February 12, 2000
AS A DISTINCT INTERNET-HEALTH CATEGORY
Internet health analysts initially
divided the world of e-health into 3 or 4 “Cs” – usually Content,
Connectivity, and Commerce (and sometimes Community).
Wit Capital has recently another C to
the list –- Clinical Care.
Wit’s excellent 58 page report
Healthcare and the Internet in the New Millennium” can be viewed in
Adobe Acrobat formats.
Wit Capital’s report identifies this
new category as -- Clinical Care: The Convergence of Disease
Management, Health Management and the Internet.
“Relentlessly rising healthcare
expenditures have plagued healthcare payers and providers for the
past two decades.
Inefficiency in the healthcare system abounds, including a high
incidence of inappropriate care, inexplicably high variation in
treatment approaches and outcomes among practitioners and regions,
and lack of information available to consumers. At the same time, individuals, increasingly disillusioned
with the healthcare system, have sought empowerment by taking more
personal responsibility for their healthcare and proactively
seeking more information and tools to better track and manage
their health. Disease management companies seek to solve many of
these longstanding issues. Increasingly, a disease management
approach to care is becoming accepted as critical to controlling
overall health costs while maintaining and in many cases improving
Wit develops an initial list of
companies in the e-clinical care space: Accordant, Avandel, Caresoft,
Confer, Global Medic, Health Hero, Lifechart, Lifemasters,
E-CARE BY OTHER ANALYSTS
What have other analysts said about
the e-care space? The
remainder of this article presents perspectives from reports issued
by Goldman Sachs, Dain Rauscher,
U.S. Bancorp Piper Jaffray,
Bear Stearns, J.C. Bradford and Company, and Hambrecht and Quest.
GOLDMAN SACHS. “Care will likely be the
most significant benefit of the Internet in healthcare, but it is
also likely to be the slowest to develop. We believe this will be an
evolutionary process, from simple content, to care management
applications, to more robust care treatment applications.” Goldman Sachs Investment
Opportunities in eHealth”
DAIN RAUSCHER. “It is widely recognized
today that the long-term solution to controlling healthcare costs is
to address the delivery of care, which represents the other 85% or
$850 billion of costs.
The goal is to move from managing costs to managing clinical
Rauscher, “The Internet’s Role in Healthcare: Realizing the Power Of
US BANCORP PIPER JAFFRAY. “Clinical systems will be
the killer apps for the foreseeable future. The Internet will be
used extensively to exchange information outside of the four walls
of the health care setting (hospital, alternative care center,
U.S. Bancorp Piper Jaffray
Equity Research, “Monthly Commentary” January 2000
BEAR STEARNS. “Web-enabled applications
can bring licensing, consulting, and implementation revenues to
firms that provide them.
We see this category as possibly the highest value-added
proposition in the health care Internet segment, based on the
ability to combine actual care management protocols with the
advantages of Web-based connectivity.” Bear Stearns, “Health
Care Internet: A New
Realm of Opportunity”
J.C. BRADFORD. “With great joy we see the
fledgling world of telemedicine pass the baton to the new era of
what we are calling ‘Web medicine.’
Web medicine embodies all of the virtues of telemedicine
while leveraging the cost benefits provided by the Internet to make
disease management a viable business. It is no longer necessary
for a costly nurse or clinician’s aid to interact with a patient to
collect vital clinical information; rather, the patient can log on
and enter the data himself.
Clinicians can spend their time intervening with high-risk
patients identified by sophisticated clinical algorithms in the
Web-medicine system rather than performing low value-added
maintenance calls to patients.
Patient compliance can be tracked by the system and
incentives put in place by the health plan to compel the patient to
Suddenly, Web-medicine begets disease management. Disease management enables
case management. Costs can be actively controlled while wellness
& Co., “hcis.com – The Internet in Healthcare: The Final Frontier” August 1999.
HAMBRECHT & QUEST. “The Internet is an ideal
platform for disease management (DM) solutions that link patients
with providers, payers, and suppliers. DM Web sites, by serving as
a resource for disease and wellness-related information and
facilitating communications with providers, enable patients to act
as their own case managers.
Given that the majority of clinical costs are from chronic
diseases, and that a significant percentage of these costs could be
avoided through better clinical focus, DM solutions offer huge
potential cost savings, as well as improvements in the quality of
care and medical research.”
Quest, “The health.net Industry:
The Convergence of Healthcare and The Internet” January 1999.
The Fifth “E-C” – Care
E-CONTENT COMPANIES BEGIN TO LOOK MORE LIKE E-CARE COMPANIES
A recent article in the
Industry Standard quotes the CEOs of HealthCentral and Drkoop,
two publicly traded health portals (e-content companies).
Drkoop CEO Donald
Hackett told analysts and investment bankers at a recent Chase H&Q
health care conference that "content is not the key." Drkoop, he said, will evolve
into a disease-management company.
Albert Greene, CEO
of HealthCentral, noted that the company’s next step is to offer
disease management services.
We will have more
to say about this significant shift in strategy. Please send your comments to
1) Internet users overwhelmingly do
not want their health information shared with anyone else without
their consent. 88%
percent of respondents said they would not be willing to submit
information if it were to be shared with advertisers or marketers.
Online medical record keeping, even if access is restricted
to an individual and his or her physician, is perceived as the
greatest threat to individual privacy on the Internet.
Physicians may hold the key to overcoming consumer's fears.
Internet health consumers are most likely to trust their physicians,
medical institutes and associations to maintain the privacy of their
personal health information.
17% of Internet users will not even search for health
information online because of privacy concerns.
1) Visitors to health Web sites
are not anonymous, even if they think they are.
2) Health Web sites recognize
consumers' concern about the privacy of their personal health
information and have made efforts to establish privacy policies;
however, the policies fall short of truly safeguarding consumers.
3) There is inconsistency
between the privacy policies and the actual practices of health Web
4) Consumers are using health
Web sites to better manage their health, but their personal
information may not be adequately protected.
5) Health Web sites with
privacy policies that disclaim liability for the actions of third
parties on the site negate those very policies.
HealthCentral issued a
press release challenging some of the findings.
examining consumer views of health privacy issues were recently
and by Medstat ("Consumers
Say Privacy of Health Information is Important, but Understand Need
for Healthcare Research" and
"Consumers Skeptical of Health Information on Internet" ).
INTERNET HEALTH ETHICS
In the autumn of
1999 more than a dozen leading e-healthcare companies began a
dialogue to address consumer concerns about the ethics and integrity
of Internet health sites.
Hi-Ethics (Health Internet Ethics) members agreed that Internet
users deserve high quality content, responsible advertising and the
protection of personal health information.
Another Internet health
ethics initiative is sponsored by the Internet Health Coalition (IHC). The IHC coordinated an
eHealth Ethics Summit in Washington DC between January 31 and
February 2, 2000. You
can review the
agenda and meeting notes at their website.
Five workgroups at
the Summit included
Security, and Confidentiality
Use of the
Internet in the Practice of Healthcare Provision
meeting notes of the last group will be of particular interest
to readers of E-CareManagement News.
(The meeting notes are rough –- what you might expect see to
on a flip chart. They
are a fascinating account of the thoughts of some of the best
international experts in this area.)
....and just last
week the American
Accreditation Healthcare Commission/URAC jumped on the bandwagon
with its own initiative to develop accreditation standards for
health web sites.
Is there any connection among the
trends discussed above?
importance of protecting patient privacy and confidentiality of
medical information cannot be underestimated. Don Kemper, President of
Healthwise and Chair of Hi-Ethics, notes that there
traditionally have been 3 factors for success in real estate –
location, location, location.
He describes the 3 factors for success for Internet
health companies as “Trust, trust, trust.”
Consumers are demanding higher standards in e-health than in
other areas of Internet commerce!
E-health companies must build firewalls between their e-content
and e-commerce initiatives.
This is parallel to a separation that already exists in
journalism –- the division between journalistic comment and
advertising. As a
practical manner, this means that diabetics browsing through
medical content on the web WON’T be seeing banner ads for
glucometers (unless they have explicitly given their
E-content companies will migrate toward becoming e-care
companies (more on this later).
A rhetorical question: Did entrepreneurs and
investors anticipate these developments when they funded e-content
OUTCOMES OF THE
KAISER-PERMANENTE TELE-HOME HEALTH RESEARCH PROJECT
study published in the Archives of Family Medicine evaluated the
use of remote video technology in the home health care setting.
The Conclusions: Remote video technology in
the home health care setting was shown to be effective, well
received by patients, capable of maintaining quality of care, and to
have the potential for cost savings.
Patients seemed pleased with the equipment and the ability to
access a home health care provider 24 hours a day. Remote technology
has the potential to effect cost savings when used to substitute
some in-person visits and can also improve access to home health
care staff for patients and caregivers. This technology can thus be
an asset for patients and providers.
Commentary: How long can the
Industrial-age peer review/publishing process last in the days of
the Internet? This
study was performed in ‘96-97 and is being published in 2000? Hello? While it’s nice to see the
cost savings shown by using telehealth technology, a few things have
happened since 1996.
(In contrast, the CHFC Ethics Survey referenced above was conducted
and published in January 2000).
recent article in the San Jose Mercury News comments on plusses
and minuses of doctor visits over the Internet.
E-CareManagement News is an
e-newsletter that tracks a major change in health care and managed
care—the paradigm shift from “managing cost” to “managing care”.
This e-newsletter is brought to you by Better Health Technologies,
LLC (http://www.bhtinfo.com). BHT provides consulting and
business development services relating to disease management, demand
management, and patient health information technologies.
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