Effective physicians must listen to their patient’s concerns, take accurate and complete medical histories, and earn patient trust and confidence. Physicians must help patients better understand their problems, and clearly communicate treatment recommendations and medical advice. Communication is a cornerstone of medical practice, while poor communication is a major cause of misdiagnosis, poor compliance of therapy, and malpractice claims (Mechanic, 1998). Telecommunication technology has created new lines of communication for patient-physician interaction. Most recently, the global computer network of the Internet has provided electronic mail (email) and the World Wide Web (Web). Email allows for a direct one-to-one communication, and the Web is used mainly as a broadcast medium for dissemination of information in a one-to-many form. Just like the Internet’s predecessor, the telephone, application and research must be done to determine how this new technology can best be used to enhance the patient-physician relationship (Mandl, 1998). The Internet provides an unprecedented level of near instantaneous lines of intercommunication. Web browser technologies provide an interface to the Internet that makes this communication accessible even to novice computer users. The combination of communication and interface technology is an opportunity to explore ways of improving patient healthcare by breaking down current barriers to quality healthcare management. Web-based communications enable a continuous interaction between physician and patients where patients can freely enter data and concerns, and physicians can address these asynchronously. With the resulting additional patient data, physicians get a more complete clinical picture, and, with the aid of trending and decision support tools, the computer can help organize and present data in meaningful ways. Patients gain a sense of partnership in their healthcare through the continuous reporting of data and more immediate feedback. This chapter discusses the design and implementation of a working healthcare management system called “Hypertension Decision Aide” or “HDA”. HDA is a World Wide Web system that provides chronic hypertension patients with data reporting, monitoring, decision support tools, and educational material. HDA provides physicians with the ability to monitor a patient’s progress between visits, view summary data, and review suggestions from decision support tools. Issues of system design, data integrity, patient confidentiality, and security will be discussed in the context of HDA.
