MedDigital Trends and Tactics to Lead into the Future

Douglas E. Goldstein

Physician executives need to harness appropriate digital technology by understanding key trends and implementing best tactics. Being and doing MedDigital means taking back control and improving care--and, at the same time, improving efficiencies and the bottom line. This article presents seven e-trends that are shaping health care: (1) Consumers and patients are pushing doctors to go digital; (2) from Web health information to MedDigital decision support; (3) beyond managed care to custom health; (4) wireless is the way of the new world; (5) Passive web portals yield to digital destinations; (6) e-commerce means lower transaction cost; and (7) develop e-health care ROI methodologies and track results. The authors provide myriad examples of new technology that will revolutionize health care and provide both physicians and consumers with valuable interactive tools to enhance health, treatment, and decision-making.

KEY CONCEPTS

* The Next Generation of Digital Technology

* Empowered Digital Consumers

* Pushing Doctors to go Digital

* Implementing Best e-Tactics

* Being and Doing MedDigital

* Beyond Managed Care to Custom Health

PREDICTION: BY 2010, 50 percent of all ambulatory health care services will be delivered through some variation of digital technology including the wired and wireless Web, Internet multimedia, and emerging telehealth and telemedicine applications.

IS YOUR ORGANIZATION leading into the future to meet patient needs or sitting on the sidelines figuring digital technology is not an issue? Using digital technology in physician practice is about more than building a website; it's about using interactive, digital services to improve patient care, communication, and operational efficiency. For doctors, it means engaging in the C-strategy of Compensation... Control... Costs... Care... and Compassion. Despite the shakeout of e-health and dot.com companies, a number of significant trends are driving consumers, patients, and physicians toward the use of digital via the wired or wireless Internet.

Physician executives need to harness appropriate digital technology by understanding key trends and implementing best tactics. Doing so will lead to better compensation, more control, lower costs, and higher quality patient care. Being and doing MedDigital means taking back control and improving care-and, at the same time, improving efficiencies and the bottom line.

Trend #1: Consumers and patients are pushing doctors to go digital

Recent studies show that 52 million adults, or 55 percent of those with Internet access, have used the Web to get health or medical information. That's more than have shopped, looked up stock quotes, or checked sports scores! 21 million of these health seekers say they were swayed by what they read online the last time they sought health information:

* 70 percent said the information influenced their decision about treatment

* 50 percent said the information led them to ask their doctor new questions or get a second opinion

* 28 percent said the information affected their decision about whether or not to even visit a doctor [1]

These empowered consumers are forcing doctors, hospitals, payers, and pharmaceutical companies to get online with cyber processes that deliver better services. Illinois-based FirstHealth began reimbursing "cybervisits" for members in chronic disease programs in January of 2001. [2] Web services, such as DiabetesWell (www.diabeteswell.com) and MyAsthma (www.myasthma.com), allow patients to manage their disease at home, by entering and monitoring key indicators, such as glucose and pulmonary function levels. Kaiser Permanente (www.kaiserpermanente.com) offers members the ability to ask online questions and receive answers from its nurses.

But despite the emergence of these services, only 9 percent of those surveyed say they have communicated with a doctor online. [1] Practices and other health care organizations have a long way to go to meet patient and consumer needs. Although 55 percent of doctors say they use the Internet daily, practices have been reticent to move operational process and information dissemination onto their Web services.

Even though the rapid increase in the number of people connecting to the Net is leveling off, users are accessing the Internet for new activities all the time. We've moved from buying books and software to placing stock trades and managing personal finances online--all in a matter of about 18 months. The key question to ask is: What do patients and members want to do with your practice or organization online, and how can these services deliver value, drive sales, and improve margins?

Delivering digital services means evaluating the entire process of patient care by comparing manual paper systems with the digitally-enabled solutions of the 21st Century. Going digital so you can serve up online appointments medical decision support, and other services to retain and build your practice means automating the encounter with an electronic medical record (EMR) and most likely replacing legacy practice management systems. This is no easy task. A comprehensive plan must be developed, staff educated, and physician buy-in achieved. There is no rush to implement, but there is an imperative to learn. Monitor the EMR and ASP technology advances and determine the right timing for your organization to cut down on manual, lengthy paper-driven processes with digital solutions. Be right instead of fast!

Trend #2: From Web health information to MedDigital decision support

The first wave of e-health care saw a number of information portals, such as drkoop, OnHealth, and AmericasDoctor come online in droves. Consumers flocked to them, but were unable to get much information beyond generic health content about conditions and diseases. Now, savvier consumers and patients are demanding information that supports their decision-making about treatments and options. They want answers, and they want them from their doctor, health plan, or hospital. Online health information searches are not about information gathering: they are about "whom can I turn to when I need to be healed or helped?" The next generation of digital technology is about is about service and support.

Companies such as iKnowMed (www.iknowmed.com) are meeting this need. iKnowMed's iKnowChart, an online record and clinical tracking tool, seamlessly integrates with the company's iKnowMyChart, which allows patients of oncologists to access their clinical and lab data from home. iKnowMyChart includes self-assessments, which indicate to staff the health and wellness status of patients, as well as information about various treatment options and clinical trials that cancer patients would be interested in. All the information is customized to the patient's diagnosis.

Support your patients and members with information, tools, and connectivity that allows them to make a decision or complete a transaction. As digital applications from DVDs to automatic patient reminders delivered via wireless technology to a cell phone become widespread, your customers will expect to get things done through clicks, on their own time, instead of being required to make a phone call or schedule a face-to-face visit.

Trend #3: Beyond managed care to custom health

The announcement about the Human Genome Sequence has fueled worldwide research that will ultimately change everything about how doctors diagnose, treat, and classify disease. In the very near future, diagnosis will go far beyond reading an EKG or testing for high cholesterol. Doctors will perform Susceptibility Tests by snatching a swab of cells from a patient's cheek, or running a blood test, and look at the SNPs--single nucleotide polymorphisms, the building blocks of deoxyribonucleic acid (DNA)--to determine if the patient is susceptible to encodes for a protein that affects a particular disease. As researchers unravel the function of the protein identified with various diseases, diagnostic Susceptibility Tests will determine whether you are at higher, lower, or average risk for say, hypertension, lung cancer, or colon cancer than other human beings.

Based on that data, a highly customized treatment plan that includes diet, exercise, and possibly medication, might thwart the manifestation of the disease. Susceptibility Testing will require doctors to shift their thinking from reactive, "take this pill or have this surgery," medicine to true preventive medicine. Unique-to-the-patient treatment plans will redefine primary care. For example, if test results indicate that a patient has a gene associated with breast cancer, primary care physicians will need to educate, counsel, and partner with that patient to ensure she complies with her individualized therapy.

But Susceptibility Testing also stands to turn the way insurance is underwritten on its head; for example, if a woman's SNPs show she is susceptible for breast cancer, does that mean it's a pre-existing condition? How will insurance companies set premium prices for that? These and other issues are likely to break the traditional insurance model, as well as the traditional medical model, wide apart. Doctors should become familiar with these issues now, and consider the ethical, clinical, financial, and other ways that genetics-based testing and custom health will change the way they practice in the future.

Much of the ongoing communication and support for custom health will be delivered through digital e-health care technologies and disease support management systems. Innovative companies are already making the first generation of customized care easy, user friendly, and cost effective using multiple connectivity methods and communication devices. HealthHero (www.healthhero.com) offers chronic disease sufferers a pager that sends personalized health messages and medication reminders and Lifemasters Supported Self Care (www.lifemasters.net) is a disease management company that provides customized call center and online support for patients with specific diseases.

Pfizer is preparing for this redefinition of preventive care as well. The company has launched GenerationalHealth (www.generationalhealth.com), an interactive Web service that allows visitors to create a family tree showing the incidence of various conditions, then print it and take it to their doctor for discussion. It's a great tool to understand the role of heredity and genetics in health, while laying a foundation for the future of custom health. Pfizer has also posted an informational White Paper about genomics, geared to the consumer (www.thepfizerjournal.com/TPJ05.pdf).

Be a leader in helping patients and doctors understand how to apply our new knowledge and understanding of genomics, the impact of environment, risk assessments, prevention, and e-health care tools for healthier lives. The key lies in supporting behavior change though cyber-communities metaphor and example, and not overloading customers with waves and waves of information.

Trend #4: Wireless is the way of the new world

Everything is connected to the wired or wireless Net! In Bill Gates' first book, The Road Ahead (New York: Penguin USA, 1996), he talks about the future ability for people to "plug in" to the Internet anywhere. That prediction is rapidly emerging, but may not necessarily involve "plugging in." While PCs, phones, and televisions converge, and cheap video cameras are being added for two- or three-way real-time connectivity, next-generation telephones and hand-held devices are going wireless with reckless abandon. And the technology is not vaporware. One of the authors is happy to report that her Palm VIIx, with a wireless Internet connection, works nearly exactly as advertised; airline timetables, stock quotes, news, movie tickets, and access to online Yellow Pages are fast and easy to access. Next generation health care applications are beginning to use similar wireless technology to deliver medication reminders, disease-specific health information, and more.

Grey Healthcare Group Inc., a division of Grey Advertising, Inc., and i3 Mobile, a wireless media solutions company, recently agreed to develop a number of wireless health care applications and distribute them to pharmaceutical companies. The first application is a wireless treatment compliance reminder service for chronic sufferers. Diabetics and asthmatics, for example, would opt-in to the service to be reminded to refill prescriptions and keep appointments--all on their mobile phone, pager, or personal digital assistant (PDA). Users will also receive important health care messages, such as treatment and motivational information tailored to their particular conditions and lifestyle.

Tevital (www.tevital.com), has designed a Medpliance with a centrally located Clinical Station integrated with the Internet Health Management Portal and "family link." It promises to revolutionize the way health care is delivered in the home, as well as the way family members and caregivers interact with the elderly. Among the most impressive under development and testing is Panasonic Technologies tele-homecare system, which is awaiting FDA approval. It comprises three parts: a home unit called the Patient Terminal, the Doctor Terminal with monitoring devices, and the Active Server, which can be hooked up to the Internet via DSL, cable, or telephone.

For physicians, the wireless digital Web is big news, as technology companies seem to have finally figured out that they and other health care workers are mobile. Wireless applications are transforming the guesswork of code selection and inefficiency of charge capture. iScribe's eCoder, for example, holds the CPT and ICD-9 CM book in the palm of your hand. Interfacing eCoder with the company's 1-Box Connected product allows physicians to enter procedure and diagnosis codes into a selected patient account, then sync that data with the practice management system once they are back at the office. Other hand-held applications, such as HanDBase and PocketBilling, offer data capture applications that eliminate hospital billing cards.

Online prescription writing is another wireless function that stands to increase physician productivity, as well as reduce medication errors by scrubbing scripts with interaction and formulary checkers before they reach the pharmacy. Allscripts, Inc. (www.allscripts.com), a provider of wireless, point-of-care e-prescribing tools recently released the results of a study that showed the substantial savings that can result from using wireless prescribing. The study found that electronic prescribing can significantly reduce pharmacy costs -- sometimes by as much as $3.20 per prescription, due to enhanced formulary compliance and generic utilization.

The increase in wireless Web applications and the merger of companies, such as America Online and Time Warner, is accelerating connecting everyone, everything, anywhere on a wired or wireless Internet platform. With a video camera in every television, 700 million wireless Web phones (by 2005), and high-speed access to hundreds of millions of people, the face of medicine will be significantly altered! Even your picture frames will be wired to the Net (Check out Ceiva, www.ceiva.com) or your latest designer wireless glucose monitoring wristwatch!

Consumers using Internet digital-enabled applications represents the fastest media adoption curve ever experienced. Nevertheless, they need to learn how to use these digital capabilities, so that means there is time to learn, plan, develop, and deploy MedDigital services that make sense for your organization, based on a well thought out business plan and ROI model.

Trend #5: Passive web portals yield to digital destinations

Clunky, text-heavy websites sponsored by stand-alone e-health companies are out. Clicks and care delivered by bricks and mortar companies that use digital technology to enhance relationships are in! This includes the delivery of online service integrated with the organization's customer service communication platform. This means that cyberspace becomes more meaningful and useful when linked with phone-space and air-space (or in person contact). Multimedia resources that integrate transactions, video, audio, and e-services will become increasingly important as the broadband connections to home and office increase from about 5 percent today to over 50 percent by 2005.

Set your business plan on being a digital destination serving and expanding your customer relationships. e-Companies are moving from information warehouses to interactive digital destinations that leverage, enhance, and transform existing and new customer relationships. e-Position your organization to make the shift from Web page and Web portal to interactive e-service.

As you design ways to make your e-service more interactive, examine leading edge Web services, such as:

* Medformation.com (www.medformation.com). Allina Health System positioned Medformation.com as the Minnesota Health Resource, delivering content, community, commerce, and soon more integrated forms of e-care. The e-service won Modern Healthcare's "Best of the Best Hospital Websites 2000."

* Medivation.com (www.medivation.com). McKesson HBOC's subsidiary offers a comprehensive solution for practices. Patients receive their own secure website, where physicians deliver diagnosis specific information, lab information, and appointment reminders. Medivation is integrated with leading practice management systems, such as Medical Manager and Medic.

* Medem.com (www.medem.com). With the benefit of multiple specialty societies on its side, Medem continues to expand its services beyond specialty-specific content. The service's encrypted physician patient communication channel is available at a fraction of what a practice or organization would have to pay if it developed its own.

Digital destinations delivering wired and wireless Web services such as these continue to evolve; a key factor in their growth is that they support the local health system and physician. Building a relationship with patients and consumers locally is what will ultimately lead to the ability to deliver e-care in a digital format.

Trend #6: e-commerce means lower transaction cost

Say goodbye to age-old hassles such as payment, authorizations, claims submission, supply purchases, man aged care paperwork, and other old economy nightmares. The speed and connectivity of the digitally-driven Internet is making online information access and real-time reimbursement a reality.

A number of companies have moved into this space, and offer online access to everything from edibility to claims status. Payer consortiums, such as MedUnite, which includes Aetna, Pacificare, and other health plans, are focused on getting doctors online for mission critical reimbursement transactions. Doing so will save time and money for payers and practices, and knowing deductible, co-insurance, and non-covered service information can help patients prepare for their medical bills.

Companies such as Envoy, part of the WebMD group (www.envoy.com), TriZetto Group (www.trizetto.com), and others are inking deals that connect physicians and payer groups. Companies such as Illinois-based RealMed (www.realmed.com) offer real-time claims submission that allows staff to receive a rejection or reimbursement amount before a patient leaves the office; MedUnite hopes to offer similar real-time services.

Processing reimbursement will soon cease being cumbersome and labor-intensive. The digital technologies using the Internet pipeline will eliminate unnecessary steps, paper, and middlemen, and ultimately connect physicians and payers in real time transactions. The key question is how long will it take? It will take some time, but early adopters who learn to use the digital Internet best will have an advantage over the laggards, and capturing a higher degree of cost savings and profitability.

Trend #7: Develop e-health care ROI methodologies and track results

During the fast-paced Web Gold Rush, many health care companies neglected to think through the transaction and service features that customers wanted, and consequently didn't build an business model to track financial success. The cybertsunami of e-health care is requiring health care executives and doctors to think through improved transaction processes, as well as content, commerce, community, and care services using new processes that harness all forms of e-capability. Calculating a return on investment (ROT) is a vital part of this process.

After analyzing its process for prescription refills, Midwest Heart, a cardiology practice in the Chicagoarea, estimated an annual savings of $75,000 per office by implementing an Internet-based software application that decreased the number of staff involved in the process from 4.0 to 1.5 FTE positions.

Richmond's Virginia Adult & Pediatric Allergy & Asthma (www.vaallergy.com) tracks ROT from banner advertisements, in addition to efficiencies brought on by the practice's Web service. Six months of banners on AOL's DigitalCity in the Richmond, Virginia Health Channel resulted in 75 to 100 monthly visitors to the practice's website--about 525 for the total banner run. The administrator estimates that if 5 percent of these visitors become new patients from this form of contact, the average new patient reimbursement for visits and testing would be about $400, which would yield in excess of $10,000 in annual revenue. If half of these patients ended up on immunotherapy (about average for any new patient population), that's another $750 per patient per year, or approximately $10,000 annually for those patients treated with weekly shots. The practice has also found benefits with online registration; approximately 70 percent of new patients register online, which has decreased the need for patients to fill out forms and delay the clinic schedule.

St. Louis-based SSM Healthcare, (www.ssmhc.com), sponsored by the Franciscan Sisters of Mary, owns, operates, and manages 19 acute care hospitals and three long-term care facilities in four states. In addition to offering clinical services, the company provides health-related information and support services, including a physician-hospital interface product called Connect. Connect improves efficiencies and lowers costs by allowing physicians to access admission, ER, lab, transcription, and radiology data, as well as order tests, and pre-admit patients online. Cost benefit analyses and ROI projections for Connect have been positive.

According to SSM Healthcare's Dave Rootz, "The nearest vendor bid for providing this functionality was about $3 million over the cost of building this capability and deploying it ourselves." He continues, "we initially estimated a savings of $3.1 million over five years for one of our health systems in Missouri. We're actually on track to save $3.6 million." [4]

Quantifying these ROI elements is critical, but don't forget to run the "qualitative" elements through your financial model. It's hard to translate improved patient satisfaction due to online convenience into a dollar amount. But don't minimize the impact of an indirect revenue/cost reduction/customer satisfaction benefit like this--even if you can't get hard dollar numbers right away. Customer satisfaction leads to word of mouth referrals and that's just good business.

Digital technology, the Internet, and MedDigital forms are not a fad. Just because the dot.com market crashed due investment banker excesses doesn't change the fundamental fact that the per unit cost of service is lower online than via the phone or snail mail. The next wave of digital e-health care innovation and ROI will be led by organizations willing to make the investment of capital and human knowledge to do things right. The most appropriate and best applications of information technology are no longer a cost center but a revenue center for organizations. Oracle is saving $1 billion a year, Midwest Cardiology has significantly lowered the cost of delivering better lipid clinics, and for many other industries, digital-enabled processes using the Internet are the cost of doing business.

What is your organization doing to achieve e-health care ROI--including more control, better compensation, and enhanced care through digital technology?

Conclusion

The time is now to lead your customers into the future with better services, fewer medical errors, higher quality, and more knowledge. Prosperity in the 21st Century depends on aggressive MedDigital actions by health care leaders. Use these trends and MedDigital tactics to do it best.

Douglas E. Goldstein is President of eHealthcare.net (www.eHealthcare.net), a strategy consulting and product development firm. He is the author of e-Healthcare: Harness the Power of Internet e-Commerce & e-Care, (Aspen Publishers, Inc., 2000) and the Internet columnist for Managed Care Interface Magazine. He served as founder, Chairman, and CEO of Health Online, Inc. and was co-founder and Vice President of 1-800-DOCTORS (1-800-DOCTORS.COM), a doctor information and appointment service. He was also the lead author of five finance, health care, and business Best of the Net Internet books from McGraw Hill Irwin and three books on health care management.

Cheryl Toth, MBA, is an alliance partner of eHealthcare.net and KarenZupko & Associates, Inc., a Chicago-based practice management consulting and training firm. She is a contributing author to e-Healthcare: Harness the Power of Internet e-Commerce & e-Care (Aspen Publishers, Inc., 2000).

References

(1.) Fox, S., Rainie, L. "The Online Health care Revolution: How the Web Helps Americans Take Better care of Themselves." Pew Internet & American Life Project, November 26, 2000, pages 3-4.

(2.) Darves, B. The Reimbursable Internet Patient visit--It's Almost Here! WebMD, November 20, 2000.

(3.) Cap Gemini Ernst & Young Confirms Significant savings from e-Prescribing, PR Newswire, October 26, 2000 (delivered through ePharm5 Daily E-News, w.epbarm5.com/news.asp?an=PRN0030001923).

(4.) Personal conversation with SSM Healthcare's Dave Rootz.

Trend #1

1. Survey patients about what they want to do online with your organization, then initiate the most feasible ideas first.

MedDigital Tactics

2. Collect patient e-mail addresses and build an e-database; even if you are not ready to use it yet. E-mail addresses are the phone numbers of the 21st Century.

3. Know the HIPAA requirements that your organization will be accountable for and the guidelines from AMIA and the AMA about physician-patient communication. Develop a written policy that all patients sign.

4. Investigate the electronic medical records (EMRs) and Application Service Providers (ASPs) for practice management. Work out ROI scenarios and define qualitative and quantitative benefits.

5. Learn from practice leaders like Midwest Cardiology, which has done 70,000+ electronic encounters and has the highest compliance at the lowest per unit for their lipid clinic.

6. Organize a digital taskforce and appoint physician and management co-chairs to guide the effort to do e-gineering with digital processes.

Trend #2

MedDigital Tactics

1. Implement online decision support about surgical procedures and post-op care, with the ability to access a nurse or doctor online. Check out www.preop.com, a new service for practices to offer their patients, as an example.

2. Be the patient's e-health care coach by delivering tools and communities that involve them in their own care, at home. Priority Health Corporation's HepatitisNeighborhood (www.hepatitisneighborhood.com) is one example of an advanced XML platform from Cytura.com that can be used to create private label communities. Cancersurvivorsnetwork.org by the American Cancer Society uses advanced thinking and community tools from NewSof.com.

MedDigital Tactics

Trend #3

1. Tune into the Genomics and Proteimic revolution! If the DNA revolution can make the cover of Time in the 21st Century, it is time to bone up. Discuss the ways genomics will change the way you practice, and anticipate custom care delivery and genetics-based testing.

2. Develop effective patient MedDigital outreach strategies and systems that use online service transactions to lower costs and improve service.

Trend #4

MedDigital Tactics

1. Understand that the addictive paper habit and lack of time are the biggest barriers for professionals to use digital PDA devices.

2. To Palm or Not to Palm? Get a PDA and test it. Download a drug interaction or charge capture database and use it in your practice. The Palm or other PDA will not likely be your final device for doing rounds, but it is a start.

3. Digital knowledge is power. Visit sites such as www.pdamd.com and www.handheldmed.com to learn the latest about wireless applications for your practice.

4. Evaluate prescription and ASP practice management vendors that use wireless technologies and applications. Be sure that they have the 4 M's of success--a good business Model, knowledge Management, lots of Money to develop and improve, and products that match the Market need.

Trend #5

MedDigital Tactics

1. Evaluate your existing website for its ability to engage patients and consumers. Can they do anything there? Can they complete a transaction, register, purchase a product?

2. Restructure your e-service to be an interactive decision support tool.

3. Consider the use of streaming audio or video, or hosting a "chat with your doctor" once each quarter, that allows patients to interact online as a group and ask questions.

Trend #6

MedDigital Tactics

1. Think...if this piece of paper started out digital...how would that change the way business is done? If patients registered online, at home or in the office, the data would not have to be entered by staff, and patient education could be done simultaneously.

2. Kick the tires of leading vendors and evaluate them based on the contracts in your organization; choose the online eligibility, claims status, and referral authorization service that makes the most sense.

MedDigital Tactics

3. Rethink existing processes using new digital and Internet technologies. Practices and payers that employ staff to verify eligibility or complete referral authorizations on the phone can re-deploy these employees if these transactions are completed online.

Trend #7

1. Chart your existing operational processes versus digital-enabled EMR and ASP solutions. Develop a realistic model and refine the quantitative and qualitative ROI elements as your digital e-services evolve.

2. Quantify the financial impact of e-services, and review it quarterly in physician meetings. Find areas for improvement.

3. Factor in qualitative benefits, such as patient convenience and satisfaction, into your financial model.

COPYRIGHT 2001 American College of Physician Executives
COPYRIGHT 2002 Gale Group