Healthcare in the Time of Digital Expansion

 

While the expansion of information technology has created a digital universe of medical resources, finding the most reliable resource with the right information can be a challenge. Increases in the volume of digital information may have the opposite effect of decreasing the chances of finding the most appropriate source of information in the least amount of time. ¹  Brian Nguyen and Leo Han write in the new edition of Contraceptive Technology that there exists no restriction on the content that can be uploaded to the internet or on the types of apps that are developed for mobile phones.²  These digital resources do not necessarily receive oversight from experts and can vary widely in their quality.³  Unlike traditional print sources that have publishers and editors to ensure the quality of content, digital resources do not have the same controls.

While digital resources for health and medical information can be more comprehensive than those that can be provided by a health care practitioner (HCP) during a clinical encounter, these resources do not always relay how the information should be used or how it may fit into the context of a patient’s condition or concern. For this reason, helping patients navigate the digital landscape plays a new but increasingly important role in the overall counseling that HCPs provide, advise Nguyen and Han. As more than 75% of patients will begin their search for health information by using popular search engines such as Google, Bing, or Yahoo, they may face difficulty in parsing out the most appropriate sources for their queries.⁴  HCPs today should thus have a repository of useful digital resources. HCPs can then direct patients to these trusted sites or applications for further information.

In a systematic review of 79 studies that examined the accuracy and utility of digital health resources found on the internet, nearly 75% of the studies expressed concerns regarding the quality of digital content.⁵  While there are many high-quality digital resources available to consumers, there are arguably many more “resources” that represent anecdotal evidence, specific opinion, or commercial interest.

Furthermore, in a study examining how lay users searched for answers to specific health-related queries on the internet, users endorsed the importance of the credibility of their sources of information; however, in observations of their browsing practices, these users never examined the “About Us” sections of websites to verify credibility and, when interviewed, could not recall the sources from where they derived their health information.^₆ Inexperienced or unguided users of digital resources may likely be met with frustration, misinformation, or incomplete information.

With quality, utility, and staying power in mind, Nguyen and Han culled digital reproductive health resources to create a foundational list in Contraceptive Technology, that they hope may become a springboard for HCPs to collaborate with patients in the digital space. Below are the URLs and descriptions of those they designate as the “top three” family planning websites.

Top three family planning websites: 

Organization	URL	Content
The Centers for Disease Control and Prevention	www.cdc.gov	Essential resource for healthcare providers. Reliable and regularly-updated home to the: U.S. Medical Eligibility Criteria (MEC) Selected Practice Recommendations  for Contraceptive Use (SPR) Sexually Transmitted Disease [STD] Treatment Guidelines Updates on infectious disease outbreaks (e.g., Zika, drug resistant-gonorrhea)
Bedsider	www.bedsider.org	Essential resource recommendation for patients. Designed with the patient’s interests and health literacy in mind, the website delivers accurate information with tools to help patients obtain access to and decide on an ideal method of contraception.
The Emergency Contraception Website	http://not-2-late.com   http://ec.princeton.edu	Resource for research, policy, and clinical information about emergency contraception (EC), including the appropriate Yuzpe dose by pill-type and where to direct patients to obtain EC.

While lay consumers of digital information and resources are at the greatest risk of encountering the shortcomings of digital health resources, early learners in the medical field are also at risk, given reports that medical students frequently rely on digital resources for their learning. Senior medical faculty have raised concerns about the ability of early learners to discern reputable from non¬reputable sources,⁷ which may ultimately have an impact on how students counsel and practice when they become HCPs.

The amount of clinical research being published continues to grow at an increasing rate.10 Healthcare providers are thus responsible for more information than ever and expected to constantly maintain up-to-date knowledge of medical evidence, healthcare policy, and professional guidelines. Fortunately, digital resources help HCPs maintain their expertise. Below are Nguyen’s and Han’s “top three” reproductive health care apps for health care providers:

Top three “must-have” family planning apps (available on Apple and Android platforms):

Source	Content
Contraceptive Guidance for Health Care Providers from the CDC	Easy-to-use, easily searchable mobile app version of the U.S. Medical Eligibility Criteria and Selected Practice Recommendations (MEC/SPR).
STD Treatment Guidelines from the CDC	Easy-to use mobile app with the most evidence-based screening and treatment regimens from the CDC.
Agency for Healthcare Research & Quality’s Electronic Preventative Services Selector (AHRQ ePSS)	Interactive, patient characteristic-specific mobile app that compiles and simplifies preventative health recommendations from the U.S. Preventative Services Task Force (USPSTF) for the primary care clinician.

1. Damman OC, Hendriks M, Rademakers J, Delnoij DM, and Groenewegen PP. How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews. BMC Pub Health 2009;9:423.
2. Nguyen B, Han L. Digital resources for health & medical information. Appendix 1. In: Hatcher RA, Nelson A, Trussell J, et al. Contraceptive Technology. 21st edition. New York, NY: Ayer Company Publishers, Inc., 2018.
3. Hirsch M, Aggarwal S, Barker C, Davis CJ, and Duffy JM. Googling endometriosis: a systematic review of information available on the Internet. Am J Obstet Gynecol 2016;216:451-458.
4. Fox S, Duggan M. Health online 2013. Washington, DC: Pew Internet & American Life Project. www.pewinternet.org/2013/01/15/health-online-2013/#. Accessed Sep 20, 2017.
5. Eysenbach G, Powell J, Kuss O, and Sa ER. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002;287:2691-700.
6. Eysenbach G, Kohler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ 2002;324:573-7.
7. Implementing digital resources for clinicians’ and patients’ varying needs. Med Inform Internet Med 2005;30:107-22.