SciPICH: Final Report - Introduction

Wired for Health and Well-Being: The Emergence of Interactive Health Communication

Editors: Thomas R. Eng, David H. Gustafson

Suggested Citation: Science Panel on Interactive Communication and Health. Wired for Health and Well-Being: the Emergence of Interactive Health Communication. Washington, DC: US Department of Health and Human Services, US Government Printing Office, April 1999.

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Chapter I.

Introduction

Virtually all aspects of society have been altered in some way by recent advances in information and communication technologies. In 1997, the information technology industry was the single largest industry in the United States in terms of sales and accounted for 33 percent of the growth in the gross domestic product in 1996 (AEA, 1998; NTIA, 1998). The percentage of US households with personal computers grew from about 8 percent in 1984 to 45 percent in 1998 (US Bureau of Census, 1998; ZD Market Intelligence, 1998). From its roots in the scientific and engineering community, the Internet has grown to become a central focus for commerce and communication—so large that even the best search engines can only catalog about 28 percent of the information on the World Wide Web (Lawrence and Giles, 1998). In mid-1998, more than 70 million US adults were active users of the Internet (NMR, 1998; Wiese, 1998) and the number of users worldwide is increasing exponentially for the foreseeable future. About one-half of all US Internet users have used it to obtain health information or support (FIND/SVP, 1997). Advances in technology have catalyzed dramatic changes in many aspects of the economy and society including commerce, financial services, telecommunication, and delivery of news and information. Other information-intensive sectors, such as health care and public health, are in the early stages of change.

Concomitant with the emergence of new media technologies, consumers are becoming increasingly assertive in health care decisionmaking and in demanding increased access to a wider range of health information and social support resources. For example, less than one year after free Medline searches became available on the World Wide Web, the number of searches increased tenfold, and 30 percent of users were members of the general public (NLM, 1998). In addition, the growing number of persons enrolled in managed care organizations in the United States—from 36.5 million in 1990 to about 67.5 million in 1996—has long-term implications for the delivery of health services and demand for health information (AAHP, 1998). At the interface of these trends, the interactive communication technologies have emerged to address the health information and support needs of consumers. Stakeholders involved with the development, dissemination, and evaluation of these technologies are now in need of input and guidance to ensure quality of, and achieve an optimal future for, these technologies (Thomas, 1996; Sonnenberg, 1997; Robinson et al., 1998).

Interactive health communication (IHC) can be defined as the interaction of an individual—consumer, patient, caregiver, or professional—with or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue (Robinson et al., 1998). The term "IHC applications" is used to refer to the software programs or modules that interface with users rather than the hardware and infrastructure technologies that run these applications. For the purposes of this report, IHC applications do not include electronic applications that exclusively focus on administrative, financial, or clinical data, such as electronic medical records, dedicated telemedicine applications, expert clinical decision-support systems for physicians, or applications focused solely on health professional education. Although most IHC applications involve the use of computers, the telephone, interactive television, personal digital assistants, and other communication devices are also employed.

The emergence of the field of IHC raises several major issues about its status, its future, and its ultimate impact on public health and health care. These include:

The potential risks and benefits of IHC
The science or evidence base for IHC
Quality and effectiveness of IHC applications
Appropriate roles for stakeholders in IHC development, implementation, and evaluation
IHC-related policies and research
Appropriate national initiatives to achieve a preferred future for IHC

To help clarify the above issues, the Office of Disease Prevention and Health Promotion (ODPHP) of the US Department of Health and Human Services (HHS) convened the Science Panel on Interactive Communication and Health (the Panel), a 14-member non-Federal panel. The Panel consists of nationally recognized experts in a range of study areas, including clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication.

The contents of this report represent the analyses and recommendations of the Panel, which were derived through a group consensus process. The Panel considered findings of published studies, online resources, and opinions of outside experts in formulating its recommendations. The Panel met 10 times over the course of more than 2 ½ years (May 1996 to February 1999). During this period, the Panel’s work and drafts were reviewed and commented on by numerous "liaisons" to the Panel. These liaisons represented more than 50 Federal agencies and offices and non-Federal or private sector organizations, including government agencies, academic institutions, health care organizations, developers of IHC applications, health care consumers, and consumer advocates (see Acknowledgments). The preliminary work of the Panel also was presented at several national conferences on technology and health to obtain public feedback.

This report provides an analysis of the major issues related to quality improvement and evaluation of IHC applications, and suggests directions for future activities and policy in this area. The Panel initially focused its deliberations on issues related to quality improvement and evaluation of IHC, but it became clear that the related issues of public awareness and understanding of IHC, stakeholder capacity to develop and use IHC, and access to IHC also needed to be addressed in this report. Although IHC applications are being developed and used throughout the world, and emerging technologies clearly have transnational and global implications for health, this report focuses on the field of IHC as it is evolving in the United States. Additional analyses of this field in other countries are needed.

Although policymakers, developers and purchasers of IHC applications, and health professionals are the primary audiences of this report, consumers and others also may benefit from reading it. This report summarizes and organizes much of the Panel’s previously published articles in scientific journals (Robinson et al., 1998; Eng et al., 1999; Gustafson, Robinson et al., 1999; Henderson et al., 1999; Jimison et al., 1999; Patrick et al., 1999) within a comprehensive framework for IHC. This framework serves as the basis for the Panel’s recommendations for moving the field of IHC forward.

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Comments: SciPICH@nhic.org Updated: 05/09/01