Online healthcare and virtual doctor visits: Are we there yet?

Online Physician ConsultationsThe harsh realities of cost are driving healthcare providers, insurance carriers and government agencies to implement policies designed to encourage consumers to take better control over their own health.

More healthcare plans and programs than ever before are including incentives for making lifestyle changes, undergoing preventive care routines, “do-it-yourself” testing as well as online consultations with physicians.

In this regard, it seems everyone is completely on the bandwagon … except perhaps the consumer.

Why is that the case? One reason might be because of what we’ve trained people to expect in the delivery of healthcare services.

For decades, American consumers weren’t given any meaningful incentives for engaging in preventive care or in making lifestyle adjustments. Several generations of Americans were acclimatized to seek out healthcare services when they needed it – and that was when something was wrong. And the billing for those services was sent directly to the insurance company for payment.

In such an environment, preventive health or cost control was the last thing on people’s minds.

I recall being hospitalized for six days back in the early 1980s, along with being given a battery of medical tests conducted by health specialists of every stripe. I’m sure the invoicing associated with my hospitalization and treatment was astronomical … but I never saw a copy of the bill to really know.

My only out-of-pocket expense for the entire week? Thirty dollars for using the television set in the hospital room.

What was surprising to me, even at the time, was that I was kept in hospitalization far longer than I felt I needed to be – my symptoms of infection were gone after just a day or two. If I had been responsible for paying for even a portion of my hospitalization, I’m sure I would have been talking with anyone I could find about how quickly I could be discharged!

Today of course, people are far more aware of skyrocketing healthcare costs – not to mention their concerns about ever-rising health insurance premiums, higher deductibles, and bigger co-pays. Still, when asked about adopting new ways of interfacing with healthcare providers, American consumers seem somewhat ambivalent about them.

A recent online survey of ~1,000 Americans age 18 and over conducted by marketing and research firm Euro RSCG Worldwide found that only ~42% of respondents are comfortable with the idea of having online consultations in lieu of personal visits with their doctors.

[Men are more receptive to this idea (~58%) than women are (~37%) … but women are the ones more apt to make healthcare decisions for their families.]

On the other hand, here’s an interesting additional insight from the survey: When told that having an online consultation with their physician might result in lower expenses, ~77% of those same respondents reported that they’d be open to trying it.

What about the concept of “do-it-yourself” testing? Close to half of the respondents in the survey (~48%) reported that they’re receptive to the idea of using mobile apps to run their own tests and checkups at home. Checking blood pressure was the most popular DIY test, along with tracking and reporting on symptoms.

Of course, as time moves forward, technology is no longer the big obstacle it once was for turning “virtual visits” and “remote care” into a reality. Instead, it’s consumer attitudes and a willingness to adapt. And to accomplish that, the purveyors of modern healthcare must try to undo several generations of “learned” behavior that’s nearly the polar opposite.

Denise Murtagh, a planning director at Euro RSCG, mentions another factor as well: the doctors themselves. “A lot will depend on how facile physicians are with the technology, and how comfortable they are with it.”

And let’s not forget age demographics, too. The survey underscores that Gen-X and Gen-Y consumers are far more comfortable with the idea of physician remote care (47% – 52% positive) than Baby Boomers and those born earlier are (only 33% – 39% positive).

It looks like we’ll need to give this trend a bit more time to come into full flower.

Improving the Prognosis for Patient Safety in Hospitals

"Josie's Story" Book"Safe Patients, Smart Hospitals" BookThere’s a newly published book just out on the issue of patient safety in U.S. hospitals that’s quite an interesting read. The book is titled Safe Patients, Smart Hospitals (Hudson Street Press, ISBN-13: 978-1594630644), written by Peter Pronovost, Ph.D, M.D., a professor at Johns Hopkins University School of Medicine, and Eric Vohr, former assistant director of media relations at Johns Hopkins University School of Medicine and an instructor of technical writing at the school. Dr. Pronovost is also Medicaid director for the Johns Hopkins Center for Innovation in Quality Patient Care. (The book is also available in a Kindle edition.)

Instead of presenting us with a dry tome like so many other books on healthcare issues, this volume starts out with a true-life medical case where procedures and protocol at a top-notch healthcare institution were not enough to save the life of a patient.

The example the authors use to introduce us to the issue of patient safety is Josie King, an 18-month old girl who was the victim of accidental scalding by hot water and who was admitted to Johns Hopkins Hospital with second-degree burns. Unfortunately, the little developed a bacterial infection from a central line catheter while in the hospital, which was then improperly treated, leading to her death.

Living not far from Baltimore area, I recall this story as being big news in the local media market back in 2001 when the case occurred. Numerous stories were broadcast along with concerns raised as to how such events could have happened at one of America’s most prestigious healthcare institutions. (The child’s mother, Sorrel King, also wrote a book about the incident – Josie’s Story – published last year.)

Both Dr. Pronovost and Mr. Vohr are intimately familiar with the Josie King tragedy because of their first-hand knowledge of the events at the time. In fact, Dr. Pronovost used the experience to develop a simple set of usage guidelines for central line catheters – reducing a ~120-page thicket of inconsistent, confusing procedures and guidelines down to a five-step checklist. When a test program across 50 intensive-care units in Michigan hospitals used the five-step checklist in lieu of the traditional guidelines, there was a dramatic reduction in the incidence of catheter line infections to near zero, along with saving an estimated 2,000 lives.

In their book, Messrs. Pronovost and Vohr are basically issuing a “call to action” for taking a similar approach to a myriad of other surgical and related procedures at hospitals. But the book also pinpoints significant hurdles the authors believe are standing in the way of action. These range from having a lack of uniform standards from one hospital to another … a propensity for doctors and other medical staff to stick to existing behaviors and protocols even if they have shortcomings … the sometimes insufficient lines of communications between physicians and nurses … and, not least, the unwillingness of some surgeons, as the prima donnas of their hospitals, to taking direction, advice or orders from other medical staff members.

In my line of work, I have the opportunity to interact with healthcare organizations ranging from smaller community hospitals to large regional “destination” health centers. From my experience, I tend to agree with the authors that different hospitals have different protocols, different priorities, and different cultures, which could certainly lead to different patient outcomes in some cases.

Nevertheless, I have never seen a case of wanton disregard for patient safety. From what I’ve observed, I think any problems that might arise would more likely come from the large volume of patients being cared for, along with the constantly evolving technologies and procedures. It’s really too bad that medical staff members aren’t blessed with a 36-hour day, because so many seem to put forth a 36-hour effort within a 24-hour day … day in and day out.

Perhaps for this reason as much as any other, it is interesting – and welcome – to read of practicals way to improve patient safety through using steps such as ones outlined by Dr. Pronovost and Mr. Vohr in their book. For anyone interested or involved in the healthcare industry, it’s a volume definitely a worth reading.

Johnson & Johnson Raises the Alarm about Counterfeiting

Johnson & Johnson logoOne of the biggest benefits of the Internet has been the ability for consumers to research medical information for themselves. It’s not surprising that people would turn to the web for answers to health-related questions, particularly if they or a family member are suddenly faced with a serious health concern. And from WebMD to other sites, the web is full of valuable information that can increase someone’s understanding of a medical condition quickly.

Unfortunately, there’s a darker side to this, too. Medical product scammers and counterfeiters have found more than a few people online to be susceptible to their “cures.” They’ve surmised that it’s only natural for a person concerned about a medical condition or ailment to be interested in a cure – or at least to find a way to alleviate the pain and discomfort associated with it.

Because the web is global, there’s precious little any government or court jurisdiction can do to control the proliferation of counterfeit pharmaceuticals or other medical products. And the web is full of them – not simply bogus drugs but also counterfeit contact lenses, glucose strips, and a whole host of items let’s just refer to euphemistically as “virility and family planning products.”

But to do nothing isn’t a solution, either. Johnson & Johnson seems to feel this way, too, and is proposing a “Medical Device Product Protection Leadership Initiative” … and inviting other companies, including medical wholesalers, to join in the effort.

In addition, a new pharmaceutical industry initiative, dubbed “Rx-360“, is starting up. It’s focused on securing the integrity of supply chains that lead into manufacturing and packaging operations.

Will these initiatives work? Judging from the spotty success to date in curtailing the proliferation of counterfeit medical products being sold online, likely it’ll be only modestly effective at best. But since we’re dealing with potentially life-and-death matters here, any amount of increased effectiveness is highly welcome.