In just a week from now, on January 15, 2009, American Well Systems will put patients face to face with doctors via web cameras and web interaction. Its first customer is Hawaii Medical Service Association, the state’s Blue Cross-Blue Shield licensee, according to an on line article in the New York Times by Claire Cain Miller. According to the company as reported by Miller, "it will make the Internet version of the house call available to everyone in the state".
While I've been expecting this sort of innovation for some time, I did expect it to emerge on a much smaller scale and the concept that this insurer would initiate the program now is quite intriguing. The service is for patients who are looking for easier access to physicians, who do not want to spend time driving to a clinic or who don't want to make a traditional appointment.
Where do I sign up!?
Undoubtedly there will be some snags along the way as this kind of program rolls out in Hawaii and likely elsewhere. Most importantly there will be the concern regarding the ability to determine from physical exam if there is significant illness requiring immediate intervention. How does one palpate the liver edge or check for rebound and guarding over the internet?
My impression is that the web based assessment will have greater application for chronic illness and for follow-up than it will have for assessment of acute injuries or emergency assessment although I expect there will be a role for these as well when the ability to transmit information on vitals and physical exam become more enhanced. This can be achieved either by an assistant at the patient end or through improved blood pressure and cardiac monitoring and even lab analysis via the internet.
I wouldn't want to see the personal interaction between professional and patient go the way of the Do-do bird but I do believe the there is great opportunity in this new approach.
It is not surprising that the initiation of this program is occurring in the US although many remote areas in Canada including some not so remote areas are developing more substantial telemedicine. Recently I had a patient only 30 minutes from a major centre who was evaluated by a specialist through a telemedicine system. He still had to travel to a video access centre but all in all he appreciated saving a drive further to town.
This approach is also a green alternative decreasing unnecessary driving and gas consumption as well as time by patients spent on the road or waiting in doctors' offices thereby increasing their productivity.
Elderly patients may avoid risky road conditions in the winter when they can contact their physician's office to arrange this kind of assessment or review of recent blood work or tests instead.
One pitfall to establishing this sort of scenario in Ontario is the College of Physicians and Surgeons of Ontario and OHIP who are quite likely to see this program as difficult to regulate and we know that command and control is really what they are both about. Whether an arrangement suits a patient's needs and the physician can accommodate them would be beside the point.
Another area of concern would be patient privacy although Generation Y does not appear to have the same concerns about privacy as previous generations. It is possible that Generation Y will not only embrace this kind of technology as time goes on but they will insist on it. Will they be willing to risk having some of their medical information on a potentially hackable system? My guess is Yes for the most part.
This new program in Hawaii will be important to watch and if successful could revolutionize the way medical care is provided in Canada. Of course, the CPSO and OHIP might have to climb out of their dark caves to see the light but maybe one day they will recognize that the basis for medical care is between the patient and the provider and the provider's team.
On this snowy day in Ottawa, I wish you all safe driving.....and I'm off to another dentist appointment with my daughter....we'll leave double the time to get there. No way to get those teeth worked on over the internet...yet.