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Greater health IT investment helps 21st century medicine take firmer shape

By Lydell C. Bridgeford

Technology that revolutionized how Americans conduct banking transactions are now firmly embedded in our nation’s culture, so deeply that consumers rarely need to enter a financial institution or speak with a banking representative.

Health industry progressives are hoping that health information technology will do the same for doctors visits.

Some health IT experts claim that the playing field is ripe for encouraging patients, physicians and health care providers to consider online medical consultations and health coaching. Health IT proponents also see the big burst in smartphone technology as an opportunity for employers to partner with health vendors that specialize in creating e-mails and text messages that address an individual’s specific health needs and benefits.

Last year’s federal stimulus law earmarked nearly $19.5 billion for investments in health IT, including incentives for doctors and hospitals to purchase and use electronic medical records. In 2015, federal regulators will start to issue penalties to physicians and medical institutions that fail to go digital. The government projects that its investment in health IT will reduce health costs by $12 billion over 10 years.

The McKesson experience

McKesson Corp., the San Francisco-based health care services company, offers its employees the opportunity to e-mail their doctors. “We began offering online medical consults and secure patient-physician communications two years ago, but really began to emphasize them last year,” says Jerry Warren, senior vice president of compensation and benefits for McKesson. The company employs approximately 32,000 people, mainly in the United States.

Warren explains that an employee logs in to the system from any Internet-connected computer, either at home or at the office and answers a few questions. “It is really a pretty easy process to get going,” he affirms.

The worker then identifies his or her doctors that are participants in the program and sets up a secure link to their practices. Once it is set up, employees are then free to send their health care provider secure messages, request prescription refills, schedule appointments or even have a full online visit, Warren explains. For the full online visit, the process walks the employee through a series of questions related to their condition.

“It’s kind of like when the nurse takes down a few notes as you are sitting in the examining room at the doctor’s office. Once the questions are completed, this goes to the doctor,” he says. The doctor can then look over the information and provide the employee with follow-up questions or make suggestions on how best to treat the situation or, if necessary, schedule an appointment for an in-person exam. RelayHealth, a McKesson outfit, provides the technology platform.

According to Warren, health plans are critical partners in the process. “They help us advocate for the approach with the various provider networks in their plans, help us adjudicate claims associated with the e-visits and, just like for regular parts of the plans, help to ensure it is a smooth and easy process for our employees,” he adds

Under the program, doctors are not directly offered incentives to participate, but “our plan pays them for online visits. Also, as the service gains in popularity with our employees, many have encouraged their physicians to participate,” Warren notes.

Once an employee has worked with a provider that participates in the program and the worker realizes how easy and convenient it is to use, he or she looks for other providers who are participants.

“The physician community is beginning to see online visits as way to compete and grow their businesses and to keep connected to their patients while offering them an attractive service,” Warren explains. “While it certainly wasn’t designed to replace the ER or the physician’s office, we do believe it can lower costs as a very efficient and cost effective way to deliver routine care.” Warren believes that e-visits allow the physician to see more patients at a lower cost than the traditional model because they can charge less and still remain profitable.

“So far this year, we have had about 8,500 of our employees signed up to use the program, as well as about 4,000 dependents,” Warren adds. His team is now setting up to study the claim-cost benefits to the online consultation. “While we can’t report those direct costs yet, we consider the program on the right path to helping our employees access the most appropriate channels of care, which I’m convinced will result in a direct positive impact on our cost trends,” Warren says.

“We have pretty wide utilization across our population. When we started down this path, I expected to see younger, more tech savvy employees as the user base. But that has not proven to be the case,” says Warren. “As you might guess, as employees age they typically have more health issues and more frequent provider questions. So, this has proven to be a popular offering with older employees as well.”

Digital visits

In 2009, The Employee Benefit Research Institute conducted an online survey of 4,226 privately insured adults ages 21 to 64. According to the survey results, respondents enrolled in consumer-driven health plans, compared to traditional plan participants, were more likely to switch to physicians who used e-mail to deliver lab tests, allowed the individual to schedule appointments online and answered patient questions via e-mail.

For example, about 60% of CDHP enrollees would change doctors to those using health information technologies for lab tests, online appointments and e-mail consultation, while only 50% of traditional plan enrollees would do the same, reports the public policy group.

“While a doctor’s visit maybe only 25 minutes in the exam room, it winds up being a-half-a day off work for most people. That’s lost productivity, so the extent in which health care that is amendable to electronic exchanges, whether it’s synchronous or asynchronous, is a tremendous boost for productivity for both the delivery system and the individual,” says Dr. Gordon Norman, chief innovation offer at Alere’s health improvement division, a Georgia-based health management services company.

“Depending on the health insurer, the doctor gets reimbursed for the online visit, and in some cases, the patient may have to pay a copayment for the e-visit. The e-visit platform may also do a better job of documenting the question-and-response process between a patient and a physician, compared to an actual visit,” says Brian O’Neill, president of Office Ally, a health-care technology firm that facilities e-medical visits. “It cuts down on the misunderstanding between patients and doctors because the e-visit platform involves an intense algorithm consisting of many questions for the patients to answer, maybe more than the doctor would ever ask,” he explains.

In addition, internal research by Blue Shield of California with a former vendor found that patients who messaged their doctor electronically were 50% less likely to report missing work due to illness and 40% less likely to report having limited work capacity due to illness, O’Neill notes.

Furthermore, Lightspeed Research, a marketing research firm, conducted a survey of 1,000 individuals in August 2009. The company found that over half of the participants would embrace e-mail communication for routine interactions with their doctor.

Still, 46% of respondents said they were unwilling to pay for an e-mail consultation, but 31% were willing to pay only if it was covered by insurance. In the survey, nearly 60% said they had no problem with receiving routine test results via an e-mail, while 53% would send an e-mail to request a repeat prescription, and 51% would do the same to update their doctors on an existing condition.

Consumers also like the idea of visiting a doctor’s Web site to conduct some of these activities, but the majority frown upon using mobile SMS (text messages) or live online chats for such activities, according to the survey’s results. Most respondents said their family doctor didn’t offer the option to communicate by e-mail, Web site, text or online chat.

When asked about the key advantages to e-mailing their primary care physician about a specific illness or condition, respondents (59%) reported that wireless communication would save time by avoiding doctor’s visits, 56% said no more waiting for an appointment, and 51% noted being able to avoid other sick people in the waiting room.

Women were more receptive to the idea of e-mailing their doctors than men, but individuals age 55 and older were least likely to see any advantages in e-mailing their doctor about an illness or condition, the survey’s report notes. Even though, that group was more likely to purchase its medications online, compared to other age groups in the survey.

“Initially, there was a lot of fear from physicians that would be inundated by e-mails by patients, that it would overtake their lives. But we did some prestudies that showed people were pretty sensitive about how their physician used their time,” says Jan Oldenburg, practice leader, health portfolio of Internet services group at Kaiser Permanente. The health insurer allows it members to e-mail their physicians.

“In regions where the medical leadership stood up and said, ‘This is how we are going to practice medicine in the 21st century, so get on board,’ we found that made a significant difference toward the attitudes of physicians in the beginning of the e-mail-your-doctor program,” Oldenburg says, adding that the physicians don’t receive additional compensation for participating in the program.

Colin Evans, chief executive officer of Dossia, a Massachusetts-based nonprofit consortium of large employers promoting electronic medical records, believes that e-medical visits are highly skewed toward providers and doctors not willing to do them with patients.

“In general, doctors get paid when you show up at the office; if they answer an e-mail, then they are reducing their salary,” says Evans. “For the most part, it’s financially driving.”

Traditionally, health IT centered on the idea of the delivery of care, rather than those who use or pay of the care, says Lilian Myers, CEO and co-founder of Allviant. The Arizona-based company offers technology that delivers personalized health information to consumers via phone, e-mail or text messaging. “The idea is to pull together all of those piece of information an deliver them to you in one place,” explains Myers.

Arizona State University uses Allviant’s technology to alert electronically its employees about upcoming wellness and health promotion classes that appeal to their health interests and needs. “We just found it was a really good way of getting information out to employees and using technology in a new way,” says Jillian McManus, director of organizational health and development at ASU.

“While the employee newsletter lists upcoming wellness and health promotion classes, e-notification reminders meant that workers don’t have to go back to a newsletter issued two months ago to find the date and time to the event,” explains McManus.