South Florida Sun-Sentinel.com
More patients are taking advantage of e-mail consults
BY BOB LaMENDOLA
South Florida Sun-Sentinel
July 21, 2008
Mike Holland came home from a business trip a few weeks ago in so much pain he tried something new: He made a doctor’s appointment online. The next morning, he arrived and saw the doctor in minutes.
A week later, on the road, his new medicine made him sick. The Hollywood computer consultant logged onto the same physician consulting Web site and filled out a form detailing the problem. Hours later, he had e-mail advice from his internist, Dr. Rene Reyes.
Another electronic medical checkup completed. The small and slow-growing trend of doctor e-consults got a little bigger.
"I figured I would never even hear back from them," said Holland, 53. "Getting specific advice about the medication I was taking and the treatment I was getting was tremendous. Not having to wait a week for an appointment and not having to sit for two hours in the waiting room, that was really something."
After more than four years in the mainstream in Florida and a few states, online doctor consultations are catching on, although not like many had hoped. Only a fraction of doctors offer the service, and a small number of their patients take advantage.
Practice on the rise
Proponents of e-consults said the number has jumped since Aetna, Cigna and other insurers began paying for them nationwide in January. They predict the practice will one day become a prime option for patients dealing with simple health issues.
"It’s really convenient for the patients and great for the doctors, too," said Dr. Maureen Whelihan, a West Palm Beach obstetrician who has consulted online for 15 months.
Blue Cross Blue Shield of Florida began offering online physician contacts in 2004 as a way to improve patient satisfaction, ease office burdens on doctors and save a little money, said Lynn Monson, the insurer’s director of health information technology.
A few thousand of the insurer’s 28,000 doctors belong to the various online systems, and the number is growing. From all those Florida doctors, Blue Cross pays for a dozen e-consults per month on average, although many more may be using the system for free contacts, Monson said.
"I would love to see it take off like hotcakes, but it hasn’t," Monson said. "It’s something that’s going to come of age."
Popular with patients
Surveys show patients like the idea of contacting doctors by e-mail. But in California, only 4 percent of people reported doing so last year.
"The reality is that most patients unfortunately are not tuning in yet," said Dr. Nigel Spier, a Hollywood OB/GYN who answers patient e-mails daily and late at night. "Younger patients are catching on. But certainly the reflex is that if people have a question, they pick up the phone, they don’t go to their computer."
To contact a doctor online, patients go to a password-protected Web site to find forms requesting lab results, prescription refills, appointments and office matters. Typically these are free and fielded by the office staff.
To initiate an e-consult about medical issues, patients answer a series of questions about their illness and medical history. The system often asks different questions depending on the patient’s answers, as a doctor would. The doctor gets notified of the inquiry and posts an answer online for the patient to look up.
"When they fill out the form, all the questions I would have asked [in person] are already answered," Whelihan said. "I can actually make a pretty good diagnosis."
E-consults cost $25 to $40, payable by credit card. If insurance covers it, the patient may only face a small co-pay.
"Once [patients] use it once or twice and realize how nice it is, they use it more and more," said Reyes, who started e-consults in April.
Not everyone’s sold
Some doctors and medical organizations are skeptical of e-consults, saying an online exchange cannot replace a face-to-face visit and increases the risk of a doctor misdiagnosing a serious problem.
"There’s so much potential for miscommunication when you can’t see someone’s face or detect the tone of their words, or watch their body language," said Dr. David Hutchinson, president of the Minnesota Academy of Family Physicians.
Proponents of cyber-medicine dismiss such fears, saying doctors can use their judgment to restrict e-consults to simple health issues.
Reyes’ hand-held wireless unit jangled with an online question from a man whose ulcer resumed bleeding one night. He said he quickly called and ordered him to the emergency room.
RelayHealth, a leading online consultation system, says about one-third of its e-consults end with the doctor asking to see the patient in person.
Doctors who like the approach tend to be younger and tech-savvy. They find that dealing online with routine illnesses and matters is faster and more efficient than taking phone calls, and produces better records.
The online systems also ease foot traffic at a time when office visits have surged by 20 percent in five years, federal figures show.
The fact that big insurers have started covering e-consults bodes well for growth, supporters say. Cigna and Aetna tested e-consults since 2006 in Florida and other states before going national. Insurance officials said the service fits the trend of having patients take more responsibility for their health and costs.
The number of Cigna doctors using the system jumped by one-third this year, spokesman Joe Mondy said, but still has reached only 12,000 of 500,000. At Aetna, not 5 percent of 490,000 doctors are signed up, spokesman Walt Cherniak said. Doctors may hold off unless many patients show interest, while patients may not even know their doctor has access.
RelayHealth, a California e-consult firm, has signed up 17,000 doctors since 1999, said Ken Tarkoff, vice president and general manager. Thousands more use Medem Inc., Medfusion and others.
One in 10 of Spier’s 5,000 patients have signed up for his service. One in five of Whelihan’s 5,000 patients have; she fields one e-consult daily.
"A lot of physicians say, ‘You’re so out there.’ We’re really not," Reyes said. "This is 2008, folks. This is a natural evolution."
Bob LaMendola can be reached at firstname.lastname@example.org or 954-356-4526 or 561-243-6600, ext. 4526.
How best to use online consultations, or e-visits, with your physician:
Use e-consults with doctors with whom you already have a relationship and for minor health issues. That includes colds, follow-up questions after an office visit, routine infections, aches and monitoring an ongoing illnesses.
Do not consult a doctor online about a new illness or about potentially serious issues such as bleeding, sharp pain, a change in pain, chest discomfort, traumatic injury, or multiple, complex symptoms.
Explain your medical issue on the Web site’s forms as thoroughly as possible, in plain language, to avoid misunderstanding. Do not leave out or exaggerate any symptoms. Avoid humor that could create confusion.
Explain your medical history fully, including all medications and supplements you take.
Make sure the doctor’s system is secured to protect your medical privacy.
Sources: American Academy of Family Physicians, RelayHealth, Medem, Medfusion
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