Monday, March 5, 2007

Clinical innovation - Information Prescription: A Primary Care E-Mail Innovation from America’s Heartland

Scarcely a day passes without another commonsensical innovation coming from a doctor who’s been there and done that and who knows what doctors can deliver and what patients want.

In this case, that doctor is Charles Smith, MD, 57, a practicing family physician in Little Rock, Arkansas, who wears three hats:

• founder in 1998 of,
• associate dean of the University Of Arkansas Medical Sciences College Of Medicine (UAMS) in Little Rock,
• teacher and attending physician at UAMS.

Dr. Smith is also the Executive Associate Dean for Clinical Affairs at the University of Arkansas for Medical Sciences (UAMS) and is a Professor in the Department of Family and Community Medicine there, where he has been working since 1989.

In his role at the University Of Arkansas Medical Sciences College Of Medicine, he also serves as the Medical Director for UAMS Medical Center and as Physician Director of Medical informatics. He is responsible for initiating and implementing software programs to assist physicians to provide care at UAMS and for overseeing quality of medical care at UAMS. Dr. Smith is clearly a man of all seasons for all the right reasons.

Dr. Smith has long been a leader in American Academy of Family Physicians circles. In his own company, EDocAmerica, Inc, he has gathered together 12 primary care national leaders – 10 family physicians, 1 internist, and one psychologist – to answer emails from concerned patients on a secure website, In his career as a family doc, Charlie has learned about ½ of patients don’t really need to come to the office to be seen – what they want and need is more information about treatment and doctor options.

Employee groups who desire to provide another health benefit for employees are the source of EDocAmerica patients. Employers pay a per use per month access fee, which usually averages less than $1 per use. has 350,000 eligible users – more than 1 million including family members, who are eligible to use the service.

Dr. Smith and his team are discriminating about what they can and cannot do. What they can do is “prescribe information” – give information, tell patients where to go to find information, link them to other relevant information websites, and tell them where to seek second opinions. What they cannot do is make diagnoses and prescribe drugs. Dr. Smith and his primary care crew say many patients visit their site on multiple occasions, and follow-up visits are welcomed.

Dr. Smith says the whole experience of communicating with patients from these employer groups has been gratifying. Because of email’s anonymity, patients share information they would not tell their personal doctors. Also, and this is a crucial point, employer groups and patients say the service saves money. A recent study of 1.2 million claims of those using the service against those who did not and found a 16 % reduction in fees, about $89 per claim, in users versus non-users.

Smith and his group have a partnership with, and Smith’s blog can be found there in the list of Revolution Health bloggers who share insights to visitors. You can also visit his blog at,

To conclude:

There once was a family physician named Smith,
Who sought to serve others through e-mail pith.
So he gathered one dozen primary care buddies,
Who were not stick-in-the-mud fuddy-duddies,
And they dispensed information forthwith.

No comments: