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The doctor will see you now online

Why your next physician's visit may be just a click away

By Kay Lazar
Globe Staff / June 1, 2009
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You know the drill. You schlep to the doctor's office and wait for what seems like hours - despite having an appointment. As the time ticks away, your frustration level rises, along with the number of other commitments you are missing.

That's today. But tomorrow holds promise for virtual improvement - literally.

In the not-too-distant future, a doctor's visit may be just a click away. Imagine having your appointment conducted as you sit comfortably in front of your home computer screen, describing symptoms or asking questions of a doctor via videoconference, and having your doctor respond in kind from the office. Need a blood pressure reading? A special cuff downloads it directly into your computer - and to your doctor in real time, just like in a face-to-face appointment.

It may sound farfetched, but virtual medicine is already happening on a trial basis in Boston, and more broadly elsewhere in the country, with Hawaii leading the way. Also in development: widespread use of Web cameras, instant messaging, and other e-technology to help ease healthcare costs, and relieve the burden that scheduling often represents.

There are clearly some limits to the new technology. It can't, for example, be used for a gynecological check up, or many other physical exams. But adaptations - such as the special blood pressure cuff - make it possible to do things that heretofore seemed possible only in person.

But is it good for patients? New studies - including a recent one that is Boston-based - suggest virtual medicine may win fans from both sides of the stethoscope.

Dr. Ronald Dixon, an internist at Massachusetts General Hospital who uses videoconferencing in his practice, is the senior author of a recent Boston survey comparing patient satisfaction with virtual visits versus face-to-face doctor's visits. The study, published in the Journal of Telemedicine and Telecare, involved 175 patients, ages 18 to 85, who were randomly assigned to specially-arranged videoconferenced "office visits" or conventional ones.

Patients ranked the virtual mode nearly as high as being there for most measures, including time spent with the physician and ease of interaction.

Overall, however, patients and physicians still preferred face to face. Dixon said the findings indicate that virtual visits may be suitable for common ailments, such as back pain and upper respiratory infections, and for routine follow-up of chronic diseases, including diabetes or hypertension. It would not, he said, work well for more complex health problems.

For patient Paul Beninger, a 58-year-old biotech researcher who participated in the study, virtual was as good as being there. Beninger, who also is a regular patient of Dixon's, was in the videoconference segment of the study and visited Dixon electronically.

"As long as one has a good working relationship with a physician, being able to do things remotely works very well," said Beninger, who is comfortable in front of an Internet-connected video camera; he regularly uses the technology to chat with his globe-trotting daughter.

But he acknowledges it is not right for everyone.

"My mother, who is 88 and doesn't even have a computer, doesn't even know where the "on" switch is," Beninger said. "I don't imagine she would be comfortable with a computer visit."

In Hawaii, doctors and patients are well on their way to being comfortable with the technology.

Hawaii's Blue Cross Blue Shield in January launched its Online Healthcare Marketplace, which allows patients who've enrolled in the program online to log in, type in their medical request at any time of the day or night, and instantly see a menu of specialists who are available at that moment for a virtual visit. Patients have an option of a videoconferenced session with a specialist, a phone consultation, or instant e-mail communication through a secure website - for the price of $10 for a 10-minute visit.

The system provides patient and physician with simultaneous and instant access to a summarized version of the patient's medical records. So far, about 4,000 patients have signed on, and about 1,000 have used it, said Mike Stollar, a vice president at Hawaii Medical Service Association, the Blue Cross of Hawaii.

Access to quality and cost-effective healthcare are the twin goals of the program, Stollar said.

"We believe if people can get the right care as early as possible there will be savings," he said, "because if they wait until something is acute, we pay through the nose."

Among those logging on is Toby Morris, a 49-year-old Hawaiian contractor who was anxious one recent night whether stomach pain he'd had for three days was something that required immediate medical attention. Morris signed on, chose a phone consultation - "I'm not that much of a techie," he said - and seconds later was reviewing the symptoms with a physician he'd never met before. They jointly concluded it was the flu.

"It was great for me because my schedule is sort of unpredictable, and I don't like to schedule much in advance," Morris said.

A few nights later, Morris's girlfriend logged on to find out quickly whether the prescribed shot she gave herself after being stung by a Portuguese Man of War, a venom-filled marine organism, would be sufficient to control her life-threatening allergy, or whether she needed emergency care.

The virtual visit reassured her, Morris said, that she didn't need to race to the ER.

The software for Hawaii's pioneering program was created by American Well, a Boston-based company founded by two brothers who are physicians.

"The beauty of this system is that it can sort through the specialists available at that moment . . . and pick a female pediatrician, for instance, who speaks Spanish," reflecting a patient's preference, said American Well CEO Dr. Roy Schoenberg.

In April, Blue Cross and Blue Shield of Minnesota announced it will roll out a similar program later this year for its 10,000 employees, with a goal of making it available to other consumers next year.

While declining to say whether a launch is in the works for Massachusetts, Schoenberg said such a prospect is a "very, very near future thing."

But what about privacy concerns? Do patients find it disconcerting to discuss the intimate details of their health online?

Apparently not. As online banking, shopping, and social networks, such as Facebook, become commonplace, patients appear to be much less worried, compared to physicians, about their medical privacy, according to a recent study coauthored by Dr. Tom Delbanco, a Harvard Medical School professor and Beth Israel Deaconess Medical Center physician.

Delbanco's study - four focus groups involving 82 participants - found that patients are much more willing to do without face-to-face visits than doctors expected.

"Patients want doctors to be able to communicate and they want it right now," he said. "Privacy takes second place."

Recently, one of Delbanco's patients called him about a rash. Delbanco asked him to take a picture of the area and e-mail it to him.

"We were able to dispose of it without a visit. It was a minor skin infection," said Delbanco, who has been e-mailing with his patients for years. "Almost everyone has a digital camera and we e-mail JPEG (computer-formatted) pictures of our kids. Why not send pictures of our skin?"

Dixon, the MGH doctor holding some appointments via videoconference, hails virtual medical technology as what he calls a valuable "enabler."

"It's not substituting, its augmenting," Dixon said. "I am not talking about introducing new widgets: I'm talking about the Internet, camera, and cellphones, using tools readily available to patients and [making them] part of their healthcare."

Kay Lazar can be reached at klazar@globe.com.

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