October 25, 1999
FINALLY! THREE E-HEALTH COMPANIES FOCUSING ON CLINICAL MANAGEMENT
PREPARING TO GO PUBLIC!
A first wave of e-health companies went public earlier this year.
These e-health companies focus primarily on 1) Automating
back-office TRANSACTIONS (Healtheon, CareInsite, Claimsnet.com) or
2) Patient and/or physician CONTENT (DrKoop.com, adam.com,
We're gratified to see funding ready to flow to companies focusing
on care management opportunities. Within about the past two months,
three care management companies have filed S1 statements with the
Securities and Exchange Commission, a required step in taking a
company public. The companies (and citations to their S1 statements)
What are these companies doing? From the summary of the prospectus
OrganicNet. "We are an application services provider (ASP) that
develops software solutions for healthcare clinics and physician
group practices using our proprietary technology platform. Our
customers can access and use our solutions over the Internet or
their local or wide area networks. We are developing integrated
solutions designed to manage all elements of the business and
clinical processes of our customers within a single system. We
currently have developed and implemented solutions in three areas:
disease management, clinical drug trials recruitment and workers'
compensation. We charge our customers a monthly subscription fee for
Landacorp. "We offer business-to-business e-medical management
solutions to healthcare payers and providers that are designed to
help our clients control the cost and improve the quality of
healthcare delivery. Our applications automate and streamline
administrative and business processes and facilitate real-time
interaction among various healthcare participants. We enable our
clients to deliver consistent and appropriate medical care utilizing
their chosen clinical guidelines and business process rules. We are
also marketing e-medical management solutions that add functionality
to payers' Web sites in order to attract repeat visits by members.
We refer to Internet-based solutions that generate repeat visits as
MedicaLogic. "Our business is connecting physicians and patients
through the Internet. For physicians, we offer a line of enterprise
and Internet-based electronic medical record products and services
for use at the point of care in the exam room, with configurations
suitable for practices of all sizes. For patients, we will provide a
Web site that will allow them to access certain healthcare
information from their physician-generated medical record, enter
personal medical information and effectively communicate with their
physician. For both physicians and patients, we will provide focused
healthcare content and commerce opportunities, keyed to information
in a selectively shared database that unites physicians and
patients. Together, these products, services and databases will
comprise our Internet Health Services Center. We believe we can
increase the efficiency and quality of healthcare and enhance the
physician-patient relationship through our Internet Health Services
We wish these companies well! Please let us know if you are
interested in commentary or analysis on similarities/differences in
their clinical and business models.
AFFILIATE CONDUCTS FIRST MAJOR ONLINE STUDY OF THE CHRONICALLY ILL
Harris Interactive is studying attitudes and health care
patterns of 10,000 chronically ill patients.
1) Non-compliance among
patients is rampant, but varies dramatically. Only 43% of those
using prescription drugs have taken them properly, as prescribed by
their doctor, for the past 12 months. All the rest have in some way
been non-compliant, and for some disease groups the story is far
worse. Those with diabetes (50%) and hypertension (49%) report the
highest levels of compliance, while those with back problems (36%),
asthma (34%), depression (28%) or migraines (28%) are having the
hardest time taking their drugs as prescribed.
2) Insurance coverage is
a big factor in drug use, especially for the elderly. Those people
without drug coverage are more likely to not fill a prescription or
be in some way non-compliant, as compared to those with some or full
drug coverage. Seniors show the biggest discrepancy. 52% of those
over 65 without drug coverage have in some way reduced their drug
use, compared to only 30% of those with at least some coverage.
3) The chronically ill
are active in online health; but commercial Web players, not
traditional health care stakeholders, are winning online. 87% of the
chronically ill who are online have looked for health care
information on the Internet. 59% of the chronically ill who have
looked for health care information online have looked at commercial
Web sites-health pages or vertical portals ("vortals") such as
drkoop.com or AOL's health channel. These types of sites are far
more popular with the chronically ill (and for that matter all
Internet users) than sites provided by traditional health care
stakeholders - hospitals, pharmaceutical companies, insurance plans,
or even patient advocacy groups.
"THE RISE OF
THE INTERNET HEALTH CONSUMER: IMPACTS OF THE INTERNET ON THE
Cyberdialogue has released a 9-page summary describing changes
in doctor-patient relationships due to the Internet. The research
examined impacts on doctor selection, on doctor-patient roles, and
on patient education. A few interesting findings:
50% of online users
would be interested in using a web site operated by their doctor's
office. This contrasts with the 4% of offices who have web sites.
48% of online patients
would like to be able to communicate with their doctors offices via
e-mail, but only 3% are doing so. 11% are aware of their doctor's
74% of online patients
agree that a doctor's recommendation would make them more likely to
trust a web site; however, only 4% say that they currently use
doctor recommendations as a means of finding sites they use.
The report concludes:
"...the question is whether physicians will participate themselves
or leave (the Internet) as a medium for others to control."
DOCTORS WORKFLOW AND EMOTIONS DAMAGED BY PAPERWORK
A group of
"anthropologists, psychologists, communication scholars and
engineers" sponsored by Intel conducted an
ethnographic research project with 100 health care
practitioners. (Ethnographic = they hung out, watched, and asked
questions of the doctors and their staffs.) The researchers observed
daily frustrations in physician offices and considered possible
Key findings focus on
1. Doctors feel
increasingly powerless in the midst of the changing organizational
and business environment of medicine. This sense of powerlessness
extends even to daily scheduling. Technological implications:
Better tools for
sharing information on treatments and outcomes, allowing doctors
and managers to reach consensus on optimal practices.
Tools for sharing
patient loads and communicating accordingly, including triage
Better tools for
automating such routine tasks as patient referral status,
patient eligibility, and other tasks that typically occupy
medical staff for hours on the telephone.
2. Doctors feel that
administrative overhead, especially paperwork, has sharply reduced
both the time and the quality of interactions with patients.
which will allow practitioners to create, access or manipulate
digital information more "naturally" in the course of patient
encounters. This means new form factors, new modalities
including voice input or audio output, and new means of
connecting technologies and integrating data.
New types of
services, including such things as Internet transcription
services, or research and reference services to place the right
content at one's fingertips at the right time.
3. Doctors are unable to
access the people, information or other resources they need in order
to provide quality care in a time-constrained environment.
A secure, reliable
system whereby patient records can be shared among appropriate
practitioners, particularly needed are standards for data
sharing and security systems for ensuring patients rights of
A means for
physicians to identify and/or locate experts, specialized
providers or others with whom they need to collaborate (both
short term and long term) to provide better quality of care.
PROMOTING PATIENT/PHYSICIAN PARTNERSHIPS:
10 CHALLENGES FOR THE INTERNET AGE
A recent article in the
Medical Journal describes 10 key challenges that must be met to
allow optimal partnerships to develop between patients and
between consumers and professional organizations
patients and clinicians use the Internet
Systems need to be
easy to access and use
Rapid access to
Easy access to
relevant, ready to use information
and face to face interactions
Redefining the roles
of patients and clinicians
access to technology and information
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
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BHT provides consulting and business development services relating
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