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The E-Doctor Will See You Now

Virtual system allows routine health care visits across the Internet

TUESDAY, Oct. 21, 2003 (HealthDayNews) -- It's a familiar scenario: A sick patient contacts her doctor. The doctor sends a prescription to the pharmacy. The patient picks up the medicine and soon starts to feel better.

Not particularly noteworthy, you would think. Except that the patient and the pharmacy are in Australia, while the doctor, Dr. Scott Conard, is in Irving, Texas.

Because of a new virtual-doctor system called Mydoconline, all this could be done via e-mail within a matter of hours. Mostly, Mydoconline enables the doctor's staff to take care of routine matters such as referrals, appointments, questions about bills or medication side effects. But the doctors can also use it for actual health care.

Conard is the second doctor in his town to implement the system, and he raves about it.

"I think it's going to open the portals of communication that we so desperately need to open," he says. "We will be able to intervene earlier for more conditions, and we are going to be able to intervene equally or more effectively than in the past. Over time it will make a huge difference."

According to Mydoconline, more than 350 physicians nationwide and more than 10,000 patients are actively using the same portal Conard and his patients use.

The medical and insurance communities aren't sure what to think of the trend. Even if the billing seems logical, there are certainly questions about electronic doctors' visits.

"It is a fairly new area of practice and, to my knowledge, there's not a [billing] code for this kind of thing," says Larry Akey, a spokesman for the Health Insurance Association of America in Washington, D.C. "I think you start to get into a dicey area when you're talking about diagnosing online."

An American Medical Association report issued in June 2001 supported online medical care within limits, including ensuring that e-mail "does not replace the crucial interpersonal contacts that are the basis of the patient-physician relationship." The report also recommended developing guidelines for electronic prescribing as well as efforts to address economic, literacy and other barriers to patients using information technology.

The idea for Mydoconline emerged about four years ago with a group of professionals who realized that technology was not most doctors' forte. "Health care tends to be a laggard in terms of the adoption of new technology," says Mydoconline Chief Executive Officer Kirk Schueler.

From Schueler's point of view, technology has the potential to improve at least two areas of health care: routine office matters and the doctor-patient relationship.

"In the managed-care environment in some cases doctors are very restricted in the amount of time they can provide to an individual," Schueler says. "Part of what we are doing through our online doctor visits is providing an opportunity for replacing office visits and, in some cases, replacing phone care. In both cases, interaction can be done very efficiently. Physicians can attach to these communications written materials so that the face-to-face time may be less, but the amount of information that can be communicated is more."

Of course, Conard and Schueler both concede, you can't do everything on line. A difficult diagnosis will require a physical exam. On the other hand, recurring conditions such as allergies or a yeast infection could be handled in cyberspace. You also wouldn't use the system to deliver bad news.

Conrad has a few rules: no pain medications or antibiotics online. He also won't refill chronic medications with patients who have not communicated their health status recently. (He will make certain exceptions to the antibiotic rule, for instance, for urinary tract infections.)

Inevitably, the issue of liability comes up. Schueler doesn't think there is one.

"The general conclusion was that you might have less liability," he says. First of all, there would be a record of all communications and, secondly, answers to patients questions are likely to be uniform.

Conard agrees. "The liability of an online visit is far less than the liability of not having the visit," he says. Why? Because you can respond to the patient in a more timely manner, because the patient is less likely to get a doctor-on-call in a shared practice, and because the doctor can intervene more quickly.

"When I get e-mail, instead of me sitting there exhausted trying to remember the correct answers, I read the entire history, integrate that with what I know about the patient and get more information in a more efficient way," Conard says.

Schueler also says the system complies with the most recent privacy regulations, most notably HIPAA. The information is encrypted and not everyone in the office is entitled to see all the information in the system, he says.

The privacy guarantees no doubt also cover your credit card information, which you need to cover the cost of your virtual visit.

"The amount we can do for patients has increased tremendously, but we are still trying to fit through that narrow straw of the doctor's visit," Conard says. "We are trying to find a way to take that straw and just blast it out, increase communication 10- or 100-fold to be a just-in-time doctor, if you will."

Even the insurance industry apparently sees some potential for it.

"The real question would be one of diagnosis and practice online and whether or not that was something doctors would be comfortable with," Akey says. "Once they get comfortable with it, we'll find a way to get comfortable with it."

More information

For more on the doctor-patient relationship, visit the University of North Carolina or New York University.

SOURCES: Kirk Schueler, chief executive officer, MyDocOnline, Round Rock, Texas; Scott E. Conard, M.D., president and founder, TienaHealth, Irving, Texas; Larry Akey, spokesman, Health Insurance Association of America, Washington, D.C.; American Medical Association Council on Medical Service report
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