State Scan

Electronic MD visits in California

By Contributing Editor Daniel B. Moskowitz

Despite dramatic advances in electronic communication, getting help from a doctor for a medical problem is generally handled much the way it was before World War II: The patient phones for an appointment, takes time off from work to drive to the doctor's office, waits among outdated magazines for a few minutes of the doctor's time and leaves clutching a handwritten prescription and trying to remember the doctor's advice. Now a group of California employers is trying to replace that system with one that looks more like the 21^st century, and it is no surprise that they are companies whose bread and butter is the IT revolution.

The Silicon Valley Employers Forum, an alliance of 15 cutting-edge tech companies in the San Jose area that has since late 1999 been part of the Pacific Business Group on Health, recently began testing two approaches to using electronic links between patients and physicians.

One of the experiments, with the Palo Alto Medical Foundation, a large group practice, will let 600 to 800 employees use electronic links to their doctors to access medical records, make appointments, get lab test results, obtain referrals and have prescriptions refilled.

In the second test, two other medical groups will try to substitute e-inquiries for office visits. Using software developed by Healinx, a new company, and for this pilot donated to the participating doctors, patients will be prompted to describe their problems and symptoms in a structured way that should make it easy for the doctor to decide whether an in-person visit is necessary or if a prescription or some simple advice will suffice. Some 2,000 employees are expected to participate in that program.

Key to the feasibility of e-advice is that the patient and doctors will not be strangers. "It's who they're going to see now," explains Forum Executive Director Sterling Somers. In fact, it is to be the doctors who actually recruit the patients to take part in the experiment. But also key is that for responding to the queries, the doctors will be paid $20 per consultation by the patient's employer.

Currently, six Forum members are taking part. Other companies may then sign on after the two pilots are evaluated at year's end. The Medical Foundation will use satisfaction surveys, the electronic office visits evaluated with satisfaction surveys plus a measure of the cost and its effect on absenteeism.

The tests evolved from a deliberate effort by the Forum to gauge why IT has so little affected the doctor-patient interplay. Executives held exploratory meetings with five of the market's biggest medical groups. "We thought we could have the greatest impact working directly with providers rather than through a carrier," Somers explains. "Historically, the providers have not been at the table." A big point of the pilot is to show the providers that they can operate more efficiently—and make more money—by investing in electronic tools. "It's really going to hinge on their adoption of the technology," Somers says.

 

Daniel Moskowitz. Electronic MD visits in California. Business and Health 2001;6:18.