Providers and patients can use computers to do many activities. Among these are:

Health education.
Several HMOs are using computer services to patients' homes for educating their members. There is overwhelming data that health education (predominantly through books) is effective in reducing cost of care and improving quality of services. Data suggest that consumers who know more about their health engage in more active self -care, are more likely to comply with their treatment, are more effective participants in choosing treatment options, and have lower health care costs., One approach to providing health education at home is through telephone access to a nurse. Patients call a nurse who, usually based on a computer protocol, advises callers to seek the appropriate level of care.- Another approach uses a librarian who helps patients shape an inquiry and then searches computerized files for the requested information. The librarian either provides the information to the patient over the telephone or mails the information to the client. In a third approach to health education, patients can telephone a computer; press touch-tone telephone keys corresponding to a particular taped health message, and listen to it. In a fourth approach, investigators have tried to educate patients by providing them with a computer and allowing them to interact through the computer with health professionals. Patients type their questions and the computer sends these questions to the computer of a health provider, who types in a response at a later time.^, Finally, in a fifth approach patients call a computer and record their questions, the computer calls the provider, who records his/her response, and then the computer calls the patient back to deliver the answer.

Social support.
Some HMOs are using computers to help patients who have similar illness to talk and exchange opinions with each other. No matter how well informed patients are about their medical condition, most need the reassurance of talking to others who have been in similar situations, who can demystify the health delivery system, and who can provide emotional and social support when things are not going well. Lack of social support, obviously, increases loneliness and puts one at risk for depression and mental illness. Lack of social support also affects physical illness and drug use. Studies demonstrate that face-to-face group support is important to a patient's recovery, but experiences of self-help groups such as Alcoholics Anonymous and Narcotics Anonymous meetings show that clients miss many group meetings. Chronic illness restricts participation in social activities. When patients lose their own community of friends, or find that their existing friends cannot satisfy their illness related information needs, patients may attempt to organize or participate in new communities and self help groups. Naturally, they seek to organize these communities around their illness. Distance from each other, lack of time, chaotic and busy life styles, and confidentiality limit patients' participation in support groups. To facilitate the creation of intentional communities of patients, some have suggested the use of electronic bulletin boards., Through these bulletin boards patients at long distances from each other can communicate in an asynchronous and confidential manner. With the spread of Internet and commercial on-line services there are increasing numbers of electronic bulletin boards. Investigators at the Maryland School of Nursing have provided electronic bulletin boards to disabled persons. Others have used the computer to assist in promotion of controlled drinking among early stage problem drinkers.,, In Washington, CapAccess provides a platform of bulletin boards and computer services for a diverse patient population. In Miami, elderly use computer bulletin boards to break their isolation and have mental simulation. In Cleveland, caregivers of persons with dementia are using computer bulletin boards. In northern California, a major HMO is using voice-bulletin boards to allow recovering alcoholics to have access to each other.

Appointment making.
Some HMOs, e.g. Blue Cross Blue Shield of Northern California, are working on ways of allowing patients to make appointments using their computers. The main advantage of computer based appointment making is the possibility that the patient can set and learn through the computer about the urgency of the visit and the self care steps that they can initiate. In one scheme (not yet implemented), patients make an appointment, then answer questions about their symptoms. The computer analyzes these responses and sends them to a clinician; who based on his/her first hand knowledge of the patient, will record a response to the patient. The response may include a recommendation to (1) by pass the provider and seek advice from a specialist, (2) seek immediate care, (3) seek care after completion of laboratory tests, (4) wait and see how the illness progresses. These types of triage decision making are the core advantage of how computer assisted appointment making may radically reduce the number of intermediary office visits and lead the patient to the appropriate and final level of care.

Taking of history and risk assessment.
Computers can be used to assess the patients before their office visits in order to alert the clinician about some underlying problems. Office visits provide a limited time for patient and clinician interaction. Computers can assist by gathering the necessary information ahead of time and alerting the physician to key findings in the patients' condition. In one study, patients were asked to call a computer and participate in risk assessment. The computer analyzed their responses, established whether they were suspect alcoholics, and sent the analysis to the patients' clinician. When patients came for visit, the clinicians reviewed the findings with them.

Home monitoring.
Computers can be used to monitor patients' health at set time intervals. For example, Visiting Nurse Association of Cleveland has designed a computer system that calls their patients with congestive heart failure and asks them a series of questions on a weekly interval to assess the need for out of plan visits to patients' homes. Patients answer the questions by pressing keys on their telephone pad or by recording their answers on the computer. If answers are recorded, the computer sends the recording to clinicians, who listen to and respond to the patients' responses.