Donita Gano woke up one Sunday morning with a problem. The 59-year-old public-health nurse had fallen and gashed her elbow about 10 days before. Now it was warm and inflamed, signs of probable infection. She logged on to an online clinic launched early this year by her health plan, Hawaii Medical Service Association, and chose an available physician. She clicked on "Connect now," and soon she and the doctor were engaged in an online chat about her symptoms. If she'd had a webcam and if the doctor had been amenable, she could have displayed her elbow for his inspection. He ordered an antibiotic, which she picked up right after logging off. "Pretty painless," says Gano.
It's easy and convenient for the nearly 150 Hawaii doctors who have signed up for HMSA's Online Care program, too. On a Maui beach near his office, internist Irving Harper towels off, picks up his cellphone, and handles questions from patients he's never seen. At home, he pulls up their medical records and E-mails them his recommendations. He has occasional video chats with patients but prefers to do those from his office, dressed more professionally than on the beach.
Patients in the Hawaii program receive care from doctors scheduled to be reachable at that moment. A 10-minute "visit" costs $10 for members and $45 for nonmembers, paid with a credit card. HMSA says thousands of patients have registered. Health plan members like Gano are pre-enrolled; nonmembers create an account and key in their medical history and other data to establish a record.
Gano and Harper are surfing a new wave of patient-friendly, relatively inexpensive, Web-based healthcare. The technology behind the HMSA program, created by American Well, a Boston company, is being picked up by other health insurance plans. Blue Cross & Blue Shield of Minnesota launched a pilot version this fall and plans to offer it to all members by mid-2010. A recent partnership between American Well and OptumHealth, a division of UnitedHealth Group, will take Online Care nationwide to all consumers, regardless of insurance provider. Then there is MDLiveCare, a national service with more than 100,000 members who may or may not be covered by a healthcare plan and who pay a flat $35 per online visit to consult with primary-care providers, specialists, and therapists in the network.
Some healthcare plans, such as Kaiser Permanente, already let members E-mail doctors, review lab tests, make appointments, and refill prescriptions online. But virtual doctor visits are in real time and don't have to adhere to office hours. In Hawaii, some of the most remote patients now have 24-7 access to basic healthcare.
Such services offer more than convenience, however. An online encounter often is a substitute for an expensive trip to the ER. It's also likely to be cheaper than an office visit, plus it confers nearly instant access to a patient's choice of available doctors and—a boon for employers—may trim the number of workdays missed for minor maladies. Ninety-five percent of Harper's patients using the Hawaii service can be managed without a face-to-face visit, says the physician.
Many Americans are would-be prospects for online care. Half say they would be interested in using the Internet not only as an information source but to receive healthcare directly, according to a recent survey by an arm of PricewaterhouseCoopers. Consumers soon may be able to choose from a range of services.
About 10,000 individuals, most of them residents of the New York metropolitan area, can already get an online (or phone) emergency consultation with one of 34 ER physicians who have signed on with a company called SwiftMD. CEO Elliot Justin, a doctor, has diagnosed a fungal infection by webcam (and a case of hemorrhoids, he says with amusement).
Patients in Brooklyn, N.Y., who don't have health insurance (and physicians who don't want to deal with insurance claims) have the option of joining Hello Health. After an initial face-to-face visit, patients pay $100 to $200 an hour for each encounter, whether it's in person or online. In addition, the $35 monthly membership fee covers unlimited E-mail exchanges with Hello Health doctors. Online, patients can see their doctor's schedule and make their own appointments. If they run late, they can whip out a BlackBerry or iPhone and post a message on a Facebook-like "wall" on the physician's Web page. Hello Health internist Sean Khozin figures he spends as much as 40 percent of his time online—following up with chronic disease cases, for example, to coordinate care. Hello Health is in the process of rolling out nationally.