Economic Evaluation of an Investment in Medical Websites and Medical Web-Based Services
Evaluation of Medical Websites and Medical Web-Based Services
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- 6.1Medical Websites and Medical Web-Based Services
6 Evaluation of Medical Websites and Medical Web-Based ServicesEstrem (2003) states that the main intention of web-based services is to enable the application of programs, improved communication and shared functionality across networks such as the Internet. In addition to and emphasizing the aforementioned suggestions, he states that “web-based services are designed to leverage the standard- based architecture of Internet to provide interoperation across a wide variety of computing platforms”. Ratnasingam (2004) gives another more business oriented definition, defining web-based services as “modular Internet-based business functions that perform specific business tasks to facilitate business interactions within and beyond the organization”. Finally she states that the adoption of web-based services/ web-based services can enable organizations to reduce the risk of having to rapidly update their obsolete technologies, or outsourcing component of their IT infrastructure to third parties. According to Ratnasingam (2004), the web-based services can enable every user to share the same standards and connection protocols something that simply means that every application will be able to communicate with other web-based services, having a universal character, without the need of producing extra programming code or involving extra costs. Tapscott et al. (2000) created classification of “virtual enterprises” consisting from
The most important aspect of this classification is the network in which knowledge is distributed and Web-based services can have an important role in the creation of such a network. Moreover, Estrem (2003) takes the view that web-based services can be the tools to unchain organizations from their organizational boundaries and promote a more efficient cooperation/communication and knowledge sharing in a wider range of activities without place, time and other physical constraints. Furthermore, he emphasises the fact that although it is difficult for organizations to adopt, deploy and use web-based services, those who achieve it will also come a step closer to the creation of a strong competitive advantage, since such services can offer an enhanced flexibility and agility in various economic sectors (Al-Ali et al., 2005). In addition to the Aforementioned opinions and suggestions he supports the opinion that web-based services/ application can provide a cost effective utility to the broader public not only to the business world. As Estrem (2003) starts investigating the concept of evaluation of web-based services he states that such evaluation should be developed in the context of a cost-benefit/effectiveness analysis although the determination of costs associated with web-based services is a very dull and complex estimation, since it includes not only the initial costs from the acquisition or internal development of a web-based service, but also it should incorporate the significant cost of the integration of this service into the existing plans and systems of the enterprise. White (1978) and Daghfous and White (1994) state that innovation should not be evaluated only in an economic context, but also in a more technical context including four evaluation dimensions:
Moreover, Estrem (2003) adds an organizational perspective to web-based services evaluation by evaluating the ability of an organization to incorporate and apply new technologies (absorptive capacity). Zahra and George (2002) proposed a four-dimensional framework for the evaluation of the absorptive capacity of the organizations as part of the evaluation of web-based services/web-based services in the organizational context. The four dimensions are:
InternetFinally, in their research, Jadad and Gagliardi (1998), attempted to evaluate the ranking instruments that various organizations are using to rank medical websites because, as they state, the assessment of the applicability and comprehensiveness of the information is much more difficult and challenging than the search mechanism. They judged the ranking instruments using as criteria:
Most instruments were developed specifically to rank medical websites while most of them did not take into consideration the authorship the attribution and the disclosure of the information provided. Most of them were using a scale of measurement but keeping unclear the methodology of the scale development process as well as they did not report the level of reliability of the websites under evaluation. These evaluation/ranking instruments of the general quality of the website are useful but as information spreads through the Internet freely without monitoring, the development of more complete instruments is of vital importance. 6.1Medical Websites and Medical Web-Based ServicesMedical websites provide services including viewing online the medical health record, symptom checkers and advice over various healthcare conditions, onset of conversations in forums about healthcare conditions and support from various specialist in healthcare issues (Silence et al, 2007a). Silence E. et al (2007a, 2007b) suggest that from 2002 until 2007 the Internet use increased by 169% and they suggest that more than 80% of the adult Internet users in USA and the 67% of the European users (Taylor and Leitman, 2002) have used the Internet in order to seek medical advice. Also they state that the number of the Internet websites that offer medical advice and in general medical web-based services has dramatically increased and their study has shown that the Internet can vigorous affect the healthcare decisions of the individuals and is a very popular method to assess healthcare conditions among adolescents. Furthermore, Morahan-Martin (2004) stated that 4.5% of all searches on the Internet around the world are related to seeking healthcare information. Jun et al. (2004) state that in 2000 about 30 million people turned to Internet for medical advice visiting one of the 7000 to 10000 medical websites. The average daily visits to health websites in USA were estimated to be 6 million far more than the daily ambulatory visits to hospitals. They also state that in UK 1-2% of the people were using Internet for medical advice until 2002, compared to 32% of the people in the USA. Nowadays many healthcare systems and individual healthcare organizations provide online medical websites and medical web-based services to the patients and the Institute of Medicine suggests that the use of IT in healthcare and the creation of safe and good quality medical online medical services can be a critical issue towards the healthcare reform of healthcare (Moreno et al, 2009). Studying a well-established body of past literature, it is obvious that medical websites and the services they offer will become more and more usable and popular among the Internet users, since they offer better results than the traditional limited telephone communication between the physician and the potential patient, since there is the possibility for the physician to view online the patient and send written advice or prescriptions (Silence E. et al., 2007a, 2007b; Moreno et al., 2009). So it is a new modality that is more preferable from both the patients and medical practitioners in cases that close physical examination is difficult or not necessary (Moreno et al., 2009). Moreover, it is stated that the Internet is a major source of medical advice and there are more than 70,000 healthcare related websites. Users/potential patients are using the Internet for various reasons and nowadays many healthcare institutions are offering web-based having as minimum features the direct communication between the patient/user and the healthcare provider and the assess to the medical records of the patient/user (Moreno et al., 2009). Some of the patients/users are seeking medical advice in order to examine the emergency of their situation or to be more prepared for a meeting with their physician or to be more reassured and to obtain another opinion concerning their healthcare state (Silence et al., 2006). Karissa et al. (2011) attempted to assess the comprehensiveness and readability of medical information of well-known medical websites and concluded that all the websites, provided medical information that adheres to the Keystone action plan conclusion (U.S. Food and Drug Administration, 1996) with an accuracy rate of information above 98%, but the readability and in general user friendliness were not taken into consideration. “The Action Plan for the Provision of Useful Prescription Medicine Information is the result of a collaborative process mandated by Congress. Public Law 104-180, which was passed on August 6, 1996, required the Secretary of Health and Human Services to organize a committee of diverse interests to develop a long-range, comprehensive action plan to improve oral and written communication to patients about their prescription medicines” (U.S. Food and Drug Administration, 1996). The purpose of the Keynote Action Plan is to assess and improve the quality of medical piece of information that is voluntarily provided to consumers with their prescription medicines. The rationale for the Plan is that providing consumers with useful information about their prescription medicines can reduce the risk of preventable, medication-induced injury and improve health outcomes (U.S. Food and Drug Administration, 1996)This Action Plan seeks to encourage healthcare providers, practitioners, patients and health related profit and non-for-profit organizations, and other interested parties to voluntarily adopt an established strategy to improve the medical information that the users have regarding the prescription the medicines they require or the medicines that are on the pharmacists, counters (U.S. Food and Drug Administration, 1996). In general, according to past studies, medical web-based services have the benefits that can help patients with chronic diseases to better monitor their health and have a better communication with the physician (Silence E. et al., 2007a, 2007b; Moreno et al., 2009). Medical web-based services provide adolescents with a more comfortable environment to encourage them ask a physician about sensitive heath care issues that they may have. Also adolescents can have better quality of information if these services are supported by a healthcare organization, rather than searching about healthcare issues via generic online search engines (Moreno et al., 2009: Gray et al., 2005). Internet users that use medical web-based services also are found to be more confident about their healthcare state, they feel that they have more control over their healthcare decisions, and also they experience a reduced asymmetry of information between patients and physician, and also save the time lost in consulting rooms and fulfil their need for emotional support and social interaction with people that deal with the same healthcare issues, thus creating a perceived benefit of convenience (Silence et al., 2006). Past studies on the field of medical web-based services/web-based services endeavoured to evaluate the trustworthiness of these services and especially the aspects of medical advice, comprehensiveness, accuracy, readability, and overall quality of the information that the medical websites and their web-based services offer (Silence E. et al., 2007a, 2007b; Moreno et al., 2009). These evaluation concepts were focused on subjective and qualitative piece of information while this research will focus on more objective quantitative financial and operational success-related data. Silence et al (2007a, 2007b) state that it is very difficult to evaluate the quality and comprehensiveness of the information that the users/potential patients receive from medical websites, while Metzger et al (2011) suggest that for certain drugs used as sample in their research, online medical websites like the Medicine plus, Yahoo health and WebMD websites, were providing more comprehensive and according the Action Plan For The Provision Of Useful Prescription Medicine Information (U.S. Food and Drug Administration, 1996). Moreover, Metzger et al. (2011) state that the accuracy of information provided by these medical websites was more than 98%. Zun et al. (2003) state that there is also a crucial need to evaluate the quality of emergency medical information on web-based services, because anything that is posted or spread by these services is not necessarily reviewed before it is published. Frosstrom and Rigby (1999) state that “healthcare is one of the most crowded markets in cyberspace” and that accuracy in web-based services should be continuously checked, as even a small mistake in software or content can have a devastating result since many people will follow the specific given advice. Also according to them many problems arise because:
Moreover, Frosstrom and Rigby (1999) propose that patients should be conscious when they are asking their doctor and even use a medical website in order to assess the quality of information they receive. Moreover, Frosstrom and Rigby (1999) they propose that a quality protocol like ISO 9000 should be developed because there seem to be a worldwide luck in well-defined policy regarding the quality assessment of medical websites and web-based services. Silence et al (2007a) examined the comprehensiveness and accuracy of information, concluding that low quality can be a major barrier to the use of these services. Approval “trustmarks” and seals such as the seal from Accreditation Healthcare Commission, URAC (Urac.org, 2014) for websites that pass a control of 50 criteria, for a fee of $5000 (Zun et al., 2003), have been suggested as a way to help users to identify quality medical web-based services providers, but they do not seem to affect the credibility and trust worthiness of the medical services content.. It is interesting that the results from Silence et al. (2007a, 2007b) suggested that the medical website design factors constitute 90% of the cited reasons that patients/users state as more influential in their decision to reject and mistrust a medical website, while the content and application providing factors consists only 6% of the reasons to select were influenced more by content issues. Websites connected to pharmaceutical companies and other related profit organizations that offer symptom checkers or medical advice were also usually rejected in favour of websites supported from non-profit entities. A professional or attractive design of the website affects the perception of the credibility of information (Fogg et al., 2002; Stanford et al., 2002). Also the appearance of heavy graphics and pop up messages and advertisements (Walter et al., 2004) tends to decrease credibility. Furthermore, personalisation of content and presentation of balanced opinions on healthcare issues tend to increase trust. Finally, advertisements had a positive effect on trust in “.com” or “.edu” domains. 66% of the users that seek advice from medical web-based services seek medical advice for them. Lack of need is the greater barrier to the use of these services, rather than lack in trust. Most people are using generic databases and Internet search engines. Birkmann et al. (2006) conclude that the most important factors that users use to evaluate websites are the comprehensiveness of information, the provision of information in mother tongue of the user, the providing of updated information, and the security and data safety certifications of the website. Adelhard and Obst (1999) attempted to summarise the criteria for medical Internet sites evaluation, as follows:
In order to assess the website quality, various certificates have been established with the Trust-e and the HONcode ones being the most popular. Health on Net Foundation has established Code of Contact (HONcode) particular for the sites that have medical content. This promotes the quality in medical sites and provides reassurance to the patients/users regarding the accuracy, reliability safety and comprehensiveness of the information on Internet (Boyer C. et al., 1998). When a site chooses to display the HONcode logo is obliged to follow certain quality standards, namely:
Slack W. (2001) provides some guidelines for health websites, as summarised below:
The medical soundness is equivalent to the first guideline of the HONcode and confidentiality is a common guideline to both sets. Bomba (2005) tries to combine Slack’s and HONcodes guidelines and produce a rating index for the medical websites (Table 1) for the evaluation of their quality characteristics. Table : Rating index for the medical websites (Bomba, 2005)
Moreover, Forstrom and Rigby (1999) suggest that patients can’t rely only on the information they receive from medical web-based services, since they lack the expertise to judge their condition quality and they should always consult their physician to avoid more hazards or before they use treatment advertised on sites. These authors also believe that while they are using medical web-based services, patients must:
In addition to the aforementioned issues, it can be added that the past studies delve into more legal and ethical issues, examining the use of medical web-based services by adolescents. They suggest that barriers to the use of these services by adolescents could be issues such as:
Adams (2011) suggests that nowadays there are some countries in which the idea of a “reflexive patient” which refers to a patient that shares his medical experiences and review doctors and hospitals via a healthcare service on the web, is growing as well as their number of websites that offer this ability to the users is increasing. As Brinsteel et al. (2008) also suggest, the combination of this end user information in healthcare with other pieces of information obtained from databases, medical science, and psychological evidences can used to create a solid evidence database of information that will promote the efficiency and transparency in the healthcare field. This might improve also “traditional” issues in the healthcare sector such as the “moral hazard” and the asymmetry of information between the doctor and the patient since the active participation of the patients in criticizing healthcare sector, and evaluating doctors as well as sharing their own experiences can be used as an effective control mechanism, although other actors involved in the healthcare field are sceptical and unsure about the ability of the users to correctly make judgements on the value of the system. Moreover many websites have their own political interests or even unconsciously transform the participation in the healthcare policy judgement from a matter that can benefit the whole society and lead to societal welfare to a political issue and a political manipulation for the public (Adams, 2011). Furthermore as Adams (2011) concludes, by using these services/web-based services on the medical websites, the patients are motivated to share resources, investigate guidelines and in general adopt a role of “health educators/regulators”. Barak A. (1999) states that many psychological web-based services, tests, psychological information banks, blogs, wikis and support groups are on the web to help users/patients and provide support to meet their needs and requirements. Moreover, El-Khalili and Brodlie (2000) state that another useful use of medical web-based services could be the surgical training over the web. They state that since there is already a large pool of web-based services for various purposes and fields, the World Wide Web can become the perfect training environment especially for training on healthcare interventions. Regarding surgical training web-based services, they emphasize the fact that the web-based services should be platform independent, all the data and processes that are required for the execution of the application should be downloaded with it, and finally the application should work on its own without the need for collaboration between other web-based services or need for accessing many users to accomplish a task. Furthermore, Colantuoni et al. (2010) designed a web application to show the impact and the burden of the Alzheimer’s disease and better understand it. Finally, Hester et al. (2009) describes the use of a medical web application for moderation training on alcoholics describing also the advantages of the web environment for such web-based services and the societal benefit from these. Although as it was shown above past studies delved into crucial issues about the medical web-based services such as legal issues, issues about the quality, trustworthiness, comprehensiveness and accuracy of the information spread through the diagnostic part of medical web-based services, analyse the benefits and the possible barriers that ma hider their use, they did not examined the saving and other economic and broader benefits that can derive from their use, both from the healthcare provider’s and healthcare system’s perspective. Economic evaluation could crucial in assessing the future of these services and present the actual impact that these services can have on the system. Finally they state that the medical training over the web will address the problem of the shortage of medical staff since it will make the training more efficient and without the need of occupying staff for training purposes. Download 1.95 Mb. Share with your friends:
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