Using the internet in asthma management: Current concepts and challenges

An essential component of quality asthma care is ongoing communication between patients and their caregivers. To make healthy, lifelong changes in their behavior, patients need to receive simple, consistent, and reinforcing messages. Interactive, electronic communication has the capacity to facilitate the timely exchange of data, including asthma-related information, among patients, their healthcare team, and other relevant decision-makers. Internet-based solutions are rapidly evolving and may be helpful, but use of the Internet for comprehensive asthma management still presents many practical challenges. Specifically, the following challenges require further investigation: (i) variable access to the Internet by patients and providers in practice settings; (ii) accelerative and unpredictable changes in asthma-specific knowledge, hardware, software, and infrastructure support; (iii) variations in website designs, navigation, and functionality; and (iv) the lack of systematic evaluation of the cost effectiveness of digital health interventions with regard to asthma-specific patient outcomes. Organizations and patients are also confronted with balancing and integrating asthma care received from face-to-face encounters and self-care assessment with advice available through virtual, Internet-based encounters. Human, institutional, and technical challenges are associated with the development phase of Internet-based solutions (such as technical infrastructure, expert knowledge, and legal issues) and with the implementation phase (such as data privacy and data exchange standards, algorithm quality, and cost). Effective responses are also needed for: (i) handling unanticipated electronic problems (such as electrical grid failures or computer viruses); (ii) accessing poor-quality, outdated, or unreliable asthma information; and (iii) coping with issues related to information overload. Many of these difficulties can be resolved on the local, institutional scale, but large-scale implementation will not occur until all involved parties collaborate to seek creative solutions. This review extends prior concepts articulated about the integrated delivery of quality asthma care and Internet development, identifies key questions to address with regard to website design and functionality, and highlights current model solutions emerging from institutional, regional, national, and international agencies.