1. The Doctor is Online Now
Or how to beat Wal-Mart and take great care of your patients

2. The Doctor Is Online Our patients have been waiting a long time
They are voting with their feet
Business has noticed

3. They are voting with their feet
Ease of access is now one of the leading reasons for patients to change practices
In our survey 30% of patients answered “Yes” to the question: Does our web site influence your decision to use our practice.

4. Business has noticed
“The fact is the time for politics in today’s debate on health care is long past.  The time for real and meaningful change has come. Yes, this is about economics.  But above all, it is about our health.  It is about all of us -- all 300 million Americans -- living the fullest and best lives we can.”
Lee Scott

5. The CEO of Wal-Mart went on to say:
“We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need – affordable access at the local level to quality health care.”

6. If you don't believe Wal-Mart…
“The vision for the future of health care starts with the premise that consumers should own their own total personal health and wellness data. As an additional premise, we believe consumers should have the right to all data…in electronic form.”
Adam Bosworth, VP Google

7. And it's a revolution

9. Our Practice

10. Secure Portal

11. Self-Care Charts

12. Algorithms

13. Patient Handouts

14. Basic Data

15. How The Portal Is Used

16. How The Portal Is Used Continued

17. Other Uses Of The Portal

18. The ecology of medical care in the United States in one month
The ecology of medical care in the United States in one month. N England J Med 2001;344:

19. Anecdotally
I have enjoyed communicating with my patients over our secure site. It has saved them and me a lot of time.
Phone calls to the office are down almost 50% by the medical assistants estimation.
Staff morale is up and the MA’s have time to catch up on other office duties.
Overtime for the staff is almost non-existent.

20. Looking ahead

21. The virtual doctor

22. Check emergent symptoms first

23. Present a summary of the answers

24. Give advice

25. Offer contact with the doctor

26. Ask for type of communication desired

27. Show information presnted to the doctor

28. Information presented continued

29. Information presented continued

30. Acute symptom assessment
Information is collected in a consistent manner
The computer is never tired or grumpy
The computer doesn’t know the patient is rude
Key questions are never omitted
The patient can take a long time answering

31. Sigmund PC
There has been consistent evidence for many years that people will tell a computer more than they will tell you.
“I feel more relaxed.”
“I’m not intimidated.”
“I can think of what I want to say in my own words.”
“I’m not embarrassed.”
JAMA 1992; Vol. 268: pp

32. But what about Health Assessment?
The same comments apply
The computer is good at math

33. Health Assessment

41. The computer as coach
Evidence is emerging that online coaching can be effective.
Automated vs. “Live”

42. Disease Management Patients with CHF can track their weight
Patients with Asthma can track their peak flow
Patients with Diabetes can track their glucose
Patients with Hypertension can track their BP

43. Create an expert Office staff can specialize
Shelly handles the diabetics
Melina handles the hypertensives
Registries of patients connect communities

44. Use tools in the office
Even if you don’t have an EMR you can use the tools in your office and print the results
Patients can use the tools at home, print the results and bring them to you.
The history portion of the visit is largely complete and well documented
Someone else manages the system

45. Tools for home care Medpac Orders and Refills
Medpacs are customized home or travel medical kits that contain both prescription and non-prescription medications to treat common medical problems and emergencies. They also contain first aid supplies. They are only available to registered members of the practice, as they are a prescription item.
The Medpacs are designed to be used in conjunction with an or telephone consultation, saving you an office, urgent care or ED visit, as well as a trip to the pharmacy. When medications expire they can be replaced for minimal cost.
Home Medpac for Adults $120
Click here to see a complete list of contents for the Home Medpac for Adults.
Home Medpac for Children $120
Click here to see a complete list of contents for the Home Medpac for Children.
Home Medpac for Families $160
The Medpac for families contains all of the medications from both the Adult and Children Home Medpacs in one convenient package for far less than buying both.
Travel Medpac $150
This Medpac has been customized for travellers to help in emergencies abroad, particularly where access to safe medical care is not readily available. Instructions on using the medications and other contents are included in case you are unable to reach us by internet or telephone. Click here to see a complete list of contents for the Travel Medpac.
Go to order form for Medpac
Go to replacement form for Medpac

46. Who's going to pay? Remember what I said at the beginning?
Some people are willing to pay out of pocket
Small businesses and the uninsured
Some insurance companies

47. Conclusions We are reaching a tipping point
Patients and businesses are playing larger roles
We can take advantage of the technology
We can play a number of roles in the process