PhD Research on eHealth Consumerism

Doctoral Project DHA
F. Gordon Jones, MHSA

Soon the Web-browser will be
as important to the physician…

as the stethoscope…

Michael Messer, MD Doctoral Project DHA

Just What the Patient Ordered
eHealth Consumerism:
An Exploratory Study
Of The Impact People Who Wish To Communicate
With Their Physician Via Internet-Based Applications
Will Have On The Physician’s Practice

By

F. Gordon Jones, MHSA, PAHM
A doctoral project submitted to the faculty of the Medical University of South Carolina in partial fulfillment of the
requirements for the degree Doctor of Health Administration in the College of Health Professions.

F. Gordon Jones, MHSA 2001 © All rights reserved.


Dedication
To my parents, Lynn and Fred
Jones, for raising me with Intestinal
Fortitude to complete such a task.
My sisters, Ashley Lawrence and
Ruth Soliday for their moral support
and the early childhood competition
to always strive to be better.


Personal Disclaimer

“Then one day I realized… I’ll never have enough RAM.”

The Environment
$1.3 Trillion
$500 Billion Unnecessary
13% Rise in Premiums
Shift of Burden to Employees
Cost of Telecom and Computing Dropping
154 Million in US with Internet Access
85 Million Regularly Search for Health Info
Physicians are Resistant to Change
Internet has Enabled Patients

The Environment
Consumerism in Healthcare is shifting
to the individual and away from the
group purchasing sponsored health
plan system of the past.


The Environment
While all of the government
mandates under HIPAA and PBR, and
the cost efficiencies associated with
utilizing the Internet will be a driver to
accept eHealth technology in the long
term…


The Consumer Mandate
It will be the early adopters and the
revolutionary initiatives of eHealth
Consumers that will require physicians
and other healthcare providers be
accessible via the Internet, 24 hours a
day, 7 days a week, from anywhere in
the world NOW NOT LATER.


The Problem
Though 85% of physicians have
access to the Internet and an email
account
Only 35% of them are using it for
their practice
And even then it is to email
colleagues and conduct research
Not communicate and interact with
their patients

The Research Question
The question that needs to be
answered for the physician
community is…
Are eHealth Consumers choosing
their physician based upon the
accessibility they, as the patient, have
to their physician via the Internet and
other eHealth technology?

What is eHealth?
eHealth: n. A term used to
described Internet and web based
applications used in the healthcare
industry.


What is eHealth?
1. The transformation of healthcare
business processes through the
application of Internet principles and
technologies.


What is eHealth?
2. New way of conducting the
business of healthcare enabling
stronger and more effective
connections among patients, doctors,
hospitals, employers, brokers, payors,
laboratories, pharmacies, and
suppliers.


What is eHealth?
3. Is the customer driven eRevolution
in healthcare.


Literature Review
Studies and Analysis in the use of
Advanced Information Systems and
eHealth Technologies.


Review of Information Technology
50 years into the information age and
while medical technology is highly
advanced…
The management of healthcare is still
decades behind.


A Gustafson et al study conducted a
demonstration of how a computer
based information management
system assisted HIV patients to better
communicate and comply with their
physician’s orders and treatment
plans.


Other studies by Batalden, Altman
and Hague demonstrated how health
information systems can improve the
quality of healthcare.


According to a 1997 IJMI article by
Dr. A. Hasman, the goal of [health]
informatics is to develop a technology
that is favorable to both the care
provider and the patient.


American Medical Association (AMA)
statistics show that, only 20% of
physicians in the U.S. were accessing
the Internet in October 1997, most for
email and research, but by the end of
2000 those estimates were as high as
85%.


Review of eHealth
A 1999 survey by the Yankelovich
Monitor found that more than half of
Americans are not satisfied with the
availability of their physicians and not
satisfied with the duration of their
meetings with their physicians.


Review of eHealth
Contrary to conventional health
industry trends, these eHealth
consumers are willing to pay cash for
eHealth services, according to a joint
survey conducted in 2000 by Deloitte
Research and Cyber Dialogue.


Review of eHealth
A Harris Interactive consumer survey
found that 93 percent of the
respondents say patient education
and individual empowerment to
participate in healthcare decisions is
very important.
82 percent of the respondents think
Internet access will improve
communication with their providers.

Review of eHealth
A Pew Institute Survey shows 52 million
American adults, or 55 percent of those
with Internet access in June 2000 (95
million), have used the Internet to get
health or medical information.
Defined as “health seekers,” half say the
resources they find on the Internet have a
direct effect on the decisions they make
about their healthcare and on their
interactions with physicians.

Review of eHealth
93 percent of health seekers say the
ability to seek information at any
hour of the day is very important
80 percent say it is important they
can get this information
anonymously.


Review of eHealth
First Consulting Group’s (FCG)
eHealth Trends Report shows that
individuals are demanding
connectivity and communication with
their insurance companies as well as
their physicians
And that these they will vote with
their feet if they don’t gain real-time
access to the information they want

Today…

US Population
290 Million

Internet Users 53%
154 Million

eHealth Consumers 29%
85 Million


Research Hypothesis
eHealth consumers are predisposed
to choosing a physician who uses
eHealth technology as a means to
making the physician more
accessible to the patient.


Research Hypothesis
 a) Females are more likely to be
eHealth consumers and choose their
physician (or one for their families)
based upon that physician’s
accessibility via eHealth.


Research Hypothesis
b) eHealth consumers over 55 are

more likely than younger eHealth

consumers to choose a physician who

uses eHealth technologies.


Research Hypothesis
c) eHealth consumers who will be
switchers can be profiled based upon their
Internet-based purchasing habits, the
distance the consumer lives from their
physician, and their level of interest in
communicating with the physician over the
Internet the next time they are ill.


The Study
Following the Pew Institute format where
after interviewing over 12,000 people, 521
“health seekers” were addressed by phone
answering 27 questions.
This eHealth Consumerism study was
conducted on the Internet site,
Zoomerang.com, which identified 5000 of
14 million Internet users who qualified as
eHealth Consumers.


The Study
The response rate was 11% with 561
eHealth Consumers responded to the 23
question online survey.
Each question was defined for a specific
purpose and edited for these criteria:
a) What is the intended use of the
information gathered from this question?
b) Is it absolutely essential to have this
information to address the research
questions?

The Questionnaire & Basic Stats
Demographic; 6 questions


Actions performed online; 6 questions


Opinion questions: 6 questions


Behavioral initiatives; 5 questions


The Baseline Demographics
eHealth Consumerism Invitees Female Male 55 & Over 17 to 54 5000
Respondents 450 107 41 517 561
81% 19% 7% 93% 100%

Purchased medical services online 36 18 11 40 57
8% 17% 26% 8% 10%

Considered in Good Health 357 77 26 319 445
80% 71% 63% 61% 79%

Discussed Health Info Online 4 3 0 8 8
1% 3% 0% 1.50% 1%

Discussed Health Info in Person 171 37 16 192 209
38% 34% 38% 37% 38%

Internet Access is Important 171 52 24 205F.DoctoralJones, MHSA
Gordon
229
Project DHA

Discussed Health Info in Person 171 37 16 192 209
The Baseline Demographics 38% 34% 38% 37% 38%

Internet Access is Important 171 52 24 205 229
38% 49% 58% 36% 41%

Miles from Physician: 0 to 2 79 17 2 94 99/18%
2 to 5 90 59 24 117 151/27%
5 to 10 115 55 22 150 156/28%
10 to 20 88 13 12 89 102/18%

Switch No 261 59 29 287 316
58% 56% 72% 55% 57%

Switch Yes 49 7 1 56 57
58% 7% 2% 11% 10%

Switch Don't Know 139 39 10 175 185
Table 2.1 31% 37% 24% 39% 33%


The Average Respondent
A 36-year-old female
Lives within 10 miles of her physician
Accesses at least two websites at least
once a month for health information
Even though she considers herself in good
health
She believes the information has
influenced her healthcare decision-making
Resulted in improving her health status
She belongs to a managed care plan

The Average Respondent
She would like access to:
 her physician’s credentials
 experience levels
 the quality of the care provided to other patients

Having access via the Internet when she is
ill is not very important
She would like to be able to:
 submit symptoms of an illness to her physician
 schedule an appointment
 access her personal medical records via the Internet

eHealth Stats – All Respondents
eHealth consumers make other purchases
Purchases online
% of eHealth Consumers

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
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Products or Services Purchased


53% stated that the information actually
influenced how they treated an illness
Did the information influence your decision how to
treat an Illness?

9%
21%
Not at All
Not too Much
Somewhat
44%
26% Yes, very Much


44% stated their latest search was
unrelated to a specific physician visit.
When did you Search

Unrelated
A visit to a Physician

Instead Of
Series1
After

Before

0% 10% 20% 30% 40% 50%


eHealth Stats – Females to Males
The first hypothesis stated that
females would be more likely to utilize
eHealth technologies.
Of the 81% of respondents who were
female, only 8% responded
“occasionally” or “often” when asked
how often they have purchased
medical services on the Internet as
opposed to 17% of the men.

39% of female eHealth consumers believe
it at least somewhat important as opposed
to 49% of males.
When next you are ill, will Internet access to your
Physician be important?

58%
60% 49% 50%
50%
38%
40%
% of eHealth
30%
Consumers
20%
10%
0%
Female/Important Male/Important Female/Not Male/Not


Both males (58%) and females (56%)
stated they would not switch to
another physician.
But 11% of females and 7% of males
responded that they would switch to
the other physician using eHealth
technologies.


A statistic that will be discussed
further the 33% of females and 35%
of males who are undecided or don’t
know if they would switching.


eHealth Stats – 55 and Over
7% of the respondents were 55 and
over.
1/4 of the 55+ said they have
purchased medical services online
While 10% of those under 55 had


Those 55 and over who have purchased
medical services online.

100%
80% 74%
60%
40%
26%
20%
0%
who have who have not


72% of those 55+ responded that they
would remain with their current physician.
55+ eHealth Consumer

62%

72%

Would not Switch Important to have Internet Access


Through discriminant analysis it was
determined that as age increases it is
less likely that they would switch.
This is contrary to the original
hypothesis where there was no
significant indication to support the
age hypothesis.


eHealth Stats – Switching
57% of eHealth consumers would
remain with their present physician
whether or not the physician used
eHealth technologies to communicate
with patients.
10% of eHealth consumers said they
would switch from their current
physician to another who uses
eHealth technology.

eHealth Stats – Switching
33% are Undecided
Change to an eHealth Physician

33%
Remain
Change
57% Don't Know

10%


Discriminant analysis
Profile potential switchers based upon the
group variables
(1) they would not switch
(2) they would switch
(3) or they did not know
As to the independent variables
(v22) the gender question
(v3.1-v3.8) previous Internet purchases
(v19) when ill is access via the Internet
important
(v8.6) described a medical condition online
(v8.4) emailed a physician symptoms

Mean Std. Valid N
Deviation (listwise)
Switch Unweighted Weighted
No
Female/Male 0.1975 0.39871 314 314

Imporant/Not 0.6433 0.47979 314 314

55+/Under 1.2962 0.4573 314 314
Purchased/Not 0.7197 0.44984 314 314
Yes
Female/Male 0.1404 0.35044 57 57
Imporant/Not 0.4211 0.49812 57 57
55+/Under 1.193 0.39815 57 57
Purchased/Not 0.807 0.39815 57 57
Don’t Know
Female/Male 0.2033 0.40356 182 182
Imporant/Not 0.5549 0.49834 182 182
55+/Under 1.2033 0.40356 182 182
Purchased/Not 0.7912 0.40757 182 182
Total
Female/Male 0.1935 0.39539 553 553
Imporant/Not 0.5913 0.49203 553 553
55+/Under 1.255 0.43624 553 553
Purchased/Not 0.7523 0.43209 553 553
Table 2.10


Based upon the hypothesis they a
potential switcher could be profiled.
There was not enough significant
difference in the means of the group
variables to identify the specific
factors defining an eHealth Consumer
that will switch.

eHealth Stats
Most eHealth consumers are using the
Internet to gather information about their
health concerns
They would like to communicate with their
physician via the Internet
But they are not choosing their physician
based upon the accessibility they have to
them via eHealth technology.


Summary of the Hypothesis
The 10% that have indicated that
they would switch to a physician
There is no indication that age or gender, as
the hypothesis predicted, is a factor
Also, the data does not give an indication as
to the specific factors that would allow the
establishment of a profile of the eHealth
consumer that is likely to switch physicians.


Effects on Revenue
An active patient equals $260 per year

PCP has an active base of 2,500 patients

29% or 725 of them are eHealth
consumers

10% or 72 of them may switch

This would result in a $15,120 per year
reduction in the revenue of the practice.

eHealth Switchers

US Population
290 Million

Internet Users 53%
154 Million

eHealth Consumers 29%
85 Million

3%
eHealth Switchers 8.4 Million


Economic Value
To the PCP sector this potential shift
of 3% of the population represents
$1.7 billion in revenue.
Additionally, 33% of the respondents
that stated they were undecided
whether they would switch or not,
represents another 5.1 billion in
primary care dollars.

The $ is the Designer
If the physician and patient is to benefit
most, then they must adopt the
technology soon
They should not expect the hospital,
health insurance company or
pharmaceutical company to pay for it
They must fund the projects themselves so
that the systems benefit their needs and
not those of the other organizations paying
the bills. Doctoral Project DHA

Technology Evolution
Launch Takeoff Saturation

eHealth Crossing the
Hype Chasm to
Explosion eHealth-2001
1999

Chasm
Innovators Early Early Early Late Laggards
Adopters Followers Majority Majority

Source: Geoffrey Moore, Inside the Tornado

Further Analysis
This study is only the beginning as it
represents a baseline of data that can
be used over time to determine the
growth of eHealth consumers and
their propensity to switch to
physicians using eHealth technologies
to communicate with their patients.


What does all this mean?
As an advisor to physicians…
Illustrate how the shift of cost of
healthcare from the employer to the
individual is going drive people to
eHealth physicians.
Demonstrate the loss of revenue


What does all this mean?
 Develop a strategy, either…
Don’t worry, stay the course,
retiring soon…
Go get ‘em, bring it on and adopt
the new with vigor!


It is not about the Technology
Political philosophy
Diversity of opinion
Heated debate to solve the problems
accessibility of care
intrusive managed care bureaucracies
the dangers of medical errors
skyrocketing costs


Conclusion
Many just happen to believe that it
will be the integration and use of
electronic medical record, financial
management and telecommunication
systems, as…

“eHealth technologies”
That will save the day for healthcare!

Acknowledgements
 My thoughts also go to my nephew, Shriver Soliday,
and other future decedents whom I pray will grow up
to pursue their dreams with the love and support of
family and friends, as I have been so fortunate to
receive.
 This project immerged out of an evolving belief that a
new era is dawning in healthcare and though as slow
as ever, accelerating everyday. David Kunz, MD has
been my closest advisor and committee member for
the past two years. He has lent great insight to this
effort and we are of like minds in our evangelistic
efforts to promote the benefits that eHealth will bring
to healthcare in the US, especially in rebuilding the
bonds between physician and patient.

Acknowledgements
 Certainly, I appreciate the excellent guidance I
received from the chairman of this doctoral project,
David M. Ward, PhD and committee member, Thomas
McIlwain, Ph.D. A very special thanks goes to
counselor and committee member, martin Jones,
ph.D., for his guidance through the doctoral project
maze and sometimes haze.
 This study would not be coherent and readable if it
was not for my editor, tom smith, with the MUSC
writing center.
 Finally, I dedicate this to God as my creator who has
blessed me with the human ability to pursue such
excellence and Jesus Christ who protects and guides
me through life.

91% of them live less than 20 miles
Mileage from Physician

30%

25%

20%

15%

10%

5%

0%
< 2 Miles 2 to 5 5 to 10 10 to 20 20 +
Miles


56% of eHealth consumers search the
Internet for health information at least
once a month, even though 79% consider
themselves in good or excellent health.
61% believe the health information they
have gotten from the Internet has
improved the way they take care of their
health, with 88% stating that the
information was “somewhat” or “very
useful.”

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