patients alike is growing rapidly. Carol Bond, Senior Lecturer in Health Informatics at Bournemouth University, examines the internet and its relationship with patient information

Bond, Carol S.

English

Bournemouth University Research Online

I find it hard to talk about the internet  historically as, although it often feels as ifit’s been around for ever, it’s only beenavailable to the public for the last 20 years.The Office of National Statistics didn’t startasking about internet use in the GeneralHousehold Survey until 2000, when only athird of households had home access to theinternet. Amongst students starting pre-registration nurse education at a universityin the south of England that year only 41 per cent had year round access to a computer with an internet connection. In the intervening 10 years not only hasinternet availability changed enormously,with 93 per cent of students having acomputer and internet connection, theinternet itself has also changedconsiderably. It has developed from being a mainly static information-givingmedium to a dynamic, interactivecommunication tool. In spite of the high level of computer ownership amongst nursing students,14 HINOW Winter 2010nurses have been slow adopters of IT, seeing computers as something that getsin the way of patient care rather thansomething that supports it. A recent clinical nurse lead for the Connecting forHealth programme is quoted as saying ‘ifarticles are branded as IT it’s unlikely thatnurses will pick them up, let alone engagewith them.’ As patients turn to the internet, however,they might lead a change in this attitude.At the moment many nurses don’tAlthough the internet has only been around for a relatively short period of time, its influence on both clinicians and patients alike is growing rapidly. Carol Bond, Senior Lecturer in Health Informatics atBournemouth University, examines the internet and its relationship with patient information.ANDPATIENT INFORMATIONTHE INTERNET14 - 15-HINOW-Winter2010-br_novitnow.qxd  22/11/2010  11:46  Page 1Winter 2010 HINOW 15understand enough about the internet andits role in patient information to be able towork effectively with their patients.Historically health professionals havebeen concerned about patient use of onlinehealth information. Two worries arearound the quality of the information beingassessed, and that patients will use it toself diagnose. The worry around the quality of health websites is to someextent justified. Research undertakenWhilst there are undoubtedly some poorquality websites in existence, research intocancer-related websites found a low incidence of inaccurate information.PATIENT INFORMATIONResearch undertaken with online breastcancer support groups found that only 0.22 per cent of posts contained wrong or misleading information and that other contributors corrected this within an average of four and a half hours. Various attempts at establishing some type of quality kitemark for healthwebsites have been made. The mostenduring is Honcode, and the NHS hasattempted to introduce its own schemes.The NHS’s most recent attempt is theInformation Standard, however this isexpensive to obtain and the number oforganisations that are listed on the website as having signed up are small. People looking for online healthinformation have been found to have poorawareness of these quality marks and theschemes have been criticised for being oflimited use to the lay end user. Online health information usersThe concern about self diagnosis is notborne out by research; many users ofonline health information are seeking tobetter understand a health problem they,or a family member, have. Rather thanseeking to self diagnose, people living withlong-term conditions tend to use information found on the internet to helpthem prepare for consultations. They are very supportive of the NHSdrive to see people living with long-termconditions as active participants in theirown care, working in partnership withprofessionals rather than being passiverecipients of care. Online healthinformation users have the expectationthat their use of online resources willimprove their interaction with healthcareprofessionals.The healthcare field, however, isstruggling to keep up with the leading edgepatients. Two factors considered in mostquality schemes are the authority of thesite and the evidence base of information.When considering interactive web 2.0 sites,however, where peers are sharinginformation, the authority is that ofsomeone living with a condition and theevidence base is their experience, whichmay include significant co-morbiditieswhich condition-specific sites oftenstruggle to deal with. The question of what constitutes goodquality information is also open to debate,especially as research has found thatmany patients using online healthinformation were seeking points of viewnot associated with mainstream medical thinking. Patients rating GPsThe internet is developing so quickly that itis difficult to know what its patients (andhealth care professionals) want from it andfrom health services. Some attempts toencourage patient participation haven’tbeen well received by the medical community, such as the ability for patientsto rate their GPs on the NHS Choices website. Patients don’t appear to particularly want this facility either.Checking my local area, half of the closest20 GP practices haven’t been rated at all.The most rated practice only has three ratings. With such low levels of participation the ratings and commentsare in danger of lacking balance. It is also worth questioning if the NHSshould play a general role in patientinformation or if it should focus onensuring that patients are aware of whatthey are entitled to under NHS care. Theinternet does not operate within countryboundaries and it is easy for patients tofind out about treatment options in othercountries, which opens practical andethical problems that need discussion. Defining informaticsAs Paula Procter says in her report fromIMIA NI on page 16 in this edition, information systems in healthcare tendunderpin financial management. Certainlyin the NHS in recent years, the focus hasbeen on the development of large scalecomputer systems. IMIA NI’s definition ofnursing informatics (agreed in 2009) iswider than this narrow technology focus:‘Nursing informatics science and practice integrates nursing, its informationand knowledge and their management withinformation and communicationtechnologies to promote the health ofpeople, families and communities world wide.’Perhaps for too long the focus has beenon the T in IT rather than the I. Instead oftalking about IT – information technology -we need to make a subtle shift and talkabout information and technology. Patientsdeserve healthcare professionals whounderstand their information needs andwork with them in a new relationship thatacknowledges that professionals are nolonger the sole source of that information. Perhaps for too long the focus has been on the T in IT rather than the I. Instead of talking about IT we need to make a subtle shift and talk about information and technology.  14 - 15-HINOW-Winter2010-br_novitnow.qxd  22/11/2010  11:46  Page 2

The Internet and Patient Information

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