E-health and Web 2.0: The doctor will tweet you now

When Janel Wood's 9-year-old son recently began experiencing migraines, the working mother decided to try a new company health care program that allowed her to communicate with a doctor through videoconferencing, voice over IP, and instant messaging.

While her son was home for lunch, Wood logged onto a local medical practice's Web site and connected via videoconferencing and IM with the doctor on duty, who then reviewed her son's electronic medical record (EMR) online. The doctor sent Wood links to migraine articles and podcasts and prescribed more hydration for her son, which worked over time.

"I ended up bringing [my son] back to school before missing any classes, which he was kind of bummed about. It was so quick and efficient," Wood said.

While telemedicine may seem a cold and impersonal approach to patient care, physicians say it's exactly the opposite. And they are quickly embracing it as a way to foster a more intimate relationship with patients and educate them about treatments prior to office visits.

"We're getting very positive feedback from patients," said Dr. Eric Christianson, assistant medical director of the emergency room at University of Minnesota Medical Center, Fairview. Fairview now has 36 physicians who are beta-testing patient Web 2.0 services powered by software from SaaS provider American Well.

Physicians take shifts during which they commit to being available for online sessions with patients. Fairview's hours are from 8 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 5 p.m. on the weekend.

American Well partnered with Microsoft to use its HealthVault EMR service, which allows patients to securely store their entire medical history online. Test results and radiological images can also be uploaded to the online records. Patients control access to their information and must specify who can see the records. Google Health is another popular online EMR service also being used to access patient information online.

BlueCross and BlueShield of Minnesota makes the online patient services available to employers, who then offer it to employees. There is a $10 or $20 co-payment fee for members, and nonmembers can use the services for $50 per session. In other states, however, BlueCross and BlueShield offers the services to any member, regardless of employer.

Social networking sites get in the game

It's not only secure videoconferencing, IM or e-mail that's being used to bolster communication with patients. Social networking sites such as Facebook and Twitter are also being used by physician practices and hospitals to disseminate health information and create online communities where patients can share their experiences.

Jeff Livingston, an obstetrician and gynecologist in Irving, Texas, said his 10-doctor practice has about 600 Facebook fans and more than 1,500 Twitter followers. They not only use the social networking service to communicate through text messaging, but can read and comment on postings about birth control, breast feeding and a variety of other health care topics.

New mothers also share baby photos through a popular Facebook community page created by patients of his practice, MacArthur OB/GYN. And MacArthur OB/GYN's Facebook fans can connect with one another through the social networking site to discuss their own experiences with medical procedures.

MacArthur uses secure messaging and a private patient portal developed by Kryptiq Corp. to allow patients to access their full charts, make appointments, get test results and communicate one-on-one with their doctors about specific, private health concerns. The portal and secure message system meet HIPAA compliance rules and allows the clinic to balance the need for secure, trackable communication with patients.

Livingston said the more he can educate his patients through Facebook or Twitter, the more prepared they'll be when they arrive for an appointment.

"If you think about the way you go to a doctor, it's kind of upside down. In a 10-minute visit, six or seven minutes are spent gathering background information -- what medicines you are on, what problems you are experiencing. Then we do a quick exam and run a test, and then spend the last few seconds talking about what we're going to do," Livingston said.

For example, on a typical day, Livingston often has young patients asking about birth control. If they've never explored the issue, then Livingston typically spends most of his time explaining options, along with their risks and benefits. If, however, he can point his patients to online resources, such as a podcast he created and links to on Facebook, then the majority of patients already know what they want when they arrive in the office.

"What's really fascinating is how often the educated patient makes the exact same decision that I would have for them," he said.

An online 'knowledge base'

Livingston said he also wants patients to see his Facebook and Twitter pages as something of "knowledge base."

"Our Facebook page is very local. It's our patients interacting with our practice," he said. "With Twitter, I can point my patients in the direction of articles and blog postings and things interesting from an OB/GYN perspective. But what's really happened with Twitter is that it's really become international. We have followers all over the world who have identified us as a good resource on women's health topics."

While Livingston said it's difficult to pinpoint a return on investment in terms of the time spent maintaining the Web pages, social networking has definitely provided intangible benefits -- including patient loyalty and more efficiency in his office.

"The most important ROI is the way a doctor's visit goes," he said. "If you allow your patients to become engaged in their own health care, they ironically make really good decisions. I think that's a new concept for a lot of people."

Patients love the convenience

Donita Gano, a nurse living in Hawaii, used her state-sponsored insurance plan through the Hawaii Medical Service Association (HMSA) to get treatment for an arm infection caused by a fall while hiking near a volcano on the Big Island.

Gano, who works for the state of Hawaii, said her older home computer didn't have videoconferencing capabilities, so she used a VoIP connection to speak with an emergency room physician at the local hospital associated with her plan. She gave the physician electronic permission to view her EMR so he could see her medical history. The hospital then issued a prescription electronically to Gano's pharmacy for antibiotics, which she picked up that day.

"You can't beat it," she said. "I like the fact that they do have my whole medical history. You have to give them [electronic] permission to see it, but really I can't imagine why anyone wouldn't do that. It just makes so much sense."

The HMSA went live with its Online Care system a little over a year ago, as did Minnesota. OptumHealth, a division of UnitedHealth Group, the country's largest health insurer, started offering NowClinic, a virtual physician service, in Texas earlier this year and plans to roll it out nationwide later this year.

Elsewhere, BlueCross BlueShield insurance organizations in upstate New York have unveiled plans to offer their members virtual physician visits beginning this summer, making New York the fourth state to provide private online chat or VoIP phone consultations.

Neal Neuberger, executive director of the Institute for e-Health Policy, said physicians connecting with patients via social networking sites is a fast-growing trend. A plethora of applications have also cropped up for devices such as the iPhone that allow patients to communicate with physicians or find medical services in their area. "There are literally hundreds of them," he said.

Privacy an issue?

But "there are the liability issues," Neuberger noted. "Those privacy issues and issues around government reimbursement would hold some clinicians back from using [Web 2.0 technology]. Many of the clinicians see value -- even if they're not getting reimbursed -- in getting some of those patient questions and issues out of the way and being able to spend more quality time by engaging the patients remotely."

Livingston said that he is well aware of potential privacy issues but feels that the issue is really much ado about nothing.

"To me, it's very simple and not controversial, but people like to make it controversial," he said. "You cannot diagnose, treat or discuss any personal health information in a nonsecure environment. So if a patient asks me a very specific question on Facebook, I cannot answer it legally."

Physicians who want to adopt Web 2.0 technologies as part of their practice should focus on broad health care topics online -- ones that do not involve any individual treatments.

"Patients follow the guidelines really well too," Livingston said. "People who are on Facebook understand Facebook. They're not going to post 'I think I have a sexually transmitted disease' on our wall for the entire world to see."

Another force behind doctors' adoption of Web 2.0 tools is that EMR providers are beginning to insert texting and videoconferencing tools right into their software, according to Conrad Clyburn, founding partner of MedTechIQ, an international content aggregation and physician collaboration Web site.

Physicians need Web 2.0 for EMR rollouts

The use of Web 2.0 isn't limited to physician-patient interactions. A wave of Enterprise 2.0 software is already being developed that allows doctors to communicate with one another or share best practices and emerging technology tips among physician groups.

"The task is so big that we're going to have to start using these tools to solve the problems" associated with rolling out complex new health information technologies, said Neuberger, who is also chairman of the American Telemedicine Association's policy committee.

Enterprise 2.0 software and services are proving particularly crucial in the rollout of EHRs among small outpatient physician practices, which represent the majority of U.S. physicians. There are now about 788,000 physicians in the U.S., and 512,000 of them work in practices outside of hospitals.

The U.S. Office of the National Coordinator is in charge of managing about $46 billion earmarked through the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed earlier this year. In order to receive tens of thousands of dollars in reimbursements for e-health technology rollouts, hospitals and other health care providers must demonstrate meaningful use of their online health records systems.

Docs need help with tech, too

Clyburn said that about 45 vendors now offer blog or microblog sites dealing with physician issues, some of the most pressing of which are the implementation of EHRs. Among the more popular sites are Sermo.com and Webicina.com.

The reason those sites are so popular is that most doctors tasked with rolling out EMR technology run small practices and have little experience with such implementations and have little or no IT staff, he said.

As a result, smaller practices are leaning toward SaaS models for EMRs, such as Practice Fusion, which is a free offering, and NoMoreClipboard. Both, Clyburn said, are "quite easy to use."

"This is going to be a very interesting next couple of years," he said. "One of the trends we're going to see is a gravitation toward the low-cost solutions -- and I think that low-cost solution will be [a] software-as-a-service subscription model. Those lend themselves very nicely to online interactivity and patient engagement through messaging and the things we've become accustomed to in the cloud."

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed. His e-mail address is lmearian@computerworld.com.

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