Area doctors to treat patients online: House call by webcam aims to cut trips to ER, handle basic needs [The Buffalo News, N.Y.]

Mar. 10--The doctor's house call, a thing of the past, is making a comeback -- on your computer screen.

BlueCross BlueShield of Western New York, one of the region's largest health insurers, plans to introduce online care this year, a service that allows patients to connect with a physician on demand 24 hours a day using webcams for video links, or secure text messages or telephone conversations.

Patients will be able to talk from their home, workplace or anywhere else with a computer connection to one of hundreds of primary care doctors. Like eBay.com, the online auction company, the service also will allow patients to rate each encounter.

Advocates see online care as a way to address a shortage of physicians who provide basic medical care and the long waits for appointments, reduce unnecessary trips to hospital emergency rooms and help patients with chronic illnesses and multiple medications better manage their conditions.

BlueCross BlueShield joins a handful of other health plans that have partnered with American Well, a Boston-based technology company, to adopt the system in the past year or so. American Well's service is integrated with Microsoft HealthVault, which gives doctors secure access to patients' health records for the online sessions.

"We have a shortage of primary doctors and a broader issue of access limited by geography, finances and the need for coordinated care," said Dr. Cynthia Ambres, the Blues' senior vice president and chief medical officer. "This gives a patient immediate access to a physician who sees their medical record.

"The service is aimed at the worried well and the gently ill," she said.

As a result, Ambres said, the company anticipates a "sea change" in emergency room visits for minor ailments.

In a typical encounter, a patient will visit the online care Web site and choose from a list of available doctors, whose names will be accompanied in many cases by video introductions from the physicians, professional information and patient ratings.

The doctor and patient will chat, and physicians can prescribe non-narcotic medications. If the patients don't consult with their regular doctor, notes from the encounter will be sent to the appropriate physicians.

HealthNow New York, the parent company of BlueCross BlueShield, plans to start the service in June in Buffalo with its 1,400 employees here and about 450 physicians and their 35,000 patients.

It plans to expand the service later this year to all of its 500,000 members in Western New York, hoping most of the insurer's 1,800 affiliated physicians embrace the technology. It also will expand to its members in Blue Shield of Northeastern New York, its division in the Albany region.

The service will open to any state resident in 2011, including uninsured patients who will pay a fee by credit card for a session, officials said.

The health plans' members will pay a co-payment similar to an office visit fee, and physicians will be reimbursed somewhat less than an office visit.

Ambres said the service is set up to eventually allow patients to upload through a USB port records and diagnostic information, such as blood pressure readings.

In January 2009 American Well began its first service in Hawaii through a BlueCross BlueShield affiliate. Since then, it has completed similar arrangements with BlueCross BlueShield of Minnesota; OptumHealth, a division of UnitedHealth Group, one of the largest health insurers in the nation; and TriWest Healthcare Alliance, a Phoenix-based health plan for military personnel and their families.

Telemedicine is not new, and there is growing use of the Internet by doctors and health insurers to transmit X-rays, review lab results, communicate with patients by e-mail and prescribe medications.

But American Well's service is considered the next big step in virtual medicine, giving patients in real time 24-hour access to a large number of credentialed doctors with connections to the patients' medical records. The technology also manages the availability of physicians, freeing them to talk to patients at their convenience.

Dr. Roy Schoenberg, chief executive and the company's co-founder with his brother, Dr. Ido Schoenberg, sees online care as a transformative force.

In addition to potentially alleviating a shortage of primary care doctors, a problem for which there is no quick solution, he said online care can make basic medical services available to sick or frail patients separated from their doctors by distance or by their inability to easily travel to a medical office.

"This is not doc in the box on the Internet," Schoenberg said. "It's woven into the fabric of overall care. We can make services available to people when they want it and from where it is most convenient for them to receive it."

Experience with American Well's services indicates that more than half the online visits involve issues that family practitioners and internal medicine doctors often deal with, such as respiratory ailments, migraines, stomach aches, rashes, urinary tract infections, children's illnesses, and backaches, he said.

Most of the other cases involve patients with such chronic conditions as diabetes and heart disease who require frequent consultations about their care.

One of the lessons learned so far is that there is demand for other types of care, including patients speaking with pharmacists and seeing mental health specialists from the privacy of their homes, he said.

The introduction of online care poses challenging questions.

Medical boards and associations in different states view online care differently, with some requiring that doctors establish a relationship with a patient before consulting with them online. Critics also argue that a video session is no replacement for a physical exam.

But Schoenberg and others said that not all physician-patient encounters require a physical exam. Much can be gleaned from seeing a person and getting a good medical history.

"If you have diabetes, a doctor doesn't need to examine you to diagnose what's wrong. If you have a migraine, the doctor doesn't need to feel your head," said Schoenberg. "This is one tier of health care. It's not the complete answer. It can deal with some things and not with others. It leaves decisions up to the doctor," he added.

Efforts at telemedicine have shown they can work in the right circumstances.

For instance, Erie County Medical Center for 10 years has operated an emergency videoconferencing network for correctional facilities. In 9,000 out of more than 25,000 teleconsultations, doctors were able to find an alternative to transferring patients to an emergency room, said Dr. David Ellis, director of telehealth and health informatics at the University at Buffalo.

He has concluded that a physical exam isn't always necessary.

"I now look at physical exams much like deciding whether to order a diagnostic test," Ellis said. "I ask if it's needed and will it likely be effective."

Ellis said online care is likely to fill a niche among patients wanting to chat with an expert at an anxious moment, but long term will have to show it truly can reduce unnecessary emergency room visits and keep people in better health.

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