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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

On-line Physician Consultations: Eating Our Own Dogfood

On-line Physician Consultations: Eating Our Own Dogfood

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At Microsoft we are famous for "eating our own dogfood"; the practice of pounding away on beta software well before final versions of the software are ever released to customers.  It's our way of testing the waters for new innovations and subjecting all software to the ultimate test; satisfying some of the most demanding users on the planet.

In that same spirit, Microsoft is leading the way in using technology to open the lines of communication between our employees and the doctors who care for them.  Prior to joining Microsoft in 2002, I co-founded a company that did some pilot work with Microsoft on technology allowing MS employees to access medical information, securely exchange e-mail with their personal physicians, and even schedule and hold "virtual office visits" with their doctors using video web conferencing.  We learned a lot during the pilot.  First and foremost, we learned that patients really like being able to correspond with their physicians by e-mail, and physicians enjoy providing clinical cognitive services electronically when they get paid for doing so.  We also learned that such technology enhances the physician-patient relationship, and more importantly, that our employees didn't abuse physicians with unnecessary or unwarranted communication.

Roll forward a few years.  Microsoft has announced that we will once again test consultations between physicians and patients with Seattle-based Virginia Mason Medical Center and a PPO operated by Premera Blue Cross in Washington.  Under the pilot, Premera will reimburse physicians for online consultations for non-urgent care with a small group of Microsoft employees and dependents.  The Blues plan, medical center, and employer all will track results.

Patients and physicians will access a Web site to use the webVisits secure messaging software of RelayHealth Corp.  The 18-month pilot will start in January with 100 physicians affiliated with Virginia Mason and established patients of the physician.  Microsoft employees and dependents who currently receive their care from Group Health Cooperative have been able to exchange secure e-mail with their doctors for more than a year already.

One day, as I predicted way too many years ago, all physicians and patients will have access to on-line consultations and care.  It is the natural evolution of technology that enables access to the most appropriate level of care, when and where it is needed, in the most cost effective and convenient way.

What do you think?  Let us know.

Bill Crounse, M.D., Global Healthcare Industry Manager, Microsoft Healthcare and Life Sciences

 

  • What ever happened to Dr Goodwell? I thought that this start up was going to provide remote office visits to Microsoft employees 5 years ago.
  • I'm very currious, How well received is this program by the 100 physicians? Currently, email exchange between patients and physicians is considered "concerning" by physicians in most of the articles I have reviewed.
  • Doctor Goodwell is now doing buisness as Goodwell Technologies. Most of the company's work has transitioned to the financial services and travel industries.

    Physicians should be concerned about on-line consultations taking place when an existing doctor-patient relatinship doesn't exist. You'll note that the newest Microsoft pilot (and the pilot we did with the Doctor Goodwell service) mandates that physician and patient have an established relationship. Most doctors are very happy to exchange e-mail with their patients when they are being appropriately paid for providing their congnitive services. Most patients appreciate the convenience. Most payors (and self-insurred employers) are beginning to see the potential for lowering costs.

    Bill Crounse, MD, Microsoft Healthcare and Life Sciences
  • I am curious about what types of visits work well over the web and which ones don't. For example, a child that potentially has strep needs to come in for the test. So those don't seem to translate well to e-visits.

    Conversely, are there some visit types that one could insist be handled through e-vists?

    I am also curious about adoption. The literature that I have read indicates that folks have been slow to embarce e-vists when made available to them. If it doesn't take off at Microsoft that wouldn't bode well for the rest of us.
  • Regarding Will Weider's comment; You are absolutely correct that e-visits are not appropriate for many chief complaints. Of course, the example you cite might be handled with a "home" OTC strep test and a video visit or e-mail with the doctor should antibiotics be necessary. In our Goodwell pilots, the decision to use an e-visit was always at the discretion of the physician. Each physician determined his or her own comfort level with the technology, and the conditions for which it was appropriate in their own patient population.

    Organizations with the most experience in using e-mail with patients have found slow but steady adoption as awareness of the service grows. E-mail or video visits will never substitute for all kinds of office visits, but provide a compelling strategy for handling the 25 to 30 percent of office visits attributable to patients seeking information or needing reassurance.

    Bill Crounse, M.D. Microsoft Healthcare and Life Sciences
  • One reason doctor/patient email has been slow to take off is that doctors fear email will be just one more set of unreimbursed messages to deal with, on top of the voicemails, faxes, and letters they already receive. What's good about RelayHealth is that it is a messaging platform that fits into the physicians' workflow, and keeps message flows structured and organized.

    Physicians sometimes worry that patients will innundate them with messages, but patients actually turn out not to abuse the privilege. What's more, it's easier for a patient to sit down and prepare a thoughtful, clear message with no time constraints than to try to express him or herself in the few moments the doctor has for questions during an office visit.

    One way to think of RelayHealth is as something between a phone call and an office visit. It's a richer medium than a phone call, but less rich than an in-person interaction.

    RelayHealth improves access to physicians, which is a good thing. In my own family, I've seen how an older relative put off seeing the doctor to discuss a seemingly minor problem only to end up in the emergency room a few days later in a panic as things turned worse. Better access to his doctor through RelayHealth could have addressed the problem before it became a crisis.

    I've written about RelayHealth on the Health business blog http://www.mppllc.com/pages/hbblog.html and have been a consultant to the company.
  • I was until recently Medical Director of Clinical Information Systems, and am now Director of Medical Informatics for Kaiser Permanente HealthConnect N. California. The issues and opinions in the previous comments are a good reflection of the discussions and data I am aware of around the subject of patient-provider e-messaging.

    My research at UC Davis showed that e-messaging reduced phone volume 18% and increased the number of office visits by 10% (http://www.blackwell-synergy.com/doi/full/10.1111/j.1525-1497.2005.40009.x, and http://www.himss.org/ASP/publications_jhim_issue.asp?issue=3/30/2005).

    UC Davis has 20,000 online patients communicating with most of its physicians and office staff. Kaiser Permanente's N. California and Northwest regions provide online access, including physician messaging, to all patients. Group Health Cooperative of Puget Sound does too, and has over 80,000 online patients. As physicians gain experience, they reliably recognize the win-win benefits and start encouraging more of their patients to e-message.
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