HEALTH Medicine program delivers patients online convenience

Some doctors are 'seeing' patients with Web calls.
SCRIPPS HOWARD NEWS SERVICE
Like many working parents, Julia Carpenter, 40, describes her day as "totally insane."
So when the Xcel Energy data analyst seeks advice about chronic back pain, she bangs out an e-mail to her doctor.
"I like the time factor. I don't have to play phone tag. They don't have to get back to me," said Carpenter, whose responsibilities include a 15-year-old daughter, an elderly parent, a horse, two dogs and a workday that starts at 6:30 a.m.
Online appointment scheduling, prescription refills, messages to doctors and even a full-blown doctor's visit are the elements of a pilot Internet medicine program launched last October by Denver-based Physician Health Partners and Emeryville, Calif.-based software vendor RelayHealth.
To date, 57 PHP doctors and 775 patients have signed onto the system. The system handles about 175 e-prescriptions and messages per week -- and that number keeps increasing.
On the other hand, the most cutting-edge application -- Web visits -- hasn't been as popular. Patients are signing up for eight sessions per month.
"It's pretty natural," said Gary Zimmerman, a spokesman for RelayHealth. "If you think of the service as two elements -- service and care -- it's not unusual for the service elements to migrate to the Web first."
Deb Munley, director of practice quality at PHP, said the group can't explain the difference, but "what I'm finding is it takes a while to catch on."
Process
The Web-based doctor's visit asks patients to sign in, and then asks if they have any of 140 symptoms.
Symptoms range from depression to itchy eyes, back pain to abdominal pain, earache to hair loss. Urgent-care needs, such as a palpitating heart, choking or sudden shortness of breath, aren't included. E-visits are intended for nonurgent problems only.
Once patients identify a symptom, such as depression, they're immediately warned that if they're in the midst of a medical emergency -- such as feeling suicidal -- they shouldn't use the service.
Assuming the problem isn't urgent, patients then describe their problems in their own words. This segment allows patients to connect with doctors, and gives doctors some insight into patients' circumstances.
The next series of questions are clinically diagnostic, mirroring those doctors ask in office treatment.
Questions might include, "How long have you felt depressed?," and ask patients to select from: "I feel restless or agitated" or "I feel more angry or irritable than usual." Next, "Have you suffered any major losses in the past year such as death or loss of a family member?" and "Are you taking prescriptions at this point?"
The questions and answers are designed to give neither too much nor too little information, a RelayHealth spokeswoman said. And the "clinical dialogue sessions" can last three minutes for athlete's foot and as long as 15 minutes for back pain.
Program's potential
Munley and other program participants are convinced that such visits are the future of medicine.
"It's the way it's going to go. I think the potential is outstanding, in part for the busy mom," said Koreen Kliewer, practice manager at New Life Family Medicine, which is participating in the pilot.
"I do my banking electronically," said Joanna Fry, who is managing Anthem Blue Cross Blue Shield's part in the pilot. "I pay bills electronically. Why can't I see my doctor electronically?"
The physician-patient communications industry was born when a rash of software companies -- Medem, RelayHealth, MyDocOnline, Kryptiq Corp. -- emerged in the late 1990s.
The idea was that everything -- shopping, hotel reservations, even room decor -- was going online. The industry got a push from federal privacy regulations, in particular the Health Insurance Portability and Accountability Act of 1996, that require all patient-physician information to remain confidential. That, in turn, requires e-mails to go through a secure server.
To date, RelayHealth says it has signed up 6,000 doctors in Colorado, California, Massachusetts, New York, Florida and Tennessee using its system.
San Francisco-based competitor Medem Inc. says it has 94,000 doctors in its network.
Low response
Despite this, the use of online physician-patient consultations is still "remarkably low," said an Oct. 23, 2003, Jupiter Research report.
Only 3 percent of online consumers had Web-based clinical consultations with doctors in 2003, even though 65 percent had said they were interested in it.
"The uptake of [online consultations] has been slower than anticipated," said Jason Best, Medem's marketing director. "It's such a paradigm shift, because it's not the way patients typically interact with their doctor."
Jupiter recommends the service for patients with chronic conditions such as asthma and diabetes, illnesses with a relatively high degree of repetitive and predictable problems.
In the RelayHealth program, for example, patients with diabetes can report their blood-sugar numbers as often as necessary.
It also recommends that health plans pay for it. The vast majority of patients surveyed by Jupiter said they'd never pay more than $10 for an online consultation.