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Web Lets Specialists Give Advice from Anywhere

Service connects patients to skilled physicians and their own doctors

THURSDAY, March 27, 2003 (HealthDayNews) -- An Internet service that lets patients from all over the world get advice from skilled physicians at Harvard Medical School and similar treatment centers has had a successful first year.

So says Dr. Joseph C. Kvedar, founder of the Partners Telemedicine organization.

"In 90 percent of cases, we have been able to achieve substantial changes in treatment plans, and in 5 percent of cases we have been able to change the diagnosis," says Kvedar, vice chairman of the Harvard dermatology department.

The service received about 1,200 calls in the first year, half from the United States and half from other countries, including South Korea, Taiwan and a number of countries in Europe and South America, Kvedar says. "We're tracking to have approximately 1,500 this fiscal year," he says.

Partners Telemedicine is unique in that it requires patients to go through their own physicians to use the service, Kvedar says. There are some other services offering medical advice to patients over the Internet, but "no other system is doing it physician to physician," he says.

Partners Telemedicine's policy is in line with the position of the American Medical Association, which says "e-mail correspondence should not be used to establish a patient-physician relationship. Rather, e-mail should supplement other, more personal encounters."

A paper in the March 29 issue of the British Medical Journal describes the service's experience with a representative sample of patients, those who came across Partners Telemedicine. Someone who logs on to the service's Web site must follow a carefully defined series of actions.

The first is to print out a letter to show to the patient's physician, describing the service. The doctor then registers with the Web site and sends information about the patient. A full-time staffer at Partners Telemedicine then picks an appropriate doctor from the 4,000 specialists on the organization's roster, with the help of three doctor advisors, to offer advice.

The patient pays a fee that covers the cost of the service. Some medical insurers now pay for the service, Kvedar says, and two companies are providing it to their employees as a benefit.

About 90 percent of those using the service have cancer, Kvedar says. "These are patients looking for answers when they have a very difficult, life-changing decision to make," he says. "They can get high-level care without leaving their own back yard."

The AMA's position is that "people shouldn't establish a relationship on the Internet," says Dr. Joseph M. Heyman, an obstetrician-gynecologist in Amesbury, Mass., who is an AMA trustee. "It's important to have a relationship established in the office."

That policy is designed "to protect the physician as well as the patient," Heyman says. "There would be problems at each end of the phone line, problems in not having a complete history of the patient."

Heyman says he does use e-mail in his practice "and it's worked out great. It's a wonderful tool, like the telephone or the fax. But it mustn't be abused."

More information

You can see what it's all about at Partners Telemedicine. If you're looking elsewhere on the Web for health information, take some tips from the National Cancer Institute.

SOURCES: Joseph C. Kvedar, M.D., corporate director, Partners Telemedicine, Boston; Joseph M. Heyman, M.D., trustee, American Medical Association, Amesbury, Mass.; March 29, 2003, British Medical Journal
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