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Sunday, September 03, 2006

The Disintermediation of Health Information

As a new millenium approaches, visionaries usher in the dawn of an information reformation unlike any since the Protestant Reformation of the 16th century. Preceding the Reformation, John Wycliffe translated the Bible and held services in English rather than Latin so "common" people could understand. Today, the advent of information technologies promises to liberate the masses by equalizing access to information via the Internet and removing the "middleman". This sublime goal is often coined "disintermediation".

Disintermediation, the ability of consumers to access information and services without an intermediary, is considered the catalyst behind economic and social change of business, healthcare, and education (Internet.com, 1998). The Internet "removes the middleman" by providing users immediate and direct access to an abundance of information at unprecedented levels. This transformation of information from a linear model to an interconnected network indisputably impacts society. According to David Thornburg, "Old economic models were based on the concept of scarcity…the laws of supply and demand have been based on the Idea that the scarcity of something determines its value. The Internet changes everything…scarcity is replaced by abundance: the law of supply and demand is replaced by Metcalfe's law of the telecosm which states the power of a network increases by the square of the number of users" (Thornburg, 1996). Implications for health educators and practitioners are profound. The World Wide Web is currently doubling in size every 53 days (Thornburg, 1996) and studies indicate health information is one of the topics most sought by daily Internet users (find this, 199).

Disintermediation of health information may prove to be the single most effective strategy for empowering individuals to take responsibility and make informed healthcare decisions, but what role does health education take in shaping and developing this goal?

• The Internet enables users to access vast warehouses of information with little to no expense: what role will the development and distribution of educational materials play in the professional development and practice of future health educators given the abundance of available information?

• The Internet creates "virtual communities": how will health education define and interact with "community" or "peers" ?

• The Internet is not bound by traditional settings, time, or sequencing: how will the process of health education respond to the needs of a digital environment?

In this information reformation, "we" are the "middleman". As one technology theorist stated; "people who sell information for a living are in real danger…bits need no warehousing and the cost to make more is effectively zero" (Willmott, 1997). This does not imply technology will replace health educators, instead, an expanded definition and fundamental shift in the professional preparation and practice of health education is needed. To realize the potential of the Internet as a communication tool requires practitioners capable of using technology to meet a growing demand for on-line health information while recognizing emerging consumer needs.

Health education is a process rather than a product. According to J. Thomas Butler (Butler, 1997), the process of health education includes:

• A planned opportunity with stated goals, objectives, activities, and evaluation criteria

• Occurring in a given setting

• At a given point in time

• As part of a sequential program

• In a comprehensive manner

• Involving interaction between a qualified teacher and learner

Technology alters this process. Health education is based on a linear model with clearly defined settings, time and sequencing; however digital dimensions are rapidly replacing traditional concepts of setting, time, and sequence. "Virtual reality", "Moo's", and "Mud's" define "setting"; time is less consequential as information is instantly accessed and delivered, geographic time-lines blur in "cyberspace", and "anytime-anywhere" computing becomes commonplace; and sequencing of information presents professionals the unique challenge of creating non-linear yet cohesive information. The ability of health education to function in a "cyber" environment requires a transformation from a linear process to a network/interconnected process suitable to a digital environment.

Innovation refers to "changed based on advances in science and technology, to new products and processes, and to changes in management, attitudes, practices, and relationships (Kazlauskas, 1995). Health education must take an innovative stance in order to recognize the full potential of the Internet. Specific areas in need of direction include:

• Adapting the process of health education to digital dimensions

• development of an integrated online information system or resource network capable of colloborating, combining, and integrating health education resources from across the nation

• expanded definition of health education to address the online community

• technological competency skills for health educators

• a re-evaluation of consumer needs, aptitudes, and support systems.

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