Got a nagging cough, but it's 11 p.m. and too late to arrange a doctor's office visit?
In the age of the virtual house call, the doctor is always online and ready to chat.
NowClinic.com has come to Texas with a service that for $45 connects patients with physicians for 10 minutes in cyberspace. "I don't think hands-on care will ever be replaced, but this is another tool," said Dr. John Willis, a Mansfield internist with the physician group MedicalEdge Healthcare. "I think of this as an evolution of the doc in the box."
Texas is the first state where Minnesota-based OptumHealth is offering the service. The company has contracted with five medical groups in the state, including MedicalEdge, to provide the service and plans to expand NowClinic nationwide.
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A similar service was introduced last year in Hawaii through Blue Cross Blue Shield, and the concept is fast catching on. By 2013, an estimated 25 percent of care that can appropriately be delivered online will be, according to OptumHealth.
The service is an example of consumer-focused healthcare and addresses problems that almost every American has run into at least once, such as running out of prescription medicine on a weekend or when out of town, said Jonathan Linkous, CEO of the American Telemedicine Association.
By making medical care accessible 24 hours a day, NowClinic is aiming at people without insurance and consumers who can't get a doctor's appointment quickly when they want one.
Consumers simply log onto a secure site and chat with a physician in real time through instant messaging or webcam. They can also talk over the phone. The goal is to provide quality, convenient healthcare, said Chris Stidman, senior vice president of OptumHealth.
"It is not intended to ever be a substitute for face-to-face, in-office interaction with a physician," he said. "But there are circumstances where a physician can deliver care or meet the needs of consumers via other modalities."
The absence of a hands-on exam and established relationship between doctor and patient troubles the Texas Medical Board, which is revising its telemedicine policies to deal with the concept.
The goal is to be broad enough to not hinder patient access but also make sure telemedicine is practiced safely, said Leigh Hopper, board spokeswoman.
The Texas Medical Association has also raised concerns.
"We support telemedicine, but only when a proper patient-physician relationship is established," said Dr. William Fleming, the group's president. "Once that relationship is established, we have no problem with it."
OptumHealth has determined that NowClinic meets Texas' guidelines, Stidman said. In the end, the physician makes decisions about the patient's care.
How to regulate online services is an issue that more states will grapple with as laws try to catch up with fast-changing technology, Linkous said.
"It's a new area, and there are some regulatory hurdles to overcome," he said. "But it is part of the emerging world, using technology to have healthcare go directly to the consumer."
'Options and flexibility'
The service is not appropriate for emergencies, said Dr. Shehetaj Abdurrahim, a Dallas internist who was already communicating with her patients through e-mail when she signed up with NowClinic. But for common maladies such as upper respiratory or urinary tract infections, it's really not necessary to see the patient in the clinic, she said.
Roughly one-third of people report having difficulty getting timely appointments for routine care, according to OptumHealth.
The 9-to-5 schedule typical at doctor's offices simply doesn't fit the way people live today, Willis said.
"Patients are looking for more options and flexibility," he said. "That does not necessarily mean they are looking for something to replace their primary physician."
But when a primary physician can't be reached, an online doctor can fax a prescription to the pharmacy, within limits. An online doctor won't prescribe controlled substances, for example, and will limit quantities if there are concerns about the patient. For example, when a patient seeking high blood pressure medication doesn't have recent blood work on file, the physician might order just a few pills to get him through the weekend.
Doctors benefit as well.
Physicians already spend a lot of time responding to messages relayed from the patient through a nurse, Abdurrahim said. And every exchange has to be documented. With the online service, patients can get their answers directly from the doctor.
Online doctor visits can also take some of the burden off busy hospital emergency rooms and fill the gap created by a shortage of primary care physicians.
For people who don't have a primary care physician, emergency rooms or urgent care centers become their best alternative, Stidman said.
Nearly 80 percent of emergency room visits are for routine problems, according to OptumHealth.
"A significant amount of waste occurs because consumers go to the ER for nonemergency issues."
Online services could also make physicians more available to consumers despite a shortage of primary care doctors.
Today more medical school graduates are going into higher-paying specialties rather than primary care, according to the American Medical Association. A 2008 report by the Association of American Medical Colleges projected a shortage of as many as 150,000 physicians by 2025.
Today more than half the counties in Texas don't have enough pediatricians, Stidman said. The service could especially benefit rural residents or those who don't have a car.
Telemedicine has already proved useful in delivering mental healthcare to patients, and its uses will no doubt expand, Linkous said.
The challenge is figuring out what care can and cannot be delivered online.
"I'm reluctant to say you have to have a physical presence in every case, because there are some where it is not required," he said.
Some large, legitimate businesses are involved in online medical services. But there are also some fly-by-night Internet companies selling drugs and using medicine as a pretense, Linkous said.
"We don't want to endanger the patient," he said. "But we want to make this new technology available so people can get help when they need it."
JAN JARVIS, 817-390-7664