Influence of the Internet in an Orthopaedic Practice: Survey of 500 Patients SELENE G. PAREKH, M.D., M.B.A., 1,3 CHARLES K. LIM, M.D., 1 ROBERT E. BOOTH JR., M.D., 2 AND DAVID G. NAZARIAN, M.D. 2 Abstract: The Internet represents a technological revolution that is transforming the way business is conducted in many industries. Internet-based healthcare companies have addressed issues such as cost-efficiencies, supply-chain relationships, and patient educa- tion. The Internet has also been used to provide medical informa- tion to patients, to sell goods and services, or to facilitate transac- tions between patients, providers, and payers. We conducted a survey among orthopaedic patients in a multi-specialty orthopae- dic practice to characterize the adoption of the Internet by these patients and their attitudes regarding the Internet’s role in health- care delivery. A 27-question survey was distributed to 550 con- secutive patients. Patients were stratified by age into six groups, and responses were compared. Statistical analysis was performed. Five hundred eight (92.3%) were returned: 63.7% of respondents use a computer, with a significant difference noted (P  0.001) between age groups (89.1% for those less than 30 years old to 20.2% for those older than 70); 56.5% of the patients use the Internet, with a significant difference (P  0.001) between age groups (77.2% < 30 years old to 15.5% > 70 years old); 46.9% of the patients who use the Internet retrieve general health and medi- cal information; 20.5% use the Internet to learn about their medical condition, 16.2% to learn about their surgical procedure, and 10.6% to learn about their surgeon. The use of the Internet for medical information and management will likely continue to in- crease in the future. As the Internet becomes an increasingly in- tegral part of our lives, creation and maintenance of a presence on the Internet is becoming a necessary adjunct to any orthopaedic office. Introduction Healthcare industry The health care industry has at times been characterized as an antiquated, inefficient, duplicated system, represent- ing a trillion-dollar industry that contributes 14% to the United States Gross Domestic Product. Although it has one of the most expensive healthcare systems in the world, the United States continues to have approximately 44 million uninsured people [1] and ranks seventeenth in life expec- tancy [2]. During the 1970s and 1980s, health care costs became uncontrollable and the United States became the number-one per-capita health care spender in the world [3]. Indemnity insurance allowed for the development of many inefficiencies and redundancies in the system, as health care providers and systems were not held accountable for con- tinuously expanding costs. In the 1990s, the health care industry had been a major focus of the presidential political agenda. An initiative was begun to curb the escalating rate of healthcare costs by attempting to replace indemnity insurance plans with health maintenance organizations (HMO). HMOs gained wide- spread popularity, with enrollment in Medicare and Medic- aid managed care above 50% [4]. New health care entities emerged, such as the independent practice organization, physician–hospital organization, and the practice–provider organization, which were innovative attempts to control health care economics. The Federal Government, in accor- dance with national insurance companies, implemented di- agnostic-related groups and capitation sites in order to limit medical spending. Academic medical centers and non-profit organizations merged to form large health care systems in an attempt to reduce redundancies and gain greater market share. Computer technology has been central to this revolution, because it affords improved delivery of information, more efficient transfer of information, and instant worldwide communication. Internet The Internet represents a technological revolution that is dramatically transforming the way individuals and organi- zations interact. The Internet was first conceived in the late 1960s by the United States Department of Defense to pro- mote communication and collaboration between academi- cians and scientists. It gained popularity on university cam- puses during the mid-1980s as an electronic medium for messages and discussions. During the early 1990s, two technological breakthroughs led to the exponential growth of the Internet. The first was the creation of the World Wide Web using a standardized programming language, which allowed pictures, audio, and video images to be transmitted and presented on a computer From the 1 Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Phila- delphia, PA, 2 Booth-Bartolozzi-Balderston Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA, and 3 Wharton Business School, Small Business Development Center, University of Pennsylvania, Philadelphia, PA. Address correspondence to: Dr. Parekh, Hospital of the University of Penn- sylvania, Department of Orthopaedic Surgery, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104. The University of Pennsylvania Orthopaedic Journal 15: 61–65, 2002 © 2002 The University of Pennsylvania Orthopaedic Journal 61