A video commentary from Bill Crounse, M.D., Microsoft's Senior Director for Worldwide Health.
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Hi Dr. Crounse,
A very thoughtful commentary there. I was wondering will we really be able to take away from the physical connect that a doctor and patient consultation provides? Perhaps not, we are really assured by a doctors advice when it is given to us "in person" rather than "in camera" or "on phone". Maybe that is also some distance away (or close) depending on how the telepresence technology progresses.
But what can be already done, and is already being done in most place in the US, is the filling of the prescription orders, reporting of the laboratory results and availability of the radiology reports to a patients PHR Portal (like how it is made available using Health Vault). I guess these are some of the areas which should become defacto standards of service at all the hospitals. That would be a first step to move away from the ineficiencies of the system that you have rightly mentioned.
The point is definitely not aimed at eliminating face to face visits in a physician's office. Rather, it is to use technology as an adjunct in the physician-patient relationship. Not everything we need from a clinician requires an in-person office visit. We need a more rational approach for allocating medical services; especially when advice, information or reassurance is the primary need of the patient. In such cases, we should use the most appropriate modality to meet the patient's need. Often this should be a reimbursed phone call, instant message, e-mail or virtual visit rather than a traditional face-to-face office visit that consumes time, personnel, equipment, and space and wastes a great deal of resources.
Bill Crounse, MD
agreed, very thoughful and though provoking.
From personal experience, I think some of the nurse lines do this well - we've saved ourselves from the wasteful waits and automobile rides. But it has all been over the phone, would be great to be able to do this via a quick cell phone picture or webcam if both parties are equipped.
perhaps the next round of be well funding will find some smart team prototyping this on a grander scale :)
With the economic challenges facing the country we actually need to accelerate the investment in transforming our health care processes not back away from it. One area that we can focus on is the better management of the 10% of the population with on-going and chronic conditions which cosume 70% of our health care dollars.
There have been some new models from both the payer and the provider side of the house that are encouraging.
According to an article in the WSJ, "Last January In January, Aetna and CIGNA declared that they would pay doctors and cover members for “virtual” or e-visits—including secure messaging and e-consults. With this move, these major health plans expanded regional experiments with e-visits to most of their members and physicians nationwide."
Other health plans have taken similar steps to catapult patient communication into the 21st century. Studies show an overwhelming number of American consumers want to communicate online with their health care providers—nearly 90 percent, according to a 2006 Harris Interactive/Wall Street Journal survey.
At Group Health in Seattle patients have had email access for the past 8 years to the 850 doctors there and 97% of the emails are answered within one day. Up to 30% of "doctor visits" at their downtown clinic are now being done by email and have opened up more doctor slots for longer in person visits and the retention rate was 6.5 percent higher for enrollees who used the digital health record system than those who didn't.
"Communicating via secure messaging also has advantages from a clinician's perspective. "I can be more proactive," says Dr. Nyland. "For example, I can change a patient's medication dose every two weeks, if necessary, rather than waiting a month or two until the patient's next office visit. Secure e-mail helps me contact my patients quickly. No more phone tag. And it allows my patients to express themselves in a different way than they do at an office visit. I learn more about them, and get to know them better.""
The real challenge will remain the 42% of the population who earn under 3$0,000 a year who still don't have regular internet access at home and how to use technology and information to bring about behavior change in high risk populations.
Thanks for sharing your wisdom. Group Health is in our own back yard here in the Puget Sound region and I frequently cite their e-health experience in my keynotes and writings. Of course, like Kaiser, they are a staff model HMO. Using e-health modalities to provision care to their members/patients makes perfect sense for their business model. The challenge is how to make it work everywhere else. Frankly, that's why I often see much more progress being made outside the US where healthcare is more "public" and governments are incented to drive greater efficiency into providing care for the population.
One final thought; the poor need not be excluded from e-health services. The airlines have trained virtually everyone how to use a kiosk, and appropriately place devices could be gateways to information and care for underserved populations. Furthermore, as American television goes digital, the "TV" in our living rooms will increasingly become the front end for telehealth/telepresence solutions.
Dear Dr. Crounse,
Thanks for the inputs.
It has been invigorating implementing the CUI based approach within the healthcare applications. I guess this is really a ground breaking work being done. These concepts are in use one way or the other in each of the applications in the market. I guess this needed to be done for the healthcare industry as a standard.