Reflections on the State of Online Health

As 2009 draws to a close, the US health care system is ailing and quasi-reform proposals are frantically being debated and voted on. Although some type of reform is likely in 2010, we will have only scratched the surface of what still needs to be changed. One particular aspect relates to the ease with which patients can use the internet to improve their health care. At eDoc, we've been using the internet to improve the health of our users for over a decade. Ten years ago, I predicted that patients would routinely use internet messaging to interact with the health care industry by now, but I was wrong. Although, increasingly, web 2.0 approaches are providing innovative communication and health management tools for patients, the growth of interaction between patients and doctors has been much slower than I predicted it would be. And the future still remains cloudy. The issues are nothing new and include:

1. Many patients still lack ready, reliable internet access. This is especially true for those who need it most: sick, elderly, and financially disabled persons.
2. Most insurance companies do not recognize e visits as reimbursible under health insurance plans. This provides a powerful disincentive for physicians to spend significant amounts of time answering e mail questions from their patients, since they are reluctant to bill patients directly for this type of service.
3. Professional liability issues have not been well worked out, leaving physicians and malpractice insurers feeling squeamish about supporting this approach.
4. Licensure issues remain the domain of individual states, are not consistent from state to state, and maintain unachievable standards in their definition of "doctor patient relationships". This requires a physician who wants to provide "on line care" to have a license in every state for which they provide this care (edoc provides medical information, not on line practice). Moreover, they define the minimum requirements for establishing a doctor patient relationship as an "in office" history and physical examination performed by that individual.
5. Physicians and health care providers who are interested in providing online care are dissuaded from getting involved lest they be tarred by the brush of thousands of online health care supplement companies, bogus care recommendations from quacks, and illegal drug distributions sites.

So, how will we deal with this, and in what direction will we go in the future? Hopefully, my predictions for the next few years will be more accurate than my last ones:

1. Online care will continue to grow, in spite of the obstacles mentioned above, because the internet an incredibly powerful and efficient resource for patients. The growing demand will eventually overwhelm the remaining barriers.
2. Patient and peer groups will become increasingly sophisticated, with or without the cooperation of health care providers, and will increasingly rely on each other, rather than sole reliance on trained professionals.
3. Grudgingly, more payers will begin to support online care as the patients/employee groups realize the benefit and demand it of their employers and insurers.
4. Access to online services will continue to grow, including adaptation on cell phone applications, which will lower the bar for patient groups that are currently left out of the action.

The ability to communicate with a physician via secure e mail has tremendous benefits, including saving unnecessary office visits, allowing patients to optimize the timing of their visits to physicians, and increasing patients' confidence to act on issues and questions. Moreover, it allows physicians and patients to emphasize and more efficiently monitor preventive practices such as healthy diet, exercise programs, weight loss programs, smoking cessation and others.

Health care reform may increase the number of patients who have some type of insurance, but thus far, has not included proposals to reform the online environment to encourage or stimulate more communication between doctors and patients.

As always, your comments or dissenting opinions are welcome.

Merry Christmas and Happy New Year to all, and thanks for being a part of eDocAmerica!