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Doctor-Patient 'Web Visits' Spur Privacy Concerns

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As more doctors go online to communicate with patients, two of the country's biggest health insurers have started reimbursing patients for the Internet visits. But critics say the online advising could lead to errors, and patient privacy could be compromised.


One new way and possibly more efficient way to get your doctor's advice or make an appointment is to go online. And more and more doctors are going online to communicate with their patients. That's because this year the nation's biggest health insurers - Aetna and Cigna - start reimbursing for a service that provides secure Web visits between patients and their doctors.

From San Francisco, Deirdre Kennedy reports.

DEIRDRE KENNEDY: At his office near downtown Oakland, internist Dr. Dean Nichols checks secured online messages from his patients throughout the day.

Dr. DEAN NICHOLS (Internist): So this is a patient who had a recent diagnosis of a relatively rare condition called polymyalgia rheumatica and is being treated with steroids and had some questions regarding the management of this problem.

KENNEDY: In the past, finding a patient's chart, reading through it, and then reaching the patient by phone might've taken days. Not anymore. Nichols gets messages through a secure portal from a wide variety of people: homebound elders, students away at school, and workers with busy schedules. It's changed the way he manages his patient load.

Dr. NICHOLS: Rather than being interrupted while I'm seeing a patient, I can handle my e-mail messages from patients either before office hours, after office hours, over the noon hour. So it really actually frees me up to spend more time with patients.

KENNEDY: By logging into a secure Web-based service called RelayHealth, Dr. Nichols's patients can request an appointment, ask for a referral or get a prescription refilled, or they can sign up for what's called a Web visit.

(Soundbite of typing)

KENNEDY: Retired oncologist Joseph Halprin and his wife Lynn are both patients of Dr. Nichols. They often sign on for Web visits to get feedback on minor conditions.

Dr. JOSEPH HALPRIN (Oncologist): For example, my wife had the flu. She coughed quite a bit, then developed a pain that I thought was - and she thought - was either a cracked rib or a muscle strain. And we didn't think it required a visit because we didn't think there could be anything done about that kind of condition but just wanted some reassurance about that.

KENNEDY: So what did Dr. Nichols end up telling you?

Dr. HALPRIN: He said it's probably a strain and it should go away within a week to 10 days, which it did.

KENNEDY: E-mail between physicians and patients is nothing new, but concerns over privacy issues, getting unedited ramblings from patients, and lack of reimbursement made many doctors reluctant to e-chat. Now major health plans are paying for the online visits to RelayHealth. And the company's secure portal serves as an electronic advice nurse that helps focus the online inquiry to the doc. Relay's general manager Ken Tarkoff.

Mr. KEN TARKOFF (RelayHealth): It's an online interview with branching logic based on a variety of questions that the system asks the patient to provide answers to, and based on those answers it provides additional questions.

KENNEDY: Questions such as how long have you been experiencing this symptom? Do you have a fever? Have you taken any medication? How is it working? Questions designed by a team of physician advisors. The online communication then becomes part of the patient's record.

This year, health insurers Aetna and Cigna started aggressively marketing the service to more than a million physicians across the country. Cigna spokesman Joe Mondy says e-visits benefit physicians, employers and patients, because it only costs $25.

Mr. JOE MONDY (Cigna): There's a substantial savings there. In addition to that cost savings, there's also, of course, the time saving, which is of value to really all three of them.

KENNEDY: But not all physicians have confidence in the technology. Cardiologist Jim Rohack is on the board of the American Medical Association. He's concerned about the security of online communication.

Dr. JIM ROHACK (American Medical Association): Once you put things in cyberspace, they can go all over the place. At least with a telephone, you know, even with a cell phone, you pretty much - it's a one-on-one conversation.

KENNEDY: And he says there are times when online communication between doctor and patient is not appropriate.

Dr. ROHACK: Any time where a physical examination has to be done to make a diagnosis - the person's having chest pain, for example, it's very difficult to make the determination over e-mail whether or not the person's having a heart attack or not.

KENNEDY: But Tarkoff of RelayHealth is confident that patients and physicians are capable of making that judgment call.

Mr. TARKOFF: It's not right for every situation. It's an additional thing that you can offer to patients where it's appropriate for patients who understand how to use it effectively and where the physicians are comfortable that those patients can provide the information over the Web.

KENNEDY: Patients are always advised to seek urgent care if they have symptoms like chest pain, a high fever, or uncontrolled bleeding.

Americans do seem to be eager to adopt the technology. A recent Harris interactive survey of online users found that 74 percent of patients would like to be able to communicate with their doctors through some sort of e-mail.

For NPR News, I'm Deirdre Kennedy in San Francisco.

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