FOR IMEDIATE RELEASE
Projects Are Gaining Acceptance What Most Patients Really Want Is
Online Interaction With Doctors
Carol Dudley left her doctor's office recently
with a new prescription, but it wasn't for a drug. It was a directive
to read up on the diet, nutrition, and exercise regime that might
help her ward off the onset of diabetes. The physician's orders
came with specific instructions on where to find the information
the 51-year-old Georgia school librarian needed. Her doctor, Jacqueline
Fincher, handed her a "Health Information Rx" that checked off the
diabetes Web site address on a list of disease-specific links.
"Most laypeople don't know what sites to go to,
or how to discern what is quackery and navigate what's not," says
Dr. Fincher, who already has handed out more than 75 information
prescriptions to her patients since an Information Rx pilot project
was launched six weeks ago. It's particularly useful for patients
with chronic diseases that need education and self-management. "There's
not enough time in a day to talk to someone who is a newly diagnosed
diabetic about everything they need to know," Dr. Fincher says.
Such "e-medicine" projects are gaining wider acceptance as mounting
evidence shows that harnessing the Internet and e-mail might offer
one creative solution to the burgeoning cost of health care in the
The Information Rx pilot project is a joint effort
between the U.S. government's National Library of Medicine and the
American College of Physicians-American Society of Internal Medicine.
Prescribing information such as what's found on the library's medlineplus.gov
consumer Web site can help patients take better care of themselves
and can reduce the need for catastrophic care down the road. But
Web site recommendations alone aren't enough. Though more than 100
million consumers go online for health information every year, many
say what they really want is more online interaction with their
A survey by Manhattan Research, a consulting firm,
found that while 57% of doctors now recommend Web sites to patients,
the number using e-mail with patients fell slightly to 19%. Two-thirds
of doctors, though, said they'd be willing to e-mail with patients
if they were reimbursed. Daniel Sands, a physician at Boston's Beth
Israel Deaconess Medical Center and a leading proponent of doctor-patient
e-mail, says patients should simply ask their physician to start
communicating with them electronically. "That's the expectation
of everyone in society today, and doctors should be no different,"
adds Dr. Sands, who offers guidelines for physician-patient e-mail
on his Web site ( www.e-pcc.org). Of course, reimbursement remains
a stumbling block. According to the Manhattan Research survey, physicians
remain reluctant to provide online consultations that take up more
of their time and don't make them any more money.
"Patients have to realize that doctors have to be paid for their
time," Dr. Sands says. Electronic medicine, he notes, is dividing
along two lines: free general medical advice such as the Medlineplus
program, and more time-consuming and personalized online consultations
for which physicians want to charge. A small but growing number
of health plans are starting to reimburse doctors for online consultations,
and the pressure is mounting for others to do so.
The American College of Physicians recently called
on the Center for Medicare and Medicaid Services and all other payers
to work with doctors to develop guidelines for reimbursement of
health-related consultations online. Donald Kemper, whose nonprofit
Healthwise Inc. helps design information-therapy plans, argues that
an "information benefit" is just as important as a "drug benefit"
-- and would cost Medicare far less to provide. (A Medicare spokesman
says online reimbursement isn't under consideration now, "but we
are open to demonstrations and opportunities to see if it can work.")
In the future, medical groups say, online consultations should take
on a growing share of the "nonurgent" care -- prescription refills,
follow-up care for problems that haven't become more severe, the
reporting of certain lab results, and easily diagnosed symptoms
such as a urinary tract infection.
They also can be used for extended personal counseling
after an office visit, and answering questions about something a
patient finds online. Studies already show significant cost savings.
In one program sponsored by 16 Silicon Valley employers, a group
of employees used a service called webVisit from RelayHealth Corp.
Doctors were paid $20 to $25 for each consultation, with patients
responsible for a $5 to $10 co-payment. Researchers at the University
of California at Berkeley and Stanford University found that compared
with a control group, webVisit users cut spending on physician office
visits $1.92 per patient per month.
For insured Americans facing higher out-of-pocket
costs from their employer-sponsored plans, meanwhile, the idea of
being able to get information and advice from the doctor without
an expensive, time-consuming and possibly unnecessary visit suddenly
looks much more attractive, even if there's a small fee. The American
Medical Association now lets patients search online for doctors
who use e-mail consultations at www.ama-assn.org. "As more costs
are shifted to the consumer, they are going to look for more-efficient
ways of getting higher levels of care for fewer dollars," says Ed
Fotsch, chief executive of Medem Inc., a for-profit venture of AMA
and other medical societies that helps physicians offer secure e-mail
consultation services. ? E-mail to Informedpatient@wsj.com.