Finance Blog number 1

Instead of calling his office, Dr. Elie Azrak’s cardiology patients can hop online to request prescription refills, check portions of their medical records or send questions about their conditions.

Dr. Azrak and his fellow physicians at St. Louis Cardiology Consultants opened the Web portal to a segment of patients late last month, part of a systemwide rollout of electronic medical records across SSM Health Care.

Within a few years, the interventional cardiologist expects to be trading e-mails with patients and possibly holding real-time Web chats.

"If we can use technology to communicate with our patients and make it easier, why not?" asked Azrak, who is also vice president of the St. Louis Metropolitan Medical Society. "I’m sure this is coming."

In fact, it’s already here.

Technological advances rapidly are changing the way patients and doctors communicate. Video-conferencing with other physicians, remote patient monitoring and e-mail already are standard tools for many physicians across the country.

One of the newest innovations, a platform that allows insurers to provide patients with real-time access to their doctors via webcam, launched in Hawaii in mid-January.

Proponents say "e-care" will help broaden access to health care, create savings for employer-sponsored health plans and help fight a growing shortage of physicians nationwide.

Others welcome technology but worry about reimbursement for e-care and the effectiveness of digital diagnoses.

"I don’t see tele-health as ever replacing a personal relationship and direct one-on-one contact with your physician," said Dr. Michael Wulfers, president of the Missouri Academy of Family Physicians. "I just don’t see how you’re going to be able to ever accurately do a physical exam over the Internet."

CONSULTATIONS ONLINE

Dr. Roy Schoenberg is working on that.

The Boston physician’s health tech company, American Well, has developed a secure communication platform that connects doctors and patients for real-time consultations.

American Well’s first customer, Hawaii’s Blue-Cross-Blue Shield licensee, took the system live on Jan. 15. Consumers access the service by logging on through the insurer’s website.

Patients can search for specific physicians or seek out specialists for 10-minute consultations through webcams or text chats. The sessions can be extended for a fee.

"Online care is a technology that allows us to extend the reach of the existing health care system so that it is much more available and in a way much more financially reachable," said Schoenberg, the company’s president and chief executive. "It has tremendous promise."

The company did not release preliminary utilization figures from Hawaii.

Doctors can search through a patient’s electronic medical records and write prescriptions. Health plan members pay $10 to access the platform. The uninsured or those on other plans pay $45 per session.

American Well receives transaction and licensing fees through its deal with the Hawaii Medical Service Association guaranteed online personal loans. Only physicians licensed in Hawaii can provide care, and they’re covered under a blanket medical malpractice policy from AIG. Doctors are reimbursed automatically and electronically.

Schoenberg declined to discuss the company’s plans to expand outside of Hawaii. However, he said a number of health plans across the country are expected to implement the platform this year.

Of course, American Well doesn’t bill itself as a cure-all. Patients experiencing chest pains or flare-ups of complex conditions should head straight to an emergency room, Schoenberg said.

Some physicians, including Wulfers, have raised concern about the potential hazards. Doctors can’t feel a patient’s abdomen or conduct a cavity exam through the screen.

"It seems to be just another (idea) along with urgent care or minute clinics, which will in the end lead to more fragmentation of care … and lower quality of health care," said Wulfers, a longtime family physician in Cape Girardeau. "It seems to me like it’s a walk-in clinic over the Internet."

Still, many patients couldn’t take advantage of "virtual house calls" if this service was suddenly available everywhere.

Only about 11 percent of U.S. Internet users have webcams connected to home computers, according to a recent study conducted for the California Healthcare Foundation. Meanwhile, about 65 percent of adult Americans have broadband or dial-up service, providing access to e-mail and the Web, according to a recent study by the Pew Internet & American Life Project.

Despite skepticism of the virtual house call, Wulfers e-mails some patients, adding that "in the future, I could do a lot of things by e-mail."

A survey by the California Healthcare Foundation also found increased use of e-mail between physicians and patients in the Golden State: 13 percent of Californians using the Internet reported getting medical advice via e-mail in 2007, up from 8 percent in 2004.

Starting March 1, Mercy Medical Group in St. Louis will test an online pilot program that gives secure Web access to a select group of patients. The patients will be able see lab results, get information about X-rays and schedule appointments through an interactive calendar.

Patients can take a picture of a suspicious rash and send the image in an e-mail. Doctors can respond to an e-mail question about high cholesterol with links to health-related websites.

Mercy plans to offer the Web portal to all patients by January, said Dr. Thomas H. Hale, president and chief executive.

Excited about the possibilities of the "electronic stethoscope," as he called the Internet, Hale also sounded a note of caution.

"What we don’t want to do is to take that opportunity and say, ‘Everything we’ve done in the past we need to throw away,’" Hale said.

"It has to be a clinical tool in the (arsenal) of physicians and caregivers."

Source