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E-healthcare and the MD-patient relationship

By Alice Anne Andress

Healthcare is experiencing a dramatic transformation in information exchange which is driven by technology. From health care e-communications to e-commerce and e-care, new developments and e-services are rolling out daily. We are going from telecommunications to e-communications! This fundamental shift will change the delivery of healthcare as it affects the consumer, the patient and the healthcare professional.

The role of the patient is changing as they educate themselves with information found on the Web. Health is now partnering with medicine, which too often in the past focused on treating patients when they were sick, not trying to keep them well. Today, millions of people are on line, doing banking, shopping, stock trading, directions, and communicating with family and friends. Medical services are periodic, unwanted purchases that most reasonable people try to avoid.

The new health and wellness approach of the 21st century is to empower and energize individuals to be healthier and to take responsibility for their own well-being, and the Internet is one of the most cost-effective distribution channels for accomplishing this. We even have insurance that can be purchased to pay individuals to have wellness checks! One company will pay each individual a yearly payment of $75 dollars if they provide documentation that they purchased a wellness service in that year. This new trend is not only about accessing health and medical information on the web, but it is also about service. Because of this, we must completely revolutionize the way health care is delivered. By using web technologies, we may see a decrease in office visits and telephone calls because patients are able to find basic information through the doctor’s interactive text, graphics, audio and video web service.

It is important to understand the difference between e-healthcare and i-healthcare. E-healthcare stands for electronic communications. I-healthcare stands for the Internet, which is a tool, not a strategy. Your physician practice cannot be “e” without the Internet, but it is more than just installing an Intranet and getting employees and doctors on line. Becoming “e” is a digital mindset. Physicians will need to concentrate more on bits and bytes instead of bricks and mortar. It will allow them to save time and money.

Today’s e-patients want more than information. They want knowledge of, and access to, health services that can help and heal. They want the power to participate in, and lead their own medical care. They use the Internet to access information on injuries, prescription drugs, health insurance and child development. There was a time that patients were not knowledgeable consumers. The new baby boomer generation, however, expects more from health care. Many of them make informed decisions regarding their healthcare based on the information they find on the web.

There are tens of thousands of websites available today. Patients can even go to the web site www.healthcarereportcards.com to see how their local hospitals “size-up” against others in the area and the number of procedures performed. One can select a city and state and instantly access clinical outcomes for cardiac care, orthopaedics, neurosciences, pulmonary care and transplants. E-patients are much more aware of your outcomes than you might think. The newly-created Patient Safety Authority will have accessible data for patients’ review. Other web sites currently used by patients are Health-Online.com, AHN.com, and Thriveonline.com where patients can integrate health systems, physicians and patients to enable e-care delivery. Patients can register for local health can wellness classes, receive lab results, refill prescriptions and access disease management tools. These e-patients are busy looking for physicians who comfortably recognize and interpret e-information that is brought to them as patients seek e-applications to better serve their patients and improve the efficiency of their practice.

Not all e-healthcare is based on disease. Much is based on wellness. Millions of Americans are seeking better health without the aid of a physician or healthcare provider, by accessing information about vitamins, clinical trials, alternative medicine, fitness and organic food. Currently, self-care is the largest form of healthcare in the country, bigger than hospital care, physician care or home care. Approximately 80 percent of healthcare expenditures in the country are related to consumer self-care and the Internet is becoming their medium of choice for seeking access to these alternatives. These patients are commonly referred to as HMRs- health med retrievers. Current data show that these HMRs represent a slightly higher percent of women than men. The HMR’s total household income is above $50,000 per year and 48 percent are college graduates. Yes, this is not your father’s health care consumer!

At www.askdrweil.com, e-patients gain knowledge of integrative medicine, defined as healing-oriented medicine that takes account of the whole person (body, mind and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

The point is, any type of patient can find what they are looking for on the web.

All this talk about efficiency and technology raises concerns by physicians, as they are skeptical about the quality of information that patients access on-line. Most physicians that I have talked with prefer to provide information to patients through methods other than the Internet. Physicians worry that patients may get inaccurate information at some sites that may cause them to mis-diagnose themselves. However, a recent study revealed that 67 percent of consumers prefer to print out information on-line and take it to their physician for discussion. Most patients reported that they want their physician involved before deciding which action to take. So, while most patients will access healthcare information on-line, they will discuss what they find with their physician before formulating any opinions, which might lead to final decisions about their medical care.

Healthcare is an information-intensive service industry. More than 80 percent of the time, healthcare providers spend their time collecting, processing, retrieving and communicating medical information. It is most important to maintain and protect the privacy of e-patients and the confidentiality of data transmitted over the Internet against the need to for access to data. Patient medical records command the highest level of confidentiality, especially with the Health Insurance Portability and Accountability Act (HIPAA) watching over us. The mission is to protect the integrity and confidentiality of medical information.

Our future finds us moving the medical record away from a paper-based format to an electronic format. Back in 1991, the Institute of Medicine began researching the electronic medical record, which they called a computer-based patient record or CPR. There are still some roadblocks to the implementation of electronic medical records. Medical practices put more emphasis on reimbursement and managed care contracting. These financial challenges require a higher priority than an electronic medical record. There needs to be a cultural change among the staff when automating the clinical aspects of medical practice. This requires significant involvement of the physician and his/her time. This, of course, is an issue as physicians never have enough time as it is. Last but not least, one of the biggest roadblocks to acceptance of this new technology is the technology-adverse provider. Many physicians today are not interested in changing from the paper-based system.

Technology is being created everyday. It is the responsibility of every healthcare provider to investigate ways to make healthcare better, faster and more efficient through technology. Today’s e-patients want e-solutions, but they want them in consultation with their physician. They need decision support and cost-effective, quality service. Are physicians up to the challenge?

Alice Anne Andress, CCS-P, CCP is a Manager at Parente Randolph, LLC, in Philadelphia, PA and the Director of Physician Services in their Health Care Consulting Division.

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