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Tracey S. Roth

Dot Com Commerce

Managing Editor, C@LL CENTER CRM Solutions

[June 20, 2000]

Online Health Care: Checking For A Pulse

Have you ever left your physician's office bewildered? Perhaps you've been diagnosed with a mild condition, and maybe it's embarrassing to talk about. You feel tongue-tied in front of your doctor, and his brusque manner doesn't invite questions. Some of us pepper our doctors with questions, while others simply say, "thank you" and quietly leave, only to sit home and wonder... Without the benefit of a copy of Physicians Desk Reference at their homes, and the skills to read it, where do they go? The Internet, of course.

There have been places to look for medical information on the Web for years. The National Institute of Health keeps several sites, notably its database called Grateful Med, a compilation of nearly every recent and not-so-recent medical article written in every language. The downside is that this information is so technical, that without a degree in physiology or a serious case of hypochondria, you won't get very far.

The launch of the medical Web site Drkoop.com was a blessing for those of us that relentlessly hunt medical information. Launched in part by Dr. C. Everett Koop, former Surgeon General of the U.S., the site was designed for laypersons with medical questions. It's a thorough site and is updated daily. The home page always features several topics that are of the highest interest to the average health information surfer: stress, insomnia, hair loss and weight loss, for example. Digging a little deeper will reveal information on more serious conditions: Lyme disease, glaucoma and Parkinson's, for example. The site covers common procedures, such as mammograms, and includes a Drug Checker so you can view information about the drugs you may be taking and understand their side effects and potential interactions with other drugs. Current news is presented, as are links to other condition-specific sites or support groups. The site draws an estimated 1.3 million visitors per month.

Unfortunately, Drkoop.com's vital signs are beginning to fail. The company's own auditors have publicly expressed doubts about its continued survival, and its stock was down 60 percent as of last month. Why is this?

Like many consumer sites on the Internet, Drkoop.com relies almost exclusively on advertising. A visit to the site will indicate why it's in trouble. Think about it -- who's going to advertise on a site like this? Chances are, you and I are not in the market for magnetic resource imaging (MRI) equipment, stethoscopes or gurneys. Pharmaceutical companies are not likely to spend too much money advertising prescription drugs on such a site, since the average consumer can't just run to the local pharmacy and buy them over-the-counter. The best a site like Drkoop.com can hope for is non-prescription drug advertising and services like weight-loss programs or smoking cessation systems. In order to attract its 1.3 million visitors per month, the company has had to earmark a heavy cash outflow for deals with portals such as America Online.

According to IDG, Drkoop.com's competitors are having a better time of things, due to a couple of deals they've recently cut. Earlier this year, Medscape merged with MedicaLogic, an online medical records company, and also offers medical transcription services to physicians' offices. HealthCentral implemented an online pharmacy and offers outsourced Web design services to medical facilities.

Drkoop.com actually toyed with the idea of online medical records keeping recently. But the company reconsidered, and has decided not to move forward with it at this time. Why?

Online medical records might seem the answer to a medical Web site's prayers. The potential benefits of this technology are wonderful. The goal for organizations implementing these types of systems is a kind of customer relationship management across the medical industry. Imagine putting all of a patient's records, including charts, blood pressure measurements, blood test results and imaging graphics such as X-rays and CT scans, in one place. Efficiency rises due to cost-containment and the ability of different health care professionals to share patient information across the same platform. Long-distance diagnostics become almost effortless: An athlete injured in a foreign country, perhaps a country with a sub-standard health care system, could have the results of his or her CT scan or MRI electronically transmitted to a sports physician in the U.S., who could then diagnose and recommend treatment from across the world. This principle is called electronic medical records (EMR), and is predicted by some analysts to replace traditional paper medical records in the not-too-distant future. These records could be available to anyone who needs to see them: physicians and other health care professionals, pharmacies, the patient and the patient's insurance company or companies.

What's the problem? Take the first few words of my sentence above: "These records could be available to anyone." There is the potential for some ugly scenarios involving EMR. For example: An individual takes a new job and attempts to get insurance coverage for herself and her dependent children. The employer or the employer's insurance company looks at the family's medical records, only to discover that the employee's teenage child was successfully treated for a drug problem the previous year. Sorry, coverage denied. Or, an employer is considering hiring a highly qualified candidate, and included in the "reference check" is a visit to the candidate's EMR files. The employer discovers the candidate takes maintenance medication to control depression. Out goes a "thanks, but no thanks" letter to the would-be employee.

I'm not nave or paranoid enough to believe that EMR will automatically enable anyone to view confidential patient records at any time. I understand only certain people or organizations would have access to them. But which people and which organizations? Insurance companies would surely be able to see them, and it would be in the insurance companies' best interest to warn the organizations they support when a candidate has an "undesirable" condition in his or her past, or is following a certain expensive or controversial medication regimen.

I'm not against EMR. I can think of just as many scenarios in which online records would be life-saving. In light of the sharpening focus on online privacy, I suspect EMR will be one of the hot spots around which this current issue will focus.

Right now, the most I can do is wish Drkoop.com well, and hope there is another venture in its near future which will keep such a beneficial site open to consumers. I've seen some recent activity in the news that Drkoop.com is considering using the site to recruit participants in clinical drug trials. Pharmaceutical companies are often desperate for willing volunteers to undergo experimental therapies, and these companies have very, very deep pockets (if you've ever spent $150 on a bottle of brand-name antibiotics, you know this firsthand). Perhaps a site that can supply a ready pool of such participants will gain the attention -- and the backing -- of some of the biggest investors in the health care market.

So if someone tells you that you suffer from myrmecophobia, don't waste time wondering about the diagnosis -- there's plenty of information available online.

Readers with an irrational fear of ants may contact the author at troth@tmcnet.com.

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