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INTERNET MEDICINE:
"Everything (almost) you always wanted to know...but were afraid to ask about..."
By Dan Groszkruger, JD , MPH, Editor and
Waldene Drake, RN, MBA, Vice President, Risk Management
How much does a Web Site cost?
It depends! If you hire an experienced Web Site designer, and keep your own time investment to an absolute minimum, development of your Web Site will run several thousands of dollars. At the opposite extreme, you can design and build your own Web Site, using free materials downloaded off the Internet, for a relatively small monetary investment. Of course, the personal time investment required to build your own could be hundreds of hours! In between these "turn key" and "amateur hour" extremes, there are software products for purchase off-the-shelf, at modest expense. Also, several Internet service providers (AOL, etc.) include instructions on how to develop a Web page as a benefit of membership. Remember that a Web Site, once developed, must be updated regularly with new information. Finally, the scope and content of your Web Site may obsolesce in a relatively brief period of time. The cost of both on-going maintenance and eventual replacement should not be disregarded.
Can I recoup any of the money spent to go on-line?
Probably the most direct cost savings associated with the Internet are potential reductions in office staff time.1 In 1998, about $230 billion was paid to U.S. physicians, but over 50% of the money went just for overhead. Depending upon your specialty, office overhead, supplies, and non-patient care items will represent 60% or more of your expenses. Various software programs are commercially available to reduce the per-transaction cost of referrals, eligibility and claims processing over the Internet. What may take hours using a telephone and a fax machine can often be accomplished in minutes over the Internet. Reducing physicians' dependence on office staff has the same effect on the bottom line as utilizing nurse practitioners and physicians' assistants as "physician extenders."
Can a Web Site help to grow my practice by showcasing strengths?
You can select features for your Web Site that draw attention to your expertise, alert patients to unique or little-known services that you offer, or reinforce the concept that you practice as part of a larger team, which is available to serve your patients' needs.
Does a Web Site establish a physician-patient relationship?
Not necessarily. A Web Site can serve as another medium for communication. As noted earlier, patients would prefer to receive health and medical information from their doctors, as compared to hospitals, insurance or drug companies.2 Encouraging physician-patient communications via e-mail, or setting up an educational Web Site, are ways to respond to patients' demand for service. Regardless of which avenues physicians choose for communicating with patients and the public, they should be cautious about giving out health information -- and should never offer medical advice -- without first seeing the patient.
Some creative physicians have addressed the dilemma by combining a disclaimer, along with the patient's acknowledgment and consent, into a nifty "Point & Click" button, labeled "I AGREE." The patient acknowledges and agrees: [1] to the limited scope and purpose of any medical information; [2] to not creating a physician-patient relationship; and [3] to not substitute the on-line information for an examination by a private physician. If patients refuse to accept all the conditions, they cannot proceed onto the Web Site.
Is a Web Site necessary to talk with patients via e-mail?
No. You can set up an e-mail address whether or not you have a Web Site. And, creating an electronic link between physician and patient is relatively inexpensive, and may improve the quality of communications. For existing patients (new patients, of course, should be initially seen and examined in the office), using e-mail instead of a phone may offer advantages: (1) avoids delays playing "telephone tag," (2) makes a permanent record of the patient's call, as well as your response, by including a copy in the medical record, (3) provides a convenient method for the patient to record any clinically-significant details, and (4) reinforces your message by allowing patients to print a copy of your e-mail instructions.
Use of electronic media does raise concerns about patient privacy and the timeliness of responses. Adopt an office policy regarding who is authorized to read and respond to patients, and what subjects require your attention. All e-mail messages should contain a warning that, unlike telephone calls, the sender cannot tell whether a message has been received and, more important, promptly read by the physician. Patients should be encouraged to call in, rather than wait for tardy e-mail responses.
1 Healthcare E-volution - a Healthcare Business Roundtable, November/December 1999, RT1-RT19 (Special Supplement).
2 The New Consumer, cover story in Hospital & Health Networks, December 1999, pp. 30-36.
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