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INTERNET MEDICINE:
"On your marks,
get ready, set...(go?)"
By Dan Groszkruger, JD , MPH, Editor and
Waldene Drake, RN, MBA, Vice President, Risk Management
CAP physicians increasingly are looking to expand their practices via the Internet. Some already have Web Sites. Many others are considering at least some type of involvement in marketing or advertising over the Internet. For those CAP physicians perched on the brink, almost (but not quite) ready for a headlong dive into Internet Medicine, here's some practical advice: "Look before you leap!"
Although new data are constantly emerging, this much is clear:
- Use of the Internet is growing exponentially; this is not just a passing fad!
- The Web may offer physicians a unique way to grow their own practices.
- Many physicians lack on-line experience, and really need to learn more.
- The window of opportunity to launch a Web Site may be time-limited.
What is Internet Medicine?
Uncertainties begin with its definition, similar to that of "Telemedicine" (See: CAPsules, 2nd Quarter 1999). Actually, physicians are involved in several types of transactions within the broad term, "Internet Medicine."
- Business-to-business encounters are called "e-connectivity" and include on-line verification of eligibility, authorization and claims processing with payers.
- "E-commerce" allows physicians and patients to do business over the Internet. M.D. entrepreneurs offer products and market services for sale, on-line.
- "Information exchange" is a third category, such as searching databases for the latest information on a new drug.
- "Telemedicine" is the last category, where clinical information about individual patients is shared with other treating physicians or consultants.
Does CAP cover Internet activities?
Only the provision of professional services, where use of the Internet is incidental, is likely to be covered. Many professional liability policies and agreements exclude coverage for services rendered out-of-state, and for non-patient care activities such as marketing, advertising and non-medical commercial enterprises. The MPT Trust Agreement excludes coverage for medical care rendered outside California, unless an express waiver is granted.1 Also, Non-Patient Activities and Media Activities, including advertising, broadcasting, radio or television appearances (with or without compensation) are excluded from coverage.2 This exclusion applies to Internet "broadcasting."
Do I need my own Web Site?
In order to answer this question, look at the changing healthcare delivery marketplace. Between 1990 and 1997, the number of annual U.S. doctor visits (about 400 million) remained static. But in 1998, almost 60 million U.S. citizens went on-line to search for health-related information. At the National Library of Medicine, the number of MedLine searches increased from 7 million in 1997 to 120 million in 1998.3 Consumers are turning to the Internet as a rich source of health and medical information. Today's health entrepreneurs are lining up to provide it. For example, providers of complementary and alternative medicine ("CAM") embraced the Internet (along with pharmaceutical companies), as a way to directly reach consumers. If you're not on the Web, "wired" patients won't find you!
The popularity of Internet health resources is evident from Wall Street's valuation of drkoop.com and Healtheon / WebMD, as prominent examples. In addition, virtually all disease management, advocacy and support groups (e.g., AIDS, child health, breast cancer) are on-line, with links to compatible Internet sites. Both Federal and State governments are prominent players on the Internet, with consumer-choice information such as malpractice awards against California physicians, posted by the Medical Board on the Internet. Patients would prefer to obtain on-line health information from their own doctors, as compared to national experts, health systems and advocacy groups.4 With all of this in mind, can you afford not to have your own website?
1. Article VIII, section 5[a][12] of the MPT Trust Agreement.
2. Article VIII, sections 5[a][1] and [21].
3. Source: Louis Harris & Associates, 1998.
4. Source: Cybercitizen Health 1999, a Deloitte Consulting-Cyber Dialogue Study
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