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E-CareManagement News

December 13, 2000

EMERGING THEMES: PHYSICIANS AND THE INTERNET

In the past several months numerous studies and analyses have examined physician adoption of Internet technology and tools.
With a dash of perspective tossed in, this essay synthesizes some major findings, conclusions, and wisdom from recent research.

1) READ THE FINE PRINT - STUDIES DIFFER ABOUT CURRENT MEASUREMENTS OF PHYSICIAN ADOPTION OF THE INTERNET

How many physicians are online? 37%? 98%? ....somewhere in between? Whatever answer you pick, you will find "scientific" evidence supporting your guestimate in this provoking article in American Medical News

"There are three types of people in this world: Those who can count, and those who can't." Seen on a bumper sticker.

2) STUDIES DO NOT DIFFER -- PHYSICIAN USAGE OF THE INTERNET CONTINUES TO INCREASE

The studies disagree about the specifics of current physician adoption of Internet technologies and tools. The studies DO NOT differ about the direction of change: physicians are adopting Internet technologies, slowly and surely. From the executive summary of a recent study by Cyber Dialogue/Deloitte Research:

Just as a large percentage of physicians do not feel the Internet is essential to their practice today, an even larger group of physicians (71%) is confident that they will increase their reliance on the Internet in five years. 

From a press release summarizing research by Gomez.com:

Physicians consider themselves open to new technologies. Despite physicians' reputations (which precedes them), 57% say they are "very open" to adopting new technologies for their medical practice, with 35% responding they are "somewhat open." ....Over 70% of online doctors plan to use wireless applications for work-related tasks in three years.
 
3) UNTIL NOW, THE PRIMARY BENEFITS OF GETTING PHYSICIANS ONLINE HAVE ACCRUED TO SOMEONE OTHER THAN THE DOCTORS

Who benefits most from getting doctors online? Payors, hospitals, eHealth companies, pharma companies? One thing is fairly clear....it's hasn't been the docs themselves.
...and we wonder why physicians have not been early adopters?

4) CRITICAL SUCCESS FACTORS TO ENCOURAGE PHYSICIAN ADOPTION ARE BECOMING APPARENT

A Forrester report entitled "Why Doctors Hate the Net" suggests a practical check-list:

Before using a net tool, doctors will ask six questions:
1) Does it save time?
2) Is it free?
3) Does it work as advertised?
4) Does it bear a trusted quality stamp?
5) Does it strengthen my power position?
6) Does it help with a mandate I can't refuse?

Cyber Dialogue/Deloitte Research narrowed their list to three:

  • integrating technology into workflow at the patient point-of-care,
  • addressing privacy/security concerns, and
  • demonstrating how online technologies and services will help them practice medicine more efficiently and effectively.
  • 5) BARRIERS TO PHYSICIAN USAGE OF THE INTERNET ARE MORE ABOUT MONEY THAN ABOUT ANYTHING ELSE

    The technology isn't perfect, but that's the least of it. The Cyber Dialogue/Deloitte Research study cuts to the chase:

    The main obstacles to adoption are purely economic. Physicians already feel financially squeezed in an era dominated by managed care; adoption of online services adds to their financial burdens in a number of distinct ways: 1) the up-front and out-of-pocket costs of information system (hardware and software) investment; 2) monetary opportunity (time) costs of learning and using a new system; 3) potential financial risks related to increased liability with EMRs and e-mail; and finally, 4) the risk of "getting burned" from making a "bad" information system decision....

    6) SOME PROMISING RESULTS ARE BEING SHOWN

    For example, two recent studies of electronic prescribing/drug reference devices show:

    Allscripts (e-Prescribing Study)

  • The aggregate impact of utilizing TouchScript for prescribing will vary by plan, ranging from $0.75 to $3.20 savings per TouchScript prescription
  • Savings come from two areas: 1) increased prescribing of generic medications, and 2) enhanced formulary compliance of physicians
  • The savings are realized by providing real time information at the point of care as a part of the prescribing process.
  • Epocrates 

  • 50 percent (of physicians) indicated that the ePocrates qRx(tm) handheld clinical drug reference guide helped them avoid one or more adverse drug events per week.
  • Over 90% of clinicians surveyed reported that it took them 20 seconds or less to find information using ePocrates qRx
  • (Read the fine print on these studies, too.)

    7) KEEP AN EYE OUT FOR POSSIBLE KILLER APPLICATIONS

    The Forrester Report lists some of the most promising applications:

  • Medical information sites for physicians
  • Wireless reference, ordering and coding systems
  • EMR (Electronic Medical Records)
  • Voice recognition
  • Physician patient email
  • Telehealth in the patient's home
  • Expert systems for decision-support
  • CHFC REPORT "HEALTH e-PEOPLE: THE ONLINE CONSUMER EXPERIENCE"

    The California HealthCare Foundation has published a Five-Year Forecast entitled "Health e-People: The Online Consumer Experience."
    This insightful five-year forecast looks at three groups of online consumers:

    1) the Well, (60% of consumers)
    2) the Newly Diagnosed (5%)
    3) the Chronically Ill and their caregivers (35%).

    The report explores their use of the Internet for health-oriented content, community, commerce, and care. Highlights from the executive summary:

    In the long run, delivery of online care will have the most significant impacts on e-health consumers. Whereas care applications will have the highest payoff, however, they will also take the longest to develop. Opportunities exist in disease management and monitoring, support for compliance with treatment regimens, electronic consults and house calls, psychological and psychosocial services, Internet-delivered diagnostics, online clinical trials, and personal medical records.

    In the next five years, online health-related products and services will develop in two stages. After a shakeout by business leaving a few survivors in each e-health niche, the nearer-term e-health environment (between now and the end of 2002) will be market driven, with ability to show a return on investment coloring continued venture capital support. The longer-term, and more significant, shift online (from 2003 through 2005) will result from an accumulation of health care data and an agreement on information standards that will make apparent the advantage of an online platform for business.

    WHAT'S WRONG WITH THIS EQUATION?

  • 150 people killed by allegedly faulty tires = front page headlines for six weeks
  • 98,000 people killed by medical errors = has anyone noticed?
  • According to a recent study by the Kaiser Family Foundation, the short answer appears to be "Yes - the issue of medical errors has reached the public consciousness." Read the "National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information".

    PEW INTERNET PROJECT

    The Pew Internet & American Life Project has published "The Online Health Care Revolution: How the Web Helps Americans Take Better Care of Themselves".

    The report describes "health seekers", the fifty-two million American adults, or 55% of those with Internet access, who have used the Web to get health or medical information. A great many health seekers say the resources they find on the Web have a direct effect on the decisions they make about their health care and on their interactions with doctors.

    E-Health: The Next Wave
    The November 2000 issue of Health Affairs contains multiple articles from world renowned authors analyzing various aspects of e-health.

    RED HERRING'S TOP TEN TRENDS 2001

    Red Herring magazine has published its annual listing of Top 10 Trends -- Technology and Business

    1) Computing: Distributed computing redefines computer networks, underpinning innovation, company formation, and investments.
    2) Intellectual property: Protecting it will be increasingly difficult.
    3) Venture capital: A shakeout forces a return to venture capital investment basics.
    4) Public markets: The rise of electronic communication networks (ECNs) will push traditional exchanges to consolidate into a single electronic trading network.
    5) Wireless: Bluetooth nears maturity, creating significant startup opportunities.
    6) Communications: Carriers shift from voice and data transmission to new high-bandwidth services.
    7) International: Wireless commerce in Japan will be a model for the rest of the world.
    8) Government: The Internet falls under the regulation of international accords.
    9) Energy: Fuel cells will reduce our reliance on oil and allow businesses and homeowners to produce electricity independently.
    10) Biotech: Functional genomics makes drug discovery cheaper and faster, reinvigorating all of biotech.

    3 REPORTS ON HEALTH CARE ASPs

    The California HealthCare Foundation and First Consulting Group (FCG) have sponsored two reports discussing health care application service providers (ASPs).

    The first report is "ASPs: An Executive Report: Are Application Service Providers Ready for Prime Time". This report discusses:

  • How did ASPs evolve?
  • Differences between ASPs and timeshare or outsourced IT offerings.
  • When are ASPs advantageous?
  • What are different types of ASPs?
  • Today's ASP market/what to ask an ASP vendor.
  • The second report is "Community Clinics: Are Application Service Providers Right for Your Clinic?". Topics include:

  • Alternative acquisition methods - the lay of the land.
  • ASP vendors and applications.
  • How to evaluate an ASP offering.
  • Conclusion: proceed with caution.
  • A third report on ASPs (by FCG) is available for those who are still curious or confused. "Application Service Providers: Unveiling the Mystery for Health Plans".

    iMcKESSON STUDY - CONSUMERS WANT COMBINATION OF HIGH TECH/HIGH TOUCH PERSONALIZED SERVICES

    iMcKesson has sponsored an interesting "Healthcare Satisfaction Study"
    (scroll 3/4 down the page to see the links to the Executive Summary and Full Report) Some of the study's conclusions:

  • Consumers want a range of options for accessing their doctors and nurses, including face to face, online and telephone
  • Consumers want physicians to use the communication option that makes the most sense
  • Consumers across all age, geographic and income groups want more sophisticated Internet-based tools to manage their healthcare
  • Consumers are beginning to factor the availability of multiple communication options into their physician and health plan selection decisions 
  • Disclosure -- No BHT clients are mentioned in this issue.



    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.

    You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2000, Better Health Technologies, LLC. All rights reserved.


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