Cutting Edge

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor.

(Credit: American Well)

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii's largest insurer, HSMA (which operates the state's Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday's launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn't a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

"That doesn't necessarily need to be done on a face-to-face basis." Shimizu said. At the same time, she doesn't see traditional visits going away.

"I don't think this situation can completely replace one-on-one doctor's visits," she said. "It's an adjunct to that."

She's found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

"The $25 has been received tremendously," said HMSA marketing Vice President Michael Stollar. "They think the fee is very fair," he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians' downtime fills a critical need. "There are not enough primary care physicians," he said. "It really allows us to capture 'care opportunities' out of the same number of physicians that were out there."

SAN FRANCISCO--Three of medicine and technology's minds gathered together Thursday at O'Reilly's Web 2.0 Summit to discuss the state of the U.S. health care system, and where it's going in the next few years. The outlook: good--just give us a swab of your cheek and $400 for the test.

Carol McCall, the vice president of research and development for Humana Inc., believes there's going to be an "explosion" of at-home testing services. Services like 23andMe (which uses a swab of your cheek) are some of the first on that front, leapfrogging tools that test for blood pressure and glucose levels, and going straight to the human genome. McCall said Humana is working with another company to create a test for cardiovascular health. (Heart disease is the nation's leading killer.) McCall believes that future advances in technology will bring similar at-home testing tools for other conditions.

One of the current limitations in testing technology is what to do with all the data that's being harvested to turn it into something doctors can actually use. Dr. Daniel Kraft, another panelist who is a faculty member at the Stanford Institute for Stem Cell Biology and Regenerative Medicine, said results from services like 23andMe are groundbreaking, but it's hard to meet patient expectations that something can be done immediately. "Right now there's not a lot of translation between genetic testing and a clinician...we need to have platforms built so I can understand the genome of that patient."

Dr. Daniel Kraft was one of three experts on a Web 2.0 Summit panel about the state of health care as technology advances.

(Credit: Stanford School of Medicine)

That framework of understanding is something that will take time--and more testing. Dr. Joanna Mountain, who is the senior director of research at 23andMe, says the company's project is building that database, although it has not yet fully been tapped due to our current level of medical science. McCall envisions something much larger though. "Why can't every citizen in this country be able to participate in studies?" she asked. "You'd have data from blood, spit, urine...and (have everyone) participate in a giant informational study. You can be a part of something real from a bottom up discovery."

For those not willing to share their genetic information so readily, the Web still holds promise. Mentioned were user forums, and live chat with physicians and nurses--things that can possibly cut out the need to go in for appointments in the first place.

The same approach is going on in the medical field with more and more use of tech to improve the patient experience. Kraft says doctors are putting more of a focus on simulation as part of the learning experience, similar to what's been done in the aviation industry: "Whole surgical teams can go into a simulation under stress and going in to de-brief afterwards," he said.

While these sweeping changes are unlikely to happen in the very near future, the process could be accelerated with the upcoming change in the White House. With many of the campaign promises of President-elect Barack Obama and former contender John McCain being centered on health care, there are high expectations for reform in both the insurance industry and medical records, the latter of which is currently being tackled by Google.

Mountain ultimately believes the biggest factor pushing reform will be transparency of that information, both in how her company handles customer results and on the part of the government, health care providers, and insurance companies. "It's a key theme that guides us."