Microsoft partners with local hospital in virtual clinic

REDMOND, Wash. -- James Pittman woke one morning with a strong squeezing sensation in his chest.

Suspecting the worst, the 42-year-old Microsoft programmer wasted no time driving 10 miles to his doctor's office only to be told -- after "a 2-second diagnosis" -- he had pulled a back muscle, probably while painting his home the previous day.

"I don't know what a heart attack feels like," he said. "And I completely forgot that I was painting the house." Next time Pittman feels the urge to see the doctor, he may have another option. Instead of driving across town on a workday, he could log on to his computer, make sure the small camera atop the monitor is correctly angled, then point and click to a Web site for "virtual" treatment. Welcome to the "virtual clinic" -- futuristic employee health care that may soon be available to 13,800 Microsoft workers at company headquarters in Redmond, and 16,000 others around the country and the world. "This may be another piece of the puzzle to economically extend health care to people wherever they are," said Dr. Bill Crounse of Overlake Hospital in nearby Bellevue, who is working with Microsoft's benefits group to make the virtual clinic a reality. "The employees are just wild for this." But they may have to wait a while. The concept is so new the American Medical Association has never heard of it. Even Microsoft has no idea when it will become a reality, spokesman Dan Leach said. Not everyone thinks it's a great idea. Jamie Court, director of Consumers for Quality Care, a Santa Monica, Calif.-based advocacy group, said practicing medicine via computer to cut costs is a slippery slope that could lead to poor patient care and litigation. "The reality is you don't know what a patient needs until you see the patient," Court said. Some medical centers already have the capacity for face-to-face two-way conferencing -- often called telemedicine -- to provide consultation services and collegial help to doctors, usually in rural areas. But new and cheaper computer technologies are rapidly bringing that capacity into people's homes and offices. Crounse believes the virtual clinic will function in the workplace within the year, and will be available in some homes within two years. "If we don't do it, someone else will," he said in an interview. "It's the missing link in health care." And Microsoft is "a natural partner" for the pioneering effort, he says. Not only are its employees more computer savvy than most and more likely to have the required hardware, software and bandwidth, but many are what Crounse calls "the worried well" -- prone to visit doctors for colds and flus, sprains and strains. Microsoft workers already have access to a watered-down version of the virtual clinic from their desktops. Crounse receives a steady stream of e-mails -- five or 10 a week -- from employees who click on an "Ask the doctor" link on the benefits Web site on the company intranet. He handles most of the queries himself, referring about 15 percent to any of 55 specialists in his e-mail bank and others to helpful Internet sites -- all at no cost to employees. Leach declined to disclose any costs to Microsoft. Workers tap the e-mail link for advice on whether a whiplash victim should seek help first from a chiropractor or a physical therapist, if it's safe for a mother to give a small dose of adult cold-sore medication to her 4-year-old and the like. But that's only a taste of things to come, Crounse told a group of employees on the Microsoft campus recently. Using Microsoft's NETMeeting software, Crounse demonstrated how a doctor and patient in a virtual clinic could see, hear and talk to each other. The doctor could call up computer images -- an anatomical drawing of a back, perhaps -- and have the patient indicate exactly where it hurts. He could fill out an electronic prescription, e-mail it to an online drugstore that offers home delivery and e-mail the patient home-care instructions and details of his or her next appointment. A virtual visit would include everything but the physical prodding and poking of a real-world visit to the doctor. Crounse, vice president and chief information officer at Overlake, does not advocate doing away with the real thing. "We're not trying to make a diagnosis or provide patient care" at the virtual clinic, he said. "It's more informational, pointing people in the right direction." Between 20 percent and 30 percent of doctor visits are unnecessary, and just as readily dealt with from the desktop, he said. A virtual visit, like a phone call, would help doctors screen out needless actual visits -- and, says Crounse, potentially save employers money. By one estimate, Americans make an average of five visits a year to the doctor, taking between one-third to one-half a day off work each time. A `90s trend of insistence on greater access to health information bodes well for the virtual clinic idea, says Greg Vigdor, senior vice president of the Washington State Hospital Association. "But there would probably be strict protocols on how it would work," to prevent lawsuits arising from incorrect assessments of patient needs, he said. That's just one of several hurdles the idea faces. "There are huge issues in terms of patient, physician and (insurance) payer acceptance," Counse said. At least some of the issues stem from the hybrid nature of the idea. How, for example, should doctors bill patients for visits that are not quite face-to-face meetings, which doctors typically charge for, but more than telephone calls, which most do not? Crounse says visits to the virtual clinic wouldn't be free -- the demands on doctors' time would be the same as in face-to-face consultations, and start-up and other computer costs would exceed those of owning a telephone. But he's confident it would be cheaper than a real-world doctor visit. And, if some doctors eventually operate exclusively on a virtual basis -- in partnership with real-world doctors -- it could be cheaper still, he said. Even those most familiar with the virtual-clinic concept said they could not guess at the costs. It's too soon, Leach said -- though he expects Microsoft employees may have to kick in for a full-fledged virtual clinic. The concept could work, said spokeswoman Barbara Stenson in the office of state Insurance Commissioner Deborah Senn, "if people like it and if doctors like it, and carriers and companies feel it's cost effective" -- which she predicted they would. "It might act as a screener" to reduce insurance claims and thus cut costs -- savings that could be passed on to consumers in the form of lower premiums, she said. For now, Crounse and team don't need all the answers. Getting a prototype off the ground is their prime concern. Insurance issues have yet to arise -- Microsoft is self-insured, so its health insurance programs are not regulated by the commissioner's office.

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