Gunther Eysenbach, M.D., Head of the Unit for Cybermedicine, Institute for Clinical Social Medicine and Public Health, University of Heidelberg, Germany
Eysenbach G, Sa ER, Diepgen TL. Shopping the Internet today and tomorrow - Towards the Millennium of Cybermedicine. BMJ 1999;319:1294 [full] (13 November)
Eysenbach G. Introduction: Towards the Millennium of Cybermedicine. In: Arvanitis T, Eysenbach G, Woodall J (eds.).Towards the Millennium of Cybermedicine. Educational Technology Research Papers of the University of Birmingham, No. 10. Birmingham/Heidelberg, 1999, p.2-3 (also published in J Med Internet Res 1999;1(suppl 1):e2)
Introduction - Medicine and the Internet
The evolution of the "information age" in medicine is mirrored in the exponential growth of medical webpages, increasing numbers of online accessible databases, and expanding services and publications available on the Internet. The handful of computers linked by the predecessor of the Internet in 1969 has grown to more than 5 million websites today. In spring 1998, the World-Wide-Web had at least 320 million web pages of general content. In addition, there are countless conversational areas on the Internet, like chat rooms and newsgroups, where people exchange messages on tens of thousands of subjects. Somewhere more than 150 million people currently communicate over the Internet.
Medical information is often said to be one of the most retrieved information on the web. In fact, according to a survey of October 1998, 27% of female and 15% of male Internet users say that they access medical information weekly or daily. An interesting observation from this and other surveys is that health and medical content appears to be one of only a few online content categories that women are more likely to use than men.
No-one knows the exact number of medical (including health and "wellness") websites, but the frequently cited figure of 15,000 health sites is probably an underestimation, given that Yahoo USA alone lists more than 19,000 websites under the topic "health", and other international Yahoo catalogs together add roughly another 15,000 sites. Assuming conservatively that a maximum of 30% of all sites are registered in Yahoo, we can estimate that there are a minimum of 100,000 health-related websites available. Health information providers on the web include mostly private companies offering medical products or medical information (news services, electronic journals, databases), individual patients and health professionals, patient self support groups and professional associations, non-governmental organisations, universities, research institutes and governmental agencies.
Cybermedicine - a definition
The developments outlined above likely have a significant impact on efficiency and quality of future health care, consumer empowerment, public health, medical education and a number of other areas.
At the crossroads of medical informatics and public health a new academic field of "cybermedicine" is emerging (fig. 1).
An arbitrary definition of the discipline "cybermedicine" could be
"the science of applying Internet and global networking technologies to the area of medicine and public health, of studying the impact and implications of the Internet and of evaluating opportunities and the challenges for health care"
[Source: Gunther Eysenbach, in:
Eysenbach G, Sa ER, Diepgen TL. Shopping the Internet today and tomorrow - Towards the Millennium of Cybermedicine. BMJ 1999;319:1294 [full] (13 November)]
Of particular interest in our "Unit for Cybermedicine" at the Department of Clinical Social Medicine in the University of Heidelberg is
- the exploration and exploitation of the Internet for
- consumer health education,
- patient self-support,
- professional medical education
- and research,
- the evaluation of
- the quality of medical information on the Internet,
- the impact of the Internet on the patient-physician relationship and quality of health care
- and the use of global networking for evidence-based medicine.
Cybermedicine is distinctive from telemedicine (although there are overlapping areas, especially as the Internet can also be used as a medium for telemedical applications): While telemedicine focuses primarily on a restricted exchange of clinical, confidential data, with a limited number of participants, for the most part from patient-to-physician and from physician-to-physician, in "cybermedicine" there is an global exchange of open, non-clinical information, mostly between patient-to-patient, sometimes between patient-to-physician and from physician-to-physician. Telemedicine for the most part is applied to diagnostic and curative medicine, while cybermedicine is applied to preventive medicine and public health.
|Geographic coverage||Local or regional||Global|
|Application area||Primarily curative medicine||Primarily preventive medicine|
|Security||High security possible||Security limited|
|Data exchanged||Clinical data||Information for patient education and self-support, anonymised clinical data for medical education, anonymised epidemiological and public health data|
|Exchange between||Patient-to-physician, physician-to-physician||Patient-to-patient, |
|Aims||monitor individual patients, diagnose and treat||Prevention, monitor populations, gather epidemiological and other data from patients, use patient feedback and consumer involvement for evidence based medicine|
|Driven by||Sometimes technological push||Mostly consumer pull|
|Setting||Controlled setting, limited number of well-defined users||Uncontrolled conditions|
|Evaluation||Possible||Impact on population very difficult to measure|
|Reach||Reaching tens or hundreds||Reaching millions|