The Doctor is Online Now Or how to

The Doctor is Online Now Or how to beat Wal-Mart and take great care of your patients

The Doctor Is Online Our patients have been waiting a long time They are voting with their feet Business has noticed

They are voting with their feet Ease of access is now one of the leading reasons for patients to change practices In our survey 30% of patients answered “Yes” to the question: Does our web site influence your decision to use our practice.

Business has noticed “The fact is the time for politics in today’s debate on health care is long past. The time for real and meaningful change has come. Yes, this is about economics. But above all, it is about our health. It is about all of us -- all 300 million Americans -- living the fullest and best lives we can. ” Lee Scott

The CEO of Wal-Mart went on to say: “We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need – affordable access at the local level to quality health care. ”

If you don't believe Wal-Mart… “The vision for the future of health care starts with the premise that consumers should own their own total personal health and wellness data. As an additional premise, we believe consumers should have the right to all data…in electronic form. ” Adam Bosworth, VP Google

And it's a revolution

Our Practice

Secure Portal

Self-Care Charts

Algorithms

Patient Handouts

Basic Data 90 Yes No 80 70 60 50 40 30 20 10 0 Do you know Have you gotten Have you about the site? a user name and accessed the password? site? Did you find it useful?

How The Portal Is Used 50 45 40 35 30 See visits 25 See labs See medicines 20 15 10 5 0 Useless 2 3 4 Very Useful No answer

How The Portal Is Used Continued 60 50 40 Send webmail to provider 30 Ask for appointment Ask for medication refill 20 10 0 % Useless 2 3 4 %Very Useful % No answer

Other Uses Of The Portal 80 70 60 50 Used self care charts 40 Used patient education Used link to Medline plus 30 20 10 0 Yes No answer

The ecology of medical care in the United States in one month. N England J Med 2001; 344: 2021 -25

Anecdotally I have enjoyed communicating with my patients over our secure site. It has saved them and me a lot of time. Phone calls to the office are down almost 50% by the medical assistants estimation. Staff morale is up and the MA’s have time to catch up on other office duties. Overtime for the staff is almost non-existent.

Looking ahead

The virtual doctor

Check emergent symptoms first

Present a summary of the answers

Give advice

Offer contact with the doctor

Ask for type of communication desired

Show information presnted to the doctor

Information presented continued

Information presented continued

Acute symptom assessment Information is collected in a consistent manner The computer is never tired or grumpy The computer doesn’t know the patient is rude Key questions are never omitted The patient can take a long time answering

Sigmund PC There has been consistent evidence for many years that people will tell a computer more than they will tell you. “I feel more relaxed. ” “I’m not intimidated. ” “I can think of what I want to say in my own words. ” “I’m not embarrassed. ” JAMA 1992; Vol. 268: pp. 1301 -5

But what about Health Assessment? The same comments apply The computer is good at math

Health Assessment

The computer as coach Evidence is emerging that online coaching can be effective. Automated vs. “Live”

Disease Management Patients with CHF can track their weight Patients with Asthma can track their peak flow Patients with Diabetes can track their glucose Patients with Hypertension can track their BP

Create an expert Office staff can specialize Shelly handles the diabetics Melina handles the hypertensives Registries of patients connect communities

Use tools in the office Even if you don’t have an EMR you can use the tools in your office and print the results Patients can use the tools at home, print the results and bring them to you. The history portion of the visit is largely complete and well documented Someone else manages the system

Tools for home care Medpac Orders and Refills Medpacs are customized home or travel medical kits that contain both prescription and non-prescription medications to treat common medical problems and emergencies. They also contain first aid supplies. They are only available to registered members of the practice, as they are a prescription item. The Medpacs are designed to be used in conjunction with an e-mail or telephone consultation, saving you an office, urgent care or ED visit, as well as a trip to the pharmacy. When medications expire they can be replaced for minimal cost. Home Medpac for Adults $120 Click here to see a complete list of contents for the Home Medpac for Adults. Home Medpac for Children $120 Click here to see a complete list of contents for the Home Medpac for Children. Home Medpac for Families $160 The Medpac for families contains all of the medications from both the Adult and Children Home Medpacs in one convenient package for far less than buying both. Travel Medpac $150 This Medpac has been customized for travellers to help in emergencies abroad, particularly where access to safe medical care is not readily available. Instructions on using the medications and other contents are included in case you are unable to reach us by internet or telephone. Click here to see a complete list of contents for the Travel Medpac. Go to order form for Medpac Go to replacement form for Medpac

Who's going to pay? Remember what I said at the beginning? Some people are willing to pay out of pocket Small businesses and the uninsured Some insurance companies

Conclusions We are reaching a tipping point Patients and businesses are playing larger roles We can take advantage of the technology We can play a number of roles in the process