Health online and the empowered medical consumer.

BACKGROUND: Lay health care consumers' emergence as active participants in online health care networks is a powerful new technological pattern that promises to take the American health care system through all stages of cultural adaptation--substitution, innovation, and transformation. Soon everyone will recognize the fundamental changes online health has produced in the way we think and act about health care.

A NEW ACADEMIC SUBSPECIALTY: A new subspecialty--consumer health informatics (CHI)--is covering two domains: (1) community CHI resources--the online networks, forums, databases, and World Wide Web sites that anyone with a home computer can access, and (2) clinical CHI resources--programs or systems developed by clinicians, system developers, or health maintenance organizations and provided to selected membership groups or patients.

EXHIBITS: Sample communications among online self-helpers within their chat groups, e-mail exchanges, bulletin boards, and USENET newsgroups for chosen health topics show what is on their mind, how they get information, how they use it, and how they correct it. Sometimes, clinicians have observed, lay care offers higher quality than professional care. Lay self-helpers, such as the originator of the Brain Tumor Mailing List, have observed several potential benefits in linking online self-helpers and providers and at a very modest cost.

FUTURE DIRECTIONS: In a coming six-level system of information-age health care, patient-consumers may seek what they need in the following order: individual self-care, family and friends, informal self-help networks, the professional as coach, the professional as partner, and the professional as authority.