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Web Tools Target Patients

July 1, 1998
by Polly Schneider
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Web Tools Target Patients

LEGISLATORS AND CONSUMER advocates across the country are debating controversial bills protecting the rights of patients under managed care. Meanwhile, a host of Internet startups is advocating a private-sector approach to help consumers take control of their health. More robust and interactive than a Web site, these products use Internet technology to connect patients with their providers, and through online surveys, research and decision support, promise to transform healthcare consumers into case managers. Healthcare organizations and payors, too, are bound to benefit when patients push valuable data back over extranets or the Internet.

According to Doug O’Boyle, program director of healthcare IT strategies for META Group, Inc., these early-stage products fall into two categories: 100 percent Web-based, and home PC applications that have a Web component. "Generally, all of these are designed to make it easy to input clinical data and relay it back to the provider," he says. "The idea is to keep patients out of the hospital."

The Florida experiment
Consumer outreach is an abiding vision behind the part resort, part high tech laboratory Celebration Health facility, located in the Disney-backed town of Celebration, Fla. With nontraditional health services like a sleep disorder center, pain center and lifestyles management center; a 60,000 square-foot fitness center, library and health food cafe on campus; owner Florida Hospital Health System has created a wellness-focused environment for the 21st century. Celebration’s commitment to technology is unfolding with medical records software from EPIC Systems Corp., Internet-based computer kiosks and touchscreen computers for patients throughout the facility, telemedicine workstations (later this year) and a Web-based patient-centric suite of applications and services.

One of the core programs, scheduled for beta roll-out this summer, is a personal health record for patients called HealthCompass, codeveloped with HealthMagic, Inc., Denver. HealthCompass is free for Celebration patients and accessible from the organization’s Web site (http://www.celebrationhealth.com). Through an interface to the EPIC system, patients will be able to receive parts of their official records--authorized by the physician--to store in their personal record, says Fred Galusha, VP of IS at Florida Hospital, Orlando.

Patients can then build on this by taking surveys or keeping a medication diary. The system also pushes relevant articles and research to patients based on their profile, and offers resource links and chat groups for 75 disease categories. Patients will be able to record vitals such as blood pressure and send the results over the Internet to the primary care provider’s office, which in turn could email reminders for preventive services--triggers that the software also could generate, according to Nelson Hazeltine, chief technology officer of HealthMagic. He says the timing of such applications is key in the current climate of managed care consumer backlash. "Baby boomers are now at an age where they’re going to demand appropriate care and they aren’t going to accept just what the doctor says," he says. "The patient has now become the case manager."

The software is NT-based Microsoft SQL Server and uses proprietary digital certificate and firewall technologies for authentication and access control, according to Hazeltine. This gives the patient secure access to his or her record but also the ability to select parts of it to share with the provider. The Web interface was designed by Renaissance Interactive, in Columbia, S.C.

Through HealthCompass and a growing slew of online services at both the Florida Hospital and Celebration Web sites--including a physician database and referral service, patient preregistration and appointment scheduling, and interactive health surveys--Galusha hopes the organization will provide better customer service, realize lower healthcare costs and gain market advantage. "We really want to provide a technology and an avenue to facilitate a relationship [between providers and their patients]."

Large employers buying in
Northern Telecom (Nortel) is launching a pilot of a similar Web-based personal health product from GlobalMedic, Ottawa, Ontario, that will be available to 12,000 Nortel employees in Canada this summer. The product will serve as a complement to Nortel’s existing wellness programs, and will help Nortel meet the health information needs of a decentralized workforce of virtual, home-based and traditional office employees, according to Anda Bruinsma, Nortel’s manager of employee well-being and global programs.

GlobalMedic President and CEO Fernand Taras, M.D., describes the Health Manager product as a single channel for employees to manage their health benefits, receive health information and maintain a personal record. It runs on a Windows NT server at GlobalMedic, and through an extranet connection, Nortel employees can log on to the program from the employee health Web site. To maintain confidentiality, Global Medic serves as a third-party administrator by issuing PIN numbers and passwords, and provides Nortel administrators with access to aggregate, disidentified patient data only. Pricing is based on a monthly per member fee ranging from 80 cents to $1.50 per user--not including customization and installation.

First, users create a personal health file based on a simple check-in-the-box questionnaire; they can update and edit their own files at any time. Another area of the site called "Self Care" allows users to do a quick online "check-up" to assess their symptoms and ascertain whether a call to the doctor is in order. The site provides access to disease and wellness information under sections such as "Women’s Health," and expert-system driven health risk surveys which could, for example, create a customized diet plan. GlobalMedic is talking with electronic medical record and practice management software vendors to establish interfaces to Health Manager so physicians can exchange information with their patients, according to Taras.

The product also may provide valuable insight to executives. "Employers want to have a sense of wellness of their employees," Taras says. Based on the analysis of claims data and patient reported-data, the system could generate preventive messages to specific segments of the population.

After the pilot has completed its first year, Bruinsma hopes to discover how employees like it, how many are repeat users and if the product had any impact on Nortel’s healthcare costs. Yet Bruinsma is quick to add that the GlobalMedic product is only one piece of a large Web-based suite of health and wellness services found on its one million-page and growing employee health site. Still, she admits that introducing employees to an electronic--not human--health assistant will take some work. "It needs to be part of a comprehensive marketing and education plan because this is a new venue for delivering health information."

Fueling outcomes research
HealthSystem Minnesota, a Minneapolis-based delivery system, is scheduled to install a browser-based patient reporting system later this year that patients will interact with at kiosks or PCs throughout its facilities, or from home over the Internet. The Java and Windows-based system, Patient Communicator, was codeveloped with @Outcome, an Austin, Texas, startup and Scott and White Memorial Hospital in Temple, Texas. It will allow patients to take satisfaction and health risk surveys and transmit them to providers, and in turn, receive information and test results, according to David Abelson, MD, associate medical director at HealthSystem. Patients log on to a Web site to access the system, which protects all transactions through passwords and point-to-point SSL encryption.

Abelson says the system will allow the organization to move away from a paper-based, disconnected data collection process to an enterprise solution for following the patient. "I see it as an infrastructure to link the patient with the care team." All data collected from the patient will be stored in a clinical data repository for both direct care and research. Abelson says Patient Communicator will be most helpful in allowing caregivers to track whether patients are following prevention and treatment plans, and eventually, will improve customer service by allowing patients to schedule appointments online and communicate with their physicians.

There are several other Web-enabled systems becoming available that incorporate some or all of the features above. HBOC has an agreement to distribute personal health diary and monitoring products from HealthDesk Corp., Berkeley, Calif. HealthDesk has secured contracts with Scottsdale Healthcare and the California Public Employees’ Retirement System, which will supply the product to 10,000 state employees. Another small company, Softwatch Inc., Burlington, Mass., sells disease-specific "Internet patient support systems" that include a diary/calendar, secure messaging with providers, and news and community links. Pharmaceutical firm Teva Marion Partners, Kansas City, Mo., has licensed the technology to build a multiple schlerosis Web service (http://www.mswatch.com).

While opportunity abounds for these new patient-focused tools to fundamentally change current methods of disease management, they won’t work unless patients see them as more than toys. Questions O’Boyle: "Will people in their homes actually use these products, or will they forget about them after awhile?" He calls this trend of patient-centric disease management the "next logical extension of healthcare services," but cautions that the concept is still untested in the marketplace.

Polly Schneider is senior editor at Healthcare Informatics.

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