Ignorance, Knowledge, Internet and Health: Collaborative Role of Healthcare, Pharmaceutical and Technology Companies in the Society's Future- World is the Market, Align Profits with Care

By Mohammad Anas Wahaj; MBA, University of Illinois at Urbana-Champaign, 2000, USA; BS in Mechanical Engineering, Aligarh Muslim University, 1993, India
Dated: 19 June 2003

Introduction

Ignorance, the disease of the mind, is the root of various problems for the society. In the context of health, ignorance could be considered as one of the major cause of human suffering from diseases and disorders that otherwise would have been understood, prevented or cured. Physician Lewis Thomas said, "The greatest of all the accomplishments of 20th century science has been the discovery of human ignorance." But the answer and the resulted success of the human race lie in finding solutions for the discovered ignorance.

Awareness and dissemination of knowledge about diseases and their causes and effects would help us prevent human pain and suffering not only physical but also psychological. Timothy Ferris, a science writer, in relation to ignorance mentions, "Our ignorance, of course, has always been with us, and always will be. What is new is our awareness of it, our awakening to its fathomless dimensions, and it is this, more than anything else, that marks the coming of age of our species." The more we know about ignorance in its various forms the better we would be able to target resources and energies to overcome it.

Integrating and consolidating efforts, with Internet as a medium, for dissemination of health and medical knowledge for diverse socio-economic segments of the society would assist to overcome ignorance and to develop an overall knowledgeable and health aware society. Technology for the improvement of health care systems, technology for drug development & delivery and technology for knowledge creation and dissemination geared towards the consumer will benefit in our quest for informed and healthier world. Bringing the information and knowledge from around the world at a single platform will reduce duplication and would lead to the faster creation and dissemination of new medical thoughts and discoveries and cure for diseases before they become global catastrophes and threaten the existence of the human race.

Consider the example of SARS and its quick spread that made the world vulnerable. To predict evolution of new illnesses and modern day epidemics is difficult. Urbanization, increase in global commerce, international travel and interaction of diverse communities has exacerbated the movement of pathogens across national boundaries. Is global information and healthcare infrastructure ready for combating or preventing SARS like happenings in the future?

According to Yues L. Doz and Gary Hamel in their book "Alliance Advantage", " Strategic alliances are a logical and timely response to intense and rapid changes in economic activity, technology and globalization, all of which have cast many into two competitive races; one for the world and the other for the future". The corporations in the technology, healthcare and pharmaceutical industry would have to collaborate at a global level in ways that has never been done before to align profits with care for healthier and knowledgeable futuristic society. These collaborative efforts should be targeted considering every individual and member of the society as the proactive health consumer, thus defining the market as the whole human race.

In his book "Leadership Engine" Noel M. Tichy mentions, "The success of the institutions in the new millennium will increasingly be determined by how much smarter they can become every day through knowledge creation and through aligning members of the organization with new knowledge". These principles of organizational collaboration and knowledge creation can be applied globally from the perspective of health in which each member of the alliance contributes in its own specialized way to better serve themselves and the society.

Ignorance: The Disease of the Mind- Local and Global Occurrence

There are numerous examples around the globe where health ignorance is prevalent in various forms and is to be fought with knowledge and education by integrated and organized efforts. According to researchers led by Dr. Mark Hawken of the Kenya Medical Research Institute in Nairobi, nearly one in every five young woman in Kenya now has AIDS virus infection.

Researchers point to ignorance as the reason for the explosive spread of HIV. Only 7% of Kenyans knew that existing medications could help prevent the transmission of HIV from a pregnant woman to her fetus. Uganda has been able to reduce its HIV prevalence rates from an estimated 14% in the early 1990's to around 8% in 2000 with the help of extensive information and education campaigns. Widespread education efforts have also assisted Senegal to maintain its HIV prevalence rates below 2%.

In U.S., a survey of 573 general practitioners, nurses and parents of children who have asthma showed that less than 60% of parents felt that they were provided complete information about its treatments. About 2/3 of parents are ignorant of the potential side effects of conventional asthma treatments. Prof. David Price of the University of Aberdeen said that the survey results indicate need for improved communication among healthcare professionals and parents of children with asthma. According to Parkinson's Disease Society (PDS) misconceptions about Parkinson's disease makes it difficult for patients to get the needed treatment. Public often considers that only elderly people get the disease, that they are stupid and always suffer from tremors.

According to UNAids report, in India public ignorance is accelerating the spread of HIV. An estimated 1% of India's one billion population has HIV. Illiterate Indians are 6 times less likely to use a condom during casual sex compared to those who finished secondary school. The survey showed that public education campaigns could make a difference. Ignorance and poverty are worst carcinogens in India according to specialists dealing with women dying of preventable cancers. " A high 80% of victims seek treatment for oral, cervical or breast cancer only at the third or fourth stage when little can be done," says Dr. Vinod Kochupillai at the Institute Rotary Cancer Hospital. Dr. Kochupillai correlates late reporting to ignorance about early signs of cancer such as ulcer in the mouth, a lump in the breast or vaginal bleeding.

Jacqueline Kerr, researcher at Munich Cancer Registry in Germany, found that women with the disease who felt their doctors did a poor job of helping them understand about the condition of their bodies suffered more lingering problems after treatment than women who felt well informed. Women say that they wouldn't be as frightened if they were more informed and have understanding of the health problem and are able to anticipate the symptoms. Information and knowledge provides more control over feelings and ability to optimize expectations.

In a speech to government officials in China, Dr. Qi Guoli of Beijing Medical University advised that people aged 30 to 50 are at higher risk of premature death due to hypertension and hyperlipemia. He mentioned that far too many Chinese have died of disease rather than of old age and that this incidence is abnormal. He wants to publicize health care and disease prevention to all government departments in China. In Japan there are consistent efforts to promote health care education through the community and everyone can attend a healthcare class each month.

These numerous cases of lack of information and knowledge about a certain disease, about a certain disorder, about a certain condition are causes of prevalent human pain, stress, depression and suffering around the globe. The challenge is to overcome the ignorance with collaborative technology integrated information, knowledge and healthcare efforts.

Internet: The Medium- Interactive and Knowledge Society

In the abstract of the 1997 paper "Realizing the Full Potential of the Web", Tim Berners-Lee, founder of the web, mentions, " The first phase of the web is human communication through shared knowledge. We have a lot of work to do before we have an intuitive space in which we can put down our thoughts and build our understanding of what we want to do and how and why we will do it. The second side to the web, yet to emerge, is that of machine-understandable information. As this happens, the day-to-day mechanisms of trade and bureaucracy will be handled by agents, leaving humans to provide the inspiration and the intuition. This will come about through the implementation of a series of projects addressing data formats and languages for the web and digital signatures".

Internet, as a powerful medium, provides convenience, functionality and reach and has potential to integrate and propagate society's varied knowledge and learning needs. Internet provides an interactive medium for real-time sharing of medical knowledge about a specific condition and related prevention and remedies. Internet can be a global medium for an early warning system about disease outbreaks and to track infectious diseases. It reduces direct physical consultations due to readily and instantly available preventative knowledge resources.

Internet provides better communication between the various elements of the healthcare supply chain- consumers, providers, insurers and health product distributors. Internet integrated standardization of patient record formats and clinical terminology will support cross-institutional research coordination and multi-center trials. Evidence-based medicine would assist us to create a knowledge base of expert consensus on best practice for most treatable conditions and disseminate this knowledge online. About 360,000 articles are published in medical journals every year but knowledge diffusion to clinicians is typically slow and Internet would assist in overcoming this. Internet has potential to integrate clinical practice and research. Healthcare managers will have more reliable financial and clinical data for effective and efficient allocation of resources. Consumers can select their preferred ePharmacy for prescriptions that will carry forward in their patient profiles.

Internet offers electronic medical records, electronic prescribing, online communication with patients and remote disease monitoring. Electronic medical records will help manage overall practice and patient documentation. Electronic prescribing would effect changes in the drug selection, prescription writing and drug fulfillment process. Online communication and remote disease monitoring offers innovative interaction with patients and would achieve quality of care and reduction in medical errors. It will assist in timely and focused decisions on treatments and interventions.

Interaction between physicians and patients is the core process in healthcare and trust is one of the defining components. Patients expect this trust to act primarily in their interest and not in the interest of third party payers, drug company, fashionable medical theories or physician's own financial interests. Internet would cause behavioral changes in this patient-physician relationship. E-Health Patient Paradox revealed that Internet complements rather than supplants traditional patient-physician relationships. Physician Gerber and Eiser postulate that the Internet age offers opportunities to improve the patient-physician relationship by sharing the burden of responsibility for knowledge. The knowledgeable and interactive global patient and physician communities of common concerns and issues can come together very easily on a single platform on the Internet.

Steven Johnson in his book "Emergence" mentions "Learning is not just about being aware of information, it's also about storing information and knowing where to find it. It's about being able to recognize and respond to changing patterns. It's about altering a system's behavior in response to those patterns in ways that make the system more successful at what its pursuing. The system need not be conscious to be capable of that kind of learning." He also says "Understanding emergence has always been about giving up control, letting the system govern itself as much as possible, letting it learn from the foot prints". Internet provides the tools for creating such an environment of creation, consumption and dissemination of knowledge and learning to overcome the barriers of various degrees of health ignorance.

Internet: The Patients- Proactive and Involved Consumers

Patients use Internet to obtain disease specific information, communicate with their physicians, reduce or eliminate frustrations related to doctor visits, fix appointments with the physicians, refill prescriptions, receive the results of the medical tests, participate in global patient communities, look for information for their spouses, children, friends, parents and other family members and after noticing symptoms of a disease use it as their first information destination. More women then men accessed online health information that indicates their care giving status.

Consumers using hospital and health plan web-sites prefer to evaluate all of their options before making health decisions. Most of them report that the online information enhances their ability to understand their health, communicate with physicians and improves their compliance with prescribed treatments. Patient's use of the online information continues to differ on the basis of the severity of their illness and their attitudes about their involvement in their healthcare. Consumers primarily rely on search engines to seek health information compared to going directly to a health web-site. Health web-sites attract consumer traffic due to doctor and pharmacist recommendations as well as referrals by others.

In U.S. some asthmatic children are already involved in pilot programs with inhalers that are embedded with electronic monitors to track dosage and timing. The data is downloaded to a PC and transferred to a central database. Algorithms are applied to the central database that identify indications of potential asthma attacks and medical intervention needed to prevent attacks.

Diabetic patients can test their blood glucose level by using an e-device that downloads the result to a health care practitioner. Patients with heart failure can step on an eScale that sends instantaneous alerts to healthcare professionals when the patient's weight exceeds the desired range. An eShirt can be worn which transmits heart rate and respiratory rate over the Internet. The federal government has invested $28 Million to evaluate home glucose monitoring via the Internet to homes of under-served rural and inner-city residents in New York State.

Market Research: Trends for Proactive Consumer

Manhattan Research

April 2003

• 45.2 million consumers with chronic health conditions and 43.6 million disease-specific information seekers are actively using health related information and services online (totaling 56.3 million overall).
• Online consumers with chronic health conditions are 20% more likely to recall pharmaceutical advertising (via any channel) compared to offline consumers with chronic health conditions.
• Online consumers with chronic health conditions are 1.9 times more likely than offline consumers with chronic health conditions to request a branded medicine from their physician.

November 2002

• While 10.3 million online consumers have used a hospital web-site in the last 3 months (up from 3 million the previous year), 38.5 million other consumers are still interested in receiving information from a hospital web-site in the future.
• While 11.3 million online consumers have used a health plan web-site in the last 3 months (up from 4.1 million the previous year), 39.2 million other consumers are still interested in using a health plan web-site in the future.
• 77% of consumers visiting a health plan web-site, and 63% of expected future users, report they currently have a chronic health condition.

Harris Interactive

April 16-23, 2002- 10,000 Patients Survey

• About 80% of all patients surveyed now search the Internet for information about health related topics.
• On average patients with chronic medical conditions are going online for health information about 9 times a year.

March 2002

• Number of "Cyberchondriacs" in U.S. has grown from 54 Million in 1998 to 110 Million.

2002- Online Nationwide 2014 Adults Survey

• 90% of those surveyed expressed a desire to be able to contact their doctor online and 37% would be willing to pay out of pocket for the opportunity.
• More than 2/3rd of the respondents would like to ask questions where no visit is necessary (77%), fix appointments (71%), refill prescriptions (71%) and receive the results of medical tests (70%).

The Pew Internet and American Life Project

May, 2002- 3 Principal Reasons to Turn Away from Health Web-site

• Too commercial and seemed more concerned with selling products than providing accurate information (47%)
• Source of the information could not be determined (42%)
• Unable to ascertain when the information was last updated (37%)

Ipsos NPD Inc.

2001

• Majority of people who visited the web in the past 12 months went to health related sites and used the sites for research rather than the purchase of prescription drugs.
• 60% of those who visited healthcare web-sites and requested a specific drug after learning about it on the web were women.

Boston Consulting Group

Online Survey of 14,000 Adults that Use Internet

• Internet is influencing patients to be more involved in diagnosing their condition and selecting treatments.
• Their 2001 research reveals that nearly 2/3 of those using the Internet to explore health questions still rely primarily on general search engines.

American Hospital Association

2001

• Women account for 66% of the 44 Million hospital procedures annually
• 61% of the 700 Million physicians visits annually
• 59% of the prescription drug purchases and 75% of nursing home residents over age 75
• Women make 75% of all household healthcare related decisions

Jupiter Consumer Survey

• 63% of consumers would switch to a doctor with a web-site that offered credible content, capabilities to schedule appointments, or secure communication channels.

Internet: The Physicians- Integrated and Concerned Professionals

The main reasons for physicians use of Internet is to find medical information and read journals, promote and advertise their practice, communicate with their patients, provide patient education and information, visit corporate web-sites for information on drugs and how to prescribe them and communicate with specialty medical societies. Physicians are using Internet to engage in more interactive activity integrating more types of web-sites to their practice and referring patients to web-sites. To enhance quality of care and improve efficiency, doctors are using patient care tools like electronic prescribing, online communication with patients and electronic medical records.

Inpatient doctors tend to be more focused on receiving clinical content from the hospital online. Outpatient doctors ranked access to payers, outpatient laboratories and continuing medical education as valuable Internet integrated capabilities. The primary reason physicians have website is to promote and advertise their practice or provide patient education and information. Physician web-sites can provide a venue for delivering trusted content as well as interactive physician-patient capabilities such as appointment scheduling, prescription renewal requests and secure electronic interaction and communication. The most active clinicians have more opportunities to diagnose conditions, manage patient care, select treatments and write prescriptions. As high involvement and volume providers, they are very valuable customers to be targeted by organizations that seek to influence the delivery of healthcare.

Information that physicians find online influences their knowledge, their diagnoses, the types of drugs they prescribe and the way they interact with patients. While seeking medical information doctors behave like online consumers often returning to their favorite sites. As a result small number of high traffic medical sites are emerging to reach a large volume of doctors online.

According to Jupiter Research medical doctor web-sites are the crucial catalyst to unlocking the $9 Billion dollar market in health transactions by 2005. Claudine Singer, Jupiter Senior Analyst and Research Director, says, "Medical doctor web-sites will be the catalysts for furthering digital adoption in the online health sector. They will drive physicians to interact with patients, forcing integration into their professional workflow and will also provide a platform for patients to use the Internet for meaningful health activities".

Market Research: Trends for Integrated Physician

Manhattan Research

May 2003

• Electronically integrated physicians are using technology to keep up with the latest drug information on the PDA, search online for patient education, complete electronic continuing medical education (CME) and occasionally communicate with patients via e-mail.
• While physicians still want product information and samples from their pharmaceutical detail representative, they increasingly demand integrated, relevant and timely prescription drug information from their online channels too.
• Primary areas of increase include the adoption and utilization of electronic detailing programs (up 10% from last year), accessing pharmaceutical corporate and product web-sites, use of Rx reference databases, as well as searching for drug information online.

Harris Interactive

February 20 to April 4, 2002- 400 Physicians Survey

• Most physicians online also say that the information they find on the Internet has an impact on their knowledge about symptoms, treatments and possible diagnoses.
• Around 3/4th continue to report that the information they find online has an impact on their prescription decisions.

American Medical Association

August to December, 2001- Interviews with 977 Physicians in the U.S.

• More than 3/4th (78%) of physicians surf the web. 2/3rd of physicians access the web per week jumped from 4.3 in 1997 to 7.1 in 2001.
• Approximately 3 of 10 physicians using the Internet currently have a web-site, a proportion that has remained constant since 1999.
• In 2001 the percentage of physicians using the web to advertise and promote their practice grew by 11% from the previous year.

Deloitte Research and Fulcrum Analytics

Telephone Survey of 1200 Practicing U.S. Physicians

• 32% of online doctors visit pharmaceutical corporate web-sites with 61% visiting to learn about new drugs and 51% learning how to prescribe those drugs.

Cyber Dialogue and Deloitte and Touche

Survey of 1200 Practicing Physicians in U.S.

• 50% of physicians use the Internet daily but 20% feel it is essential to their professional practice.

Internet: The Health Industry- Networked and Responsive Organizations

Internet health market is a combination of doctors, nurses, patients, hospitals, insurance companies, laboratories, governmental agencies, pharmacies, researchers and service organizations. Healthcare services are very complex and knowledge intensive businesses. Each health profession has its unique view of the patient's needs, its own language and terminology, and highly territorial perception of its contribution and involvement in the care process. This has created protected information architecture with specific data systems that process and records for payment of the services it provides.

Transactions, information and interaction are the main Internet channels for healthcare market. Integrated technologies can be used to automate various manual processes and administrative tasks, provide real-time information to clinicians and patients and reduce the number of redundant communications and transactions along the healthcare supply chain. Internet enabled integration of varied services will create improved operating and communication efficiencies.

Internet intends to overcome one of the biggest barriers in the healthcare industry- response time. It reduces the time it takes to make referrals, get test results, get paid, find patients for clinical trials, disseminate best practices, share cost information etc. Internet eliminates overpayments and reduces rework and manual processes for providers. For suppliers it reduces administrative tasks for sales representatives and provides them more time to sell. Real time availability of sales transactions allows suppliers to better fill orders and manage operations.

Electronic prescribing, with its major impact on formulary enforcement, poses an obvious threat to pharmaceutical companies because it may limit their influence over drug selection by physicians. As more physicians recommend health-related web-sites to their patients there is convergence in reaching the physicians and patients. Hence healthcare players can have a unified marketing approach to target both physicians and patients.

According to Cyber Dialogue Internet is one of the most cost-efficient channels to create consumer demand for prescription medication. There are variety of electronic prescribing solutions that are available in the market like programs for hand held devices, Internet based applications and systems designed to interface with office management software and electronic medical records. Some systems provide printed prescriptions, drugs based on a patient's insurance coverage or warn about potentially dangerous drug interactions. More sophisticated systems suggest drugs customized to the patient's medical condition and even initiate lab tests to monitor the patient's response to treatments.

Healthcare organization web-sites that intend to achieve acceptability by physicians and other healthcare providers should integrate them in site development. Internet strategy should include online programs that complement offline initiatives intended to increase demand, improve compliance and promote patient success. Pharmaceutical companies can analyze opt-in online data obtained from direct to consumer (DTC) web-sites to maximize the return on investment while also improving the quality of life for site visitors.

A DTC web-site that offers online condition management could also offer personalized product messages, support information, patient education and monitoring tools that enable online communication between a patient and physician. This would make consumers more comfortable interacting with pharmaceutical companies because of the benefits they will receive in return. A study of several major pharmaceuticals industry DTC web-sites by Electronic Ink has found that poor user experience has likely had a negative impact on ROI.

Pharmaceutical companies spent about $13 Billion in 2000 marketing to doctors almost exclusively through traditional channels such as sales force, physicians meetings and advertisement in print journals according to WR Hambrecht & Co. Research shows that only 1% of that amount to reach doctors through the net. As physicians, unlike patients are easy to find online, it will be easier for healthcare companies to tap into the power of online knowledge enrichment by targeting them. More than 2/3rd of physicians surveyed behave like online consumers returning regularly to between 2 & 5 sites.

Pharmaceutical companies can fund studies that are published in online and offline journals, targeted advertisements that disseminate medical information on sites frequented by physicians. Companies should make clear distinction between information and promotion. According to Cyber Dialogue the ability of web-sites to provide more information about a drug than a commercial or advertisement pays off for the drug companies.

Internet represents power shift towards patients and away from institutions and professionals. This represents a need for a focused hospital Internet strategy. The most valuable use of the Internet is not to market the hospital but to make the use of the hospital easier and more transparent to consumers. Hospital executives should view Internet applications as facilitators of building relationships with consumers and reduce the cost of resolving their health problems. Internet may also help replace bricks and mortar based administrative and clinical processes with electronic processes that are more responsive and transparent to their users.

Global market in health can now be imagined with a global patient community willing to travel different places for specifically identified treatments or remain at home but receive best-in-class care from a provider halfway around the globe. The Internet delivers the possibility of uniform and local access to global information and services as well as access to best quality care. HIPAA (Health Insurance Portability & Accountability Act) compliance impacts every layer of the healthcare delivery system, from doctors to insurance providers, from medical records clerk to hospital CEO's and according to IDC would lead to the growth in IT spending to more than $18 Billion by 2006.

Health care is a very highly regulated legally complex field and information itself is becoming the subject of unprecedented controversial new laws. In order to succeed in this lucrative niche companies will have to master not only technology but also the complex law and culture of their market. The emergence of ePharmacy has raised questions about the ability of US FDA and state licensure agencies to effectively control the sale and distribution of prescription drugs. The combination of heavy encryption and untraceable digital cash could lead to a noticeable increase in the flow of controlled substances to illicit users, as well as lot of potentially dangerous selfmedication.

How to maintain supervision and control of prescription drugs while opening a new and valuable channel for cost reduction is a complex policy issue.

Internet: Health Alliances- Dynamic and Adaptive Collaborations

Jeffrey H. Dyer in his book "Collaborative Advantage" mentions, "Competitive advantage is increasingly jointly created, and shared, by teams of firms within a value chain- Collaborative Advantage within the extended enterprise. The term extended enterprise refers to a value chain in which the key players have created a set of collaborative processes that allow them to achieve virtual integration and work together as an integrated team."

In the age of rapid changes, rapid innovations with no single solution, no single technology there is an unprecedented need for dynamic and adaptive collaboration. Collaborative model for healthcare, pharmaceutical and technology companies would be a creative, coordinated and integrated use of core competencies to be aligned with the common goal of providing total healthcare experience to the networked society. Reduced barriers between industry players will enable new levels of collaboration to create a resilient fabric of interdependent health focused players linked in real time over the net.

Healthcare providers should focus their resources towards an operating strategy of dynamic and adaptive collaboration. Internet integrated technologies that reduce the cost of coordination lead to the success of this alliance strategy. The key challenge is to bring together different organizations with complementary capabilities and competencies that together add greater value to customers and society then they would alone and are able to adapt to the changing needs of the market. This kind of collaboration and coordination would be the theory of "Emergence" applied to organizations.

Warren Bennis in "Organizing Genius" says, "In a global society, in which timely information is the most important commodity, collaboration is not simply desirable, it is inevitable." He further adds, " Gifted individuals working alone may waste years pursuing a sterile line of inquiry or become so enamored of the creative process that they produce little or nothing."

The demand for talent and capital required for the success of providing technology integrated health services to the overall society may be too cumbersome for a single company to handle. World-class skills and competencies may be easier to find outside from complementary sources than to be developed totally internally.

Consilience of genetics, comparative genomics, high throughput biochemistry and bioinformatics provides tools that allows analysis and understanding of the function of organisms in health and disease at a very high level of molecular detail. Anticipating and predicting human health progress with the help of genetic analysis, consolidated medical records and medicine history and the present health condition and providing preventive measures would require collaborative efforts between variety of researchers, practitioners and organizations in the healthcare, pharmaceutical and technology industry.

Accurate real-time sharing of reliable data will facilitate effective planning and delivery of seamless services across organizational boundaries. The creation of structured databases promotes standardized nomenclatures and methodologies, codification of medical knowledge and interdisciplinary, inter-institutional and industrial collaboration.

According to Jorgen Drews of Hoffman La Roche, integration of genomics, signaling pathway analysis, target validation, combinatorial chemistry, whole cell functional assays, fluorescence technologies, robotics, miniaturization and drug screening is the key to obtaining novel drugs from individual technologies.

According to Caroline Kovac, GM IBM Life Sciences, "What will occur in the future is that doctors will actually use electronic record databases systems, which eventually will be a combination of patient records and genomic records to practice medicine. Doctors, pharma and researchers will electronically mine databases to glean information that will help them make better diagnoses, rather then relying only on their past experiences with just their own patients and what little time they likely have to read current medical literature to stay up-to-date. Drug companies and researchers will plumb the data stores to develop clinical trials."

The US FDA has approved a drug with a heavy reliance on data patients recorded themselves in a handheld computer. The drug, Acular LS, will be prescribed for pain in patient recovering from refractive corneal surgery, also known as "laser" surgery. The Invivodata electronic patient diaries, deployed on Palm software and hardware, captured continued real-time data after corneal refractive surgery.

eHealth Initiative Inc., consortium of public health agencies and healthcare companies plans test of a data collection and distribution network that is designed to act as an automated early warning system in the event of epidemics like global spread of SARS virus. eHealth Network will capture patient data collected by hospitals, especially in the emergency rooms and automatically distribute information to health agencies. Syndromic surveillance system can also gather information about sales of over the counter medicines.

Consumers benefit from interactions between academia and industry that facilitate medical innovations and advance research collaborations. The success of these partnerships relies on the dynamic and adaptive roles and contributions of industries and universities in various stages of the medical innovation process. The flow of information between academia and industry has to be more dynamic and adaptive considering the rapid changes in technological innovations and markets. University medical centers in partnership with the industry can set up knowledge centers for specific diseases and offer international services.

Internet2 projects has a new initiative on health sciences called " Internet2 Health Science Advanced Internet Development" and is intended to facilitate and coordinate the creation and enhancement of health applications that the current Internet technologies and infrastructure are unable to provide. It intends to facilitate and coordinate the development of general application tools to take advantage of Internet2 advanced network services.

Center for Future Health at University of Rochester provides an example of the focused collaboration in the research and academic setting for the personal health system geared towards total patient care. This multi-disciplinary team of physicians, health practitioners, bio-organic chemists, computer scientists, informatics experts, engineers, and behavioral scientists is working towards inventing smart technology that allows consumers, in the privacy of their own homes, to maintain health, detect the onset of health problems and manage disease.

Institute of Healthcare Improvement is collaborating with British Medical Journal on a new website QualityHealthCare.org that will be defining global healthcare improvement collaborations.

Conclusion

Health ignorance has to be overcome with knowledge and information delivered and disseminated through Internet integrated technologies that provide operating efficiencies for the organizations and convenience to the proactive consumers and integrated professionals.

Efforts for global health improvement would focus on availability of Internet integrated extensive databases of protein structural information, development of informatics platform for drug discovery and development, integrated information systems for customized drug delivery based on patient's genetic make-up and technologies to generate comprehensive gene expression profiles of human immune system.

Collaborative and coordinated global strategies of the healthcare, pharmaceutical and technology organizations would result in opportunities to expand the modern medical and health thoughts and knowledge, development of innovative medical applications and would assist to focus integrated resources and efforts for the healthier world by aligning profits with care.

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