Over the last few decades, consumer involvement in healthcare has been dramatically transformed. Not the least of these transformations has been consumers' access to and participation in decision-making about their own health and the health of their family members. Increased responsibility for one's own care brought about the need for readily available and quality health information. The Internet has provided healthcare consumers with an empowering portal to health information and resources. Early consumer health informatics applications were centered on sharing of support between healthcare consumers in online communities and on the provision of information through a myriad of Web sites. Research documents the success of these evolving Internet health information resources as supporting better health outcomes for consumers.

Telehealth applications and community outreach programs have provided effective access to care from distant sites. Tailored consumer health information has personalized the provision of health information and further supported the value of these Internet-based applications in improving health outcomes. Consumer health informatics has advanced, along with the electronic medical record, to include the provision of access to personal health information via the Internet. This access to individual personal health records improves the ease of information sharing between consumers and their personal healthcare providers and even further empowers consumers as partners in their own care.

There are a number of implications for nursing. While research supports the positive outcomes associated with the use of consumer health informatics applications, further inquiry is needed to understand how the Internet is changing provider-patient relationships and patient decision-making. Some providers have embraced the use of e-mail and discussion boards as a way to communicate with consumers, whereas others have not, and although information is empowering, the sheer volume of Internet-based information on virtually any subject has, at times, been a source of frustration for healthcare consumers. As healthcare providers, we need to continually evaluate our role in this new delivery system and utilize interventions to improve the provider-patient interaction and facilitate access to resources that will support improved patient decision making.

As the point of care moves into the community through telehealth and Internet advances, the opportunity for nursing to influence health promotion is greatly increased. Community-based initiatives are evolving that provide remote access to care as well as systems for response and information in times of public health or national crisis. Nursing's role in the design, development, and delivery of these community-based initiatives is essential.

In the course of creating consumer health informatics tools, consumers, providers, and informaticists must pay attention to ethical and social issues so that together they shape the future as they would like it to be, in terms of how technology is used and what kinds of regulations are put in place. Standards are being developed at the federal level to ensure that information is interoperable, accurate, and secure. More work is needed to ensure that the Internet provides safe and credible health information. Nursing has been and should continue to be actively involved in the development of policies and standards at all levels of care.

Finally, these changes in healthcare delivery require the integration of consumer health informatics as part of the nursing informatics education at all levels of practice for our student/learners. We need to ensure that nurses have the knowledge to think critically and evaluate these new technological advances.