E-Medicine Increases in Popularity

Online doctor visits are beginning to make a mark on medicine. More than 9 million U.S. adults e-mailed their physicians in 2009, according to Manhattan Research, a New York City health care research firm. Even the American Medical Association is "supportive of the use of online evaluation services between a physician and an established patient," says group spokeswoman Lisa Lecas.

Take diabetes patient Cynthia Livingston, for example. Recovering from knee surgery last December, Livingston, 54, of Port St. Lucie, Fla., wasn't eating and had hypoglycemia. Low blood sugar levels left her confused and unbalanced. Livingston got on her computer, logged into a secure service her doctor uses and conducted an e-visit with her doctor, who instructed her to stop taking insulin but to remain on her oral diabetic medication.

"That stabilized my sugars," says Livingston. "The Web visit was a godsend because I couldn't get to the office anyway." Livingston has visited her doctor digitally a dozen times to seek relief from colds, fever and a urinary tract infection, and to manage her diabetes.

"I'm busy, I work long hours and I'm in school," says Livingston, a nurse. "It's hard for me to find time to go to the doctor."

The practice of e-visits, which can include e-mail, secure messaging and face-to-face online doctor visits aided by a webcam, got a boost when insurers like Aetna and Cigna began paying for them. Livingston's insurer, Aetna, covers the $30 Web visit fee.

Early evidence shows online doctor-patient consults can be good for your health. This month, Kaiser Permanente researchers reported in the journal Health Affairs that Kaiser members with diabetes and hypertension who securely e-mailed their doctors were more likely to get the recommended care to treat their conditions.

How it works

Whenever she has a health issue, Livingston logs into a secure Web-based program through RelayHealth — the company that facilitates Web visits for 13 health insurers and 25,000 providers — and indicates she wants to Web-visit with her own doctor.

Then Livingston chooses what's troubling her from a list of problems or symptoms. More than 150 nonurgent issues can be dealt with online, including allergies, arthritis, back pain, colds/flu, diabetes and post-op wound care. An interactive interview narrows down a patient's specific problem, generating a succinct summary that is sent to the doctor. The doctor responds to the patient within 24 hours, typically providing advice or a diagnosis, prescribing a medicine or, if the situation warrants, directing the patient to come in for an office visit.

From RelayHealth's online service, Livingston can also schedule her doctor appointments, renew her prescriptions, request referrals, and get test and lab results.

Because the service is Web-based, there is no need to download programs or anything else. Livingston connects with her doctor via a secure RelayHealth website requiring a username and password.

The RelayHealth service requires that patients conduct Web visits only with their existing doctors, which differs from some approaches. For example, American Well Corp.'s Online Care service offers face-to-face, virtual visits with doctors not necessarily your own. American Well's product is available through certain insurers, RiteAid and other health care organizations.

With Online Care, a consumer can pick a provider to visit online. That doctor or other clinical provider reviews the patient's information — based on what the patient sent — converses with and sees the patient via webcam, prescribes medication as needed, and suggests follow-up care. Patients can use online chat or a phone if they don't have a webcam. When the encounter is complete — typically within 10 minutes — a summary is sent to the patient.

Julie Swanson, 56, of Minnesota decided last February to use Online Care, offered through Blue Cross and Blue Shield of Minnesota, to deal with her annual bout of bronchitis. "Typically, I can't get into my own doctor during the cold and flu season," Swanson says. She paid $20 of the $45 cost (her employer picked up $25).

"It was the best bronchitis experience I've ever had," Swanson reports, as she was able to see a doctor sooner and get her medicine faster.

"This is a whole new care model," says MaryAnn Stump, chief innovation officer at the Minnesota Blues. Members who have used it report they saved time, and 93 percent are "very satisfied," she says.

What you need to know

The technology needed on the consumer end for online doctor visits is minimal, thanks to Web-based programs. A Web browser and Internet connection — sometimes a webcam — are all that's needed. Several of the online services have developed, or are rolling out, apps for smart phones.

Understanding privacy policies and how secure your connections are to an online provider is important. "A lot of this is happening on unsecured systems," says Monique Levy, Manhattan Research's senior research director. Your best insurance against any violation of your privacy is the insurance industry itself. Insurers covering online visits require services such as RelayHealth and American Well to use certain technologies or secure formats to protect patient privacy, in order to abide by federal privacy laws. Still, if you or your doctor converse digitally, be sure to ask about the established privacy policy.

Other things to consider:

• Type of care. Online consults are not appropriate for emergency or urgent care situations, or if you need tests or a physical exam.
• Costs. Fees range between $25 and $50, and typically are cheaper than retail clinics and office visits. See if your insurer covers any of the costs; if not, you can pay by credit or debit card.
• Doctor or provider. Some services require you to only conduct online consults with your existing doctor, while others don't.