Tuesday, January 6, 2009

E-medicine, clinical innovtion- Web Calls - Sign of the Times?

No man is an island, entire of itself.

John Donne

American Well, a Web service that puts patients face-to-face with doctors online will in introduced in Hawaii on January 15.

Claire Miller, New York Times, January 5

Face-face? Maybe click-to-click, byte-to-byte, or even island-to-island, or in the future, Skype-to-Skype, might be more descriptive.

In any event, the new Hawaii online service is a boldly innovative thing to do. The distant from your doctor and time away from your home or work, or even the cost of care, will no longer be barriers from your doctor.

The Hawaii Medical Service Association, the BCBS licensee, will make the online service available to everybody on the island, all 1.275 million of them, not just 700,000 BCBS members.

The idea is to make access easy for the uninsured and insured alike, and for those who have to travel long distances, which don’t have a personal doctor, who simply want a prescription refilled, or who need a convenient post-surgery follow-up.

Patients can use the service by logging into health plan websites. The cost for members is $10 for a 10 minute online appointment (more for visits over 10 minutes) and $45 for the uninsured for a 10 minute gig. You can get your prescription refilled, your problem diagnosed and treated, and your anxiety relieved.

The system just might be the ticket in Hawaii, where travel between islands is slow, distants are great, and rural doctors are rare. Besides Hawaii is a healthy place with great demographics. Cigarette and alcohol consumption rank low (48th in the U.S.), the obesity rate is also low (47th), the number of uninsured is the U.S. best (9%), the unemployment rate of 3.2%, rising but still great, and it is has a low population ranking among states (it has 1.275 citizens, 42nd among all states).

Online care has its critics. Online care is impersonal. Doctors might miss visual cues, signs, and symptoms; you can't test for everything online, e.g. strept throat; there’s always the danger of unwittingly supplying drugs to addicts; and the uninsured might not have broad band access (though 2/3s of the uninsured do, according to the California Healthcare Foundation). And in the future the lack of visual contact could be overcome with a Skype connection.


The technology surf is higher in Hawaii than on the mainland. The Skype’s the limit.

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