The perception of the Internet as a useful resource has steadily increased among physicians since 1997, according to the AMA. The appreciation physicians have gained for the Web over the last few years corresponds with a 50 percent growth in the proportion of online physicians. While it may be difficult to convince some doctors to change the way they have been doing business for years, understanding and adapting to new technologies will enable them to compete in the ever-evolving health care environment.

Internet technology is changing the operations of health care and medical education. Over 100 million Americans now have Internet access and health information is the most frequently searched topic. The consumer is better informed of medical diagnoses and procedures with greater access to medical information. According to a report issued by Pew Internet and American Life Project, consumer health-related use of the Internet hit a new high this past year, involving more than 52 percent of all Internet users.

An additional driver to the adoption of the Internet is that U.S. physician office visits have been steadily increasing over the past 10 years. This increase is largely due to population growth and to an aging population that needs to see their doctor more often.

Physicians find it necessary to control costs and be more aware of expected payments from the payers and the insured. Tools available to physicians to accomplish these goals include patient eligibility, claim submissions, ordering supplies, interactive care services and physician education. This is possible through building an online relationship with the payer to review and monitor claims. Physicians are able to admit patients, schedule patients and, transparent to the end user, process patient eligibility online.

It is predicted that business-to-business spending, which includes physician transactions, is expected to continue to drive the growth of Internet health care spending over the next four years. As the Internet becomes more accessible and less expensive, physicians are tapping into this resource and capitalizing on it.

Verify Patient Insurance Eligibility

Physician offices currently have two ways to verify their patients’ insurance eligibility, either over the phone or on the Web. Checking a patient’s eligibility can take up to three minutes when calling the insurance company over the phone. Checking a patient’s eligibility over the Web can be accomplished in seconds with much less hassle. The benefit to the physician practice is a reduction in overhead and improved patient satisfaction. Over 100,000 physicians currently use UnitedHealthcare Online, a Website where doctors can instantly check patient eligibility. While this represents only 30 percent of the doctors working with UnitedHealth, the company is pleased with the usage since the site has only been in use since July 2001.

Claims Submissions

Providers who develop relationships with their payers and have online claim submission capabilities have a better idea of where their claims are in the claims process. Claims that have been rejected due to errors, or claims that have been submitted incorrectly, are resolved in a more timely fashion. Physicians have a better idea of expected reimbursements and are able to better control the fiscal side of their business by improving cash flow and cash management. Internet usage opens doors for transaction-processing applications such as claims processing and claims status checking. This functionality can reduce the cost, time and effort per claim processed and reduce accounts receivable from having to wait weeks or months for payments.

Ordering Supplies

Ordering medical supplies is not something physicians frequently think about since it is usually the responsibility of a nurse or office staff, with the hope that they do not run out of anything and they are getting the best price. Ordering office and medical supplies online has become one of the most common and growing uses of the Internet for physician offices. Benefits include a reduction in expenses and a more efficient ordering system with quicker delivery since everything is automated. In addition, most products are offered at discounted prices since invoices can be paid via the Internet and the process involves less manual effort by the vendor. Buying supplies on the Internet could save offices 10 percent or more. Plus, there is the benefit of reducing time to order supplies. Nurses could spend hours going through their supply cabinets to find out what they needed. They also have to receive vendor sales representatives whenever the salesperson visits, taking up time needed for patient care. Ordering supplies on the Internet cuts down the amount of time nurses spend on ordering.

Interactive Care Services

Products are being developed to provide interactive care services via the Internet. Current development is centered on remote monitoring solutions for certain medical conditions. This already is in use today for Diabetes tracking (specifically for blood-sugar levels), solving the problems associated with repetitive office visits and patients with access or mobility issues. Diabetes is often referred to as a "24-hour" disease, with all the management complications that this infers (frequent trips to medical facility, need for data collection and interpretation "on demand," etc.). Devices are currently available that connect to a standard home PC and provide monitoring for items such as blood pressure, ECG and blood glucose. Similar products are currently underway for other chronic, "24-hour" diseases and aliments. Examples are AIDS, Alzheimer’s, Arthritis, Asthma, Back Pain, Cancer, Eating Disorders, Heart Disease, High Blood Pressure and Insomnia. The many benefits of these products and services are:

• Improving the quality of life for patients by reducing time spent in, and traveling to, the clinic for information, testing and monitoring.

• Providing more up-to-date information to the care team about the patient’s status, preventing possible complications.

• Patient profiling and custom tailored self-care program.

• Integration into existing patient records system.

Patient-Physician Communication

A 2001 AMA study of physicians’ use of the Internet examined, for the first time, electronic communications between patients and physicians. The study found that 25 percent of online physicians use e-mail to communicate with patients. Some samples of emails are general medical questions, patient education, multiple drug interaction questions, prescription refill requests, referrals and appointment scheduling. Physicians can respond to e-mails during non-patient hours, not interfering with their already hectic schedule. Patient-physician communication does not need to be a burden on physicians. Just as with phone messages, many of the e-mails received may be handled by a nurse or assistant. In addition, when patients ask some questions, they are performing some of the work that either the physician or nurse would have to do. Electronic messages are easy to sort and organize. They can also be printed and made part of the permanent record.

What’s next on the horizon? Telemedicine visits with patients. Health plans are currently looking into telemedicine-based "cyberpractices," where doctors visit their patients on the Internet. Until this is commonplace, the insurance companies and our government will need to develop policies (i.e. reimbursement) and strategies.

Education

Physicians are utilizing the Internet for continuing medical education classes and viewing online medical seminars. Obtaining CME credits over the Internet will reduce time away from the office and associated travel expenses. In addition, communicating with colleagues and participating in clinical trials over the Internet will occur more and more frequently. Online discussions groups, message boards, notifications and updates from regulatory commissions will also keep the physician fully informed with national and international changes to health care.

Concerns related to privacy and security are keeping some physicians from fully embracing the Internet. The Health Insurance Portability and Accountability Act (HIPAA) has been developed to mitigate these risks by requiring a certain level of security regarding communication of patient-identifiable health information. The proposed HIPAA security regulations will enable physician office to move forward and use the Internet to its greatest potential. Software vendors that provide the services mentioned above will need to provide secure Websites to the physician practices.

As health care costs continue to increase and reimbursements are reduced, physicians are confronted with having to implement cost saving measures and, at the same time, invest to stay competitive in an ever-changing market. Capitalizing on an existing technology and being aware of upcoming changes to technologies will give the physician an opportunity to decrease overhead. Implementing transaction-based applications such as claims submission and ordering supplies will reduce time and cost. Physician offices focused on automating existing processes and promoting efficiency into labor-intensive activities will welcome and take advantage of the Internet.