Will health reform move more medical care online?

Last month over at FierceHealthcare, we reported on a study revealing that 90 percent of parents surveyed would welcome email access [1] to their child's doctor. Picture me, a mom of two tough-to-wrangle toddlers, raising my hand emphatically from behind the laptop.

How nice would it be if I could just beam our pediatrician a digital photo of a rash, describe any other symptoms and get a response--even if it's that I'll need to make an appointment--without necessarily having to haul both kids over there and inevitably bring the healthy one back with the germs of some other kid who couldn't resist smooshing his face right up against the giant fish tank? As a parent and as a patient, it would be very nice indeed.

But as a healthcare journalist, I appreciate the reasons the physician-patient email trend hasn't really taken off. Although 68 percent of American adults now use the Internet to search for healthcare information, just 42 percent of U.S. physicians say they've discussed clinical symptoms online with patients, according to the Los Angeles Times [2].

Despite the practicality and convenience of asynchronous communication at one's fingertips, assuming the technology is secure and encrypted, at the end of the day, responding to patient email is yet another uncompensated task [3] on a seemingly infinite to-do list. As Kevin Pho, MD, author of the popular medical blog, KevinMD.com [4], put it in a recent opinion piece for CNN.com [5], "When a primary-care doctor routinely sees 30 patients or more in a day, combined with hours wasted on health insurer bureaucracy, taking the additional time to email patients is not fiscally feasible when it is not reimbursed by Medicare or most health insurers."

As of last year, the Times confirms, less than 5 percent of doctors communicating online with their patients were being paid to do so.

But it's important to be specific about our terms, notes Joseph C. Kvedar, MD, an associate professor at Harvard Medical School and the founder and director of the Center for Connected Health [6]. "Since email is inherently not secure, I don't expect insurers to pay for email exchanges. If we mean online messaging [better still, online secure messaging], I beg to differ," he tells FiercePracticeManagement.

A number of big insurers, including Cigna (NYSE: CI [7]), Aetna (NYSE: AET [8]), most Blue Shield plans, WellPoint (NYSE: WLP [9]) and Humana (NYSE: HUM [10]), have begun to reimburse doctors for online visits. "There is a CPT code for billing and the reimbursement is in the range of $35," Kvedar says. "The delay, in my opinion, involves the necessary changes to physician work flow and the required software implementation."

Perhaps health reform [11]--and physicians' need to figure out how to squeeze 32 million newly insured patients between the 15 to 30 patients they already see, diagnose, treat, chart, code and haggle over with insurers every day--will help move things along. So far, telemedicine has been a frequently cited strategy, among others, to work around that pesky 24-hour limit to a given doctor's day.

If that's true, establishing greater comfort with online messaging seems like a logical place to start. And I'd optimistically (remember the fish tank?) like to think that even more insurers would begin to put dollars behind the potentially cost-saving service.

Some insiders say there's hope. "With reform, we'll see a lot more demonstrations," Jonathan Linkous, chief executive of the American Telemedicine Association, a medical telecommunications technology trade group, told the Times. At the same time, he adds, the infrastructure will be set up to allow e-visit technology to go mainstream.

"Medicare and states and the private insurers are going to move into this as just another way of providing healthcare," Linkous says. "Five years from now, people will not remember any other way of doing it."

Do you foresee it happening? What changes would have to take place for your practice to make one or more small steps into cyberspace? - Deb [12]