New vital sign: degree of patient's online access

Searching online for health information is the third most common online activity behind checking e-mail and using a search engine, finds a new survey by the Pew Research Center's Internet & American Life Project.

But that doesn't mean physicians should assume that everyone has access to the Internet when it comes to patient education and communication. In fact, the survey showed that those who might most need access to online information are least likely to own an Internet-connected computer.

Patient use of the Internet has moved beyond what physicians used to refer to as Dr. Google -- the stacks of information printed from a Google search that patients would bring to the exam room.

So much of health care is moving online that many physicians assume that everyone uses the Internet.

But that assumption could lead to patients missing out on important information, or being unable to access certain tools. So experts and analysts recommend that doctors start asking their patients whether they have Internet access -- or whether a loved one or advocate does.

The Pew survey found that the number of Internet users searching online for health information has remained constant, at eight in 10 users.

But considering the fact that a quarter of adults do not go online at all, the percentage of online health information seekers is 59% of the total U.S. population.

Susannah Fox, associate director of the Pew Internet & American Life Project and author of the report, said that if there's a need for up-to-date health care information, such as drug recalls or information that could affect treatment choices, physicians should be aware that not everyone will see it if it's disseminated online.

Factor in "secondary-degree" access

According to the survey, there are good predictors of who may be looking for health information online. Groups with less than 50% of their population doing so include African-Americans, Latinos, adults living with a disability, adults age 65 and older, adults with a high school education or less, and adults living in households with incomes less than $30,000.

By age, patients older than 65 are least likely to be online, yet they are the highest users of health care and are most likely to be managing chronic illnesses, Fox said. This group is most likely to seek traditional sources of information, such as their physicians, and say they don't need the Internet.

Even though a patient might not have direct access, the survey found, many have "secondary-degree" access, meaning a loved one or caregiver can go online and search for information on their behalf. "But only if it's brought up in the course of an appointment or some other kind of interaction," Fox said.

Nearly half of Internet users looking for health information online said that their last search was on behalf of someone else, according to the survey results.

"Whether the physician has the time or resources to involve the caregivers, it's at least important to know that although there might be just one patient in the room at the time, you might imagine their 'network,' who is invisible during the appointment," Fox said. "Even if you might know that the person doesn't use the Internet or you might guess or assume they don't use the Internet, remember that they are most likely in a network of people who do use the Internet."

Among those most likely to be online are adults who have provided unpaid care to a family member or loved one, women, whites, and adults between the ages of 18 and 49 who are college educated and living in a higher-income household. And even though men and women are equally likely to be online, women are more likely than men to do online health searches. Not a single search topic studied in the survey attracted more men that women.

Bryan Vartabedian, MD, a pediatric gastroenterologist at Texas Children's Hospital and assistant professor of pediatrics at Baylor College of Medicine in Houston, has come to refer to online information as the "third party in the exam room."

Although Dr. Vartabedian said he's not sure access to online information is necessary for patients to be healthy, he said it can improve an already good relationship between physician and patient. For a patient with a physician who spends less time on education, "a patient's relationship with their information becomes critical," he said. The benefits depend on whether the information is good, which is not always the case, he added.

Others are concerned that those caught in the digital divide not only will lack information that affects the quality of care but also will lack electronic tools, such as personal health records or telemedicine solutions, that could help reduce health care disparities in the same communities.

Community resources

Jennifer Garvin, PhD, researcher at the IDEAS Center at the Salt Lake City VA Center, said physicians and health care organizations should look for partnerships in the communities to address the digital divide.

Efforts already exist, she said, to educate certain communities on health risks that affect them disproportionately, such as the African-American community, where diabetes is prevalent. She said churches, libraries and community centers could be access points for patients not only to receive information offline, but also to access online information and tools on public computers at these locations. Physicians and health care facilities could pursue relationships with those organizations so doctors have a place to refer patients for help getting connected, she said.

Diane Warner, manager of professional practice resources for the American Health Information Management Assn., said more efforts also are needed to make some of these tools as accessible as possible. Personal health records that are available through a web-based model, for example, could be accessed anywhere there is an Internet connection. Or PHRs that have an app module could be downloaded to a phone.

Some surveys also have found that the use of mobile technology is more prevalent in minority communities. A 2010 Pew study found that nearly two-thirds of African-Americans (64%) and Latinos (63%) are wireless Internet users and are more likely than their white counterparts to own a cell phone. Additionally, black and Latino cell phone owners take advantage of a much wider array of their cell phones' data functions compared with whites.

But Warner said it's not only lack of access keeping patients from using online information and tools. She said a big challenge is simply educating patients on available information and how they can use it. "Patients don't realize what it is they can get or what they even need," she said. "And each patient is different."