The problem of Internet information is not only a shallow, encyclopedic rendering of complex topics^**, but also an ever-growing cesspit of misinformation from unscrupulous persons (see quackery.)

The internet is choked with unscientific “alternative” health sites which purport to hold insights into “what doctors don’t want you to know.” They prey on the uniformed, the naive and the desperate, to peddle dietary supplements, exotic foreign juices and daily colonics. All of which are, at best, expensive placebos, and at worse, dangerous and sinister. These fraudsters sidestep the FDA, double-blind tests, and the scientific method by verbal slight of hand and faulty logic such as, “If doctors were successful at curing people, they would be out of a job, so it’s in a doctor’s best interests to keep you sick.”

And then there is Web2.0 that, with all its promise, is also full of user-generated nonsense. “Blogs have become so dizzyingly infinite that they’ve undermined our sense of what is true and what is false, what is real and what is imaginary. These days, kids can’t tell the difference between credible [information] by objective professional[s] and what they read on [any blog]“^***

So, in summary, ten minutes of Goolging doesn’t make you a doctor, much of what you read online is false, massive doses of vitamin C doesn’t cure cancer and Kevin Trudeau is a con man.

So, how do we solve this problem? “All animals are created equal, but some are more equal than others,” was certainly bad policy for the pigs in Animal Farm, but when applied to Internet medical content, it’s unarguable that not all content is created equal. Perhaps some sort of non-profit certifying organization could help mark the reliable and credible sources of information? Democratic moderation isn’t the answer, because what is popular is not the same as what is correct. Expert systems are a step in the right direction. An EHR that allows you to chat/email with physicians is another good remedy. What do you propose?

* “A survey of 106 GPs, published last month in Australian Doctor magazine, found almost 40 per cent of doctors spent nearly a day a week on patients who had incorrectly diagnosed themselves or their children.”
see http://www.smh.com.au/news/technology/diagnosis-by-internet-wastes-time-say-gps/2007/07/13/1183833772789.html

** “A little Learning is a dang’rous Thing;
Drink deep, or taste not the Pierian Spring:
There shallow Draughts intoxicate the Brain,
And drinking largely sobers us again.”
An Essay on Criticism, Alexander Pope

*** Andrew Keen, The Cult of the Amateur: How today’s Internet is killing our culture

Some people will give you big lists of PROS and CONS. Not I. Hosting your own EHR is dumb and I’ll tell you why. YOU’RE A DOCTOR. You’re supposed to be practicing medicine, not worrying about server uptime and security and maintenance patches. You should let a competent EHR company manage your data and the program upkeep. Client server programs were great in the early 90s before the Internet, but they are something much less than intelligent now. Here’s the reality: everyone is online nowadays. If you’re not online, you need to buck up and get online. It’s a necessity in today’s world. Your patients need to be online. They need access to their own medical records, too. The client server approach doesn’t provide that. ASPs do — they allow you to access your data anywhere in the world at any time. That’s the power of the Web and you should be leveraging that.

Some will argue that a web approach isn’t as “rich” a user experience as the client/server. Those people were right several years ago, but with AJAX, Flash, and Java they are now WRONG; everything you can do in a client/server graphically, you can do in a browser. Others will say that ASPs are slower. Again, this is simply an antiquated view. Bandwidth is cheaper than an in-house IT staff. If you want to be ensured of constant connectivity, buy several DSL lines from different vendors and aggregate them together. You will save money.

Don’t be fooled by 80s era companies living in the dark ages. The ASP model is the right one. Choose it and be happy.

Some releated links for further reading:

http://emruser.typepad.com/canadianemr/2004/06/is_asp_vs_clien.html
http://businessweek.buyerzone.com/software/electronic-records/buyers_guide6.html
http://www.emrexperts.com/emr-ebook/client-server-vs-asp-comparison.php