1. Joseph E. Scherger, MD, MPH Charles W. Smith, MD
Health Care Online: The Impact of Revolution Health & eDocAmerica on Family Medicine
Joseph E. Scherger, MD, MPH
Charles W. Smith, MD

3. The Time Problem Time Needed for Chronic Illness Care
Time Needed for Preventive Care
Time Needed for Acute Care
Total face to face time for 2500 patients
Ann Fam Med 2005;3:209
Am J Pub Health 2003;93:635
10.6 hours a day for 2500 patients
7.4 hours a day
4.6 hours a day
22.6 hours/day

4. Primary Care Not Working
Only 27% of hypertension is adequately controlled
Only 26% of people with diabetes have blood pressures well controlled
Only 25% of people with depression receive treatment
50% of patients hospitalized with CHF are readmitted within 90 days
Compiled by the Institute for Healthcare Improvement, 2005

5. The Mistakes Doctors Make
Misdiagnosis occurs in 15 to 20 percent of all cases, according to some research. It turns out that the mistakes are rarely due to technical factors, nor is misdiagnosis usually due to a doctor's lack of knowledge about what later is found to be the underlying disease. Rather, most errors in diagnosis arise because of mistakes in thinking.   Boston Globe - March 19, 2007

6. The Ticking Clock in the Doctor’s Office: Patients on routine visits to their primary doctors often have lots of questions but not enough time to get good answers
NY Times Feb. 6, 2007

8. Information Technology Changing Medicine
Knowledge Management and Decision Support Tools
Patient Information EHR , All Clinical Data
Communication Digital Connection of Patients with Caregivers

9. Internet use More than 1 billion people have logged on worldwide1
~170 million users in America2,3
Over 550 billion Web-connected documents4
More than 2% of websites are health related5
Miniwatts Marketing Group. Internet usage statistics - The big picture: World Internet users and population stats [webpage] Sept 18. Cited 2006, Oct 26. Available from:
Madden M. Data Memo: Internet penetration and impact [Pew Internet & American Life Project website]. [Washington DC: Pew Internet & American Life Project]; April Cited 2006 Oct 26. Available from:
Lenhart A, Madden M, Hitlin P. Teens and Technology: Youth are leading the transition to a fully wired and mobile nation. Washington DC: Pew Internet & American Life Project; 2005 Jul 27. Cited 2006, Oct 26. Available from:
Lyman P, Varian HR. How much information [website on Internet]. Berkeley, Calif: University of California at Berkeley, School of Information Management and Systems; Available from:
Powell J, Clarke A. The WWW of the World Wide Web: Who, what, and why? J Med Internet Res [serial online] Jan-Mar;4(1):e4. Available at:
Miniwatts Marketing Group, Internet usage statistics, 2006:
Madden, Internet penetration, 2006,
Lenhart, et al., Teens and Technology, 2006,
Lyman, et al., How much information, 2000,
Powell, et al., J Med Internet Res 2002,

10. Health and the Internet
80% of adult Internet users (~ 95 million Americans) have searched the Internet for 1 of the 16 major health topics online1
specific disease or medical problem 66%
certain medical treatment or procedure 51%
sexual health information 11%
136 million Internet users have visited an online support group or website for a specific medical condition2
Fox S. Health Information Online. Washington, DC: Pew Internet & American Life Project; Available from:
Harris Interactive. Number of “cyberchondriacs" – Adults who have ever gone online for health information– Increases to an estimated 136 million nationwide. The Harris Poll® #59, August 1, [Cited 2006 Oct 27]. Available from:
Fox, Health Information Online, 2005.
Harris Interactive. "Cyberchondriacs," 2006,

11. Reasons for going online
Search for health information
Research a diagnosis or prescription
Prepare for surgery or find out how to recover from one
Seek and provide support
1. Harris Interactive. Number of "cyberchondriacs" – Adults who have ever gone online for health information– Increases to an estimated 136 million nationwide. The Harris Poll® #59, August 1, [Cited 2006 Oct 27]. Available from:
1. Harris Interactive. "Cyberchondriacs," 2006,

12. American adults seeking health information on the Internet
Fox S, Fallows D. Internet Health Resources: Health searches and have become more commonplace, but there is room for improvement in searches and overall Internet access. Washington, DC: Pew Internet & American Life Project; 2003 July 16. Available from:
Fox S. Health Information Online. Washington, DC: Pew Internet & American Life Project; Available from:
Harris Interactive. Number of "cyberchondriacs" – U.S. adults who go online for health information – Increases to estimated 117 million. The Harris Poll® #54, July 15, [Cited 2006 Oct 27]. Available from:
Sources:
Fox, et al., Internet Health Resources, 2003.
Fox, Health Information Online, 2005.
Harris Interactive. "Cyberchondriacs," 2005,

13. Young Can’t Imagine Life Without Online Access
Martha Irvine
Associate Press
December 5, 2004

14. Revolution Health Started by Steve Case, founder of America Online
Goal: Become a medical home for people on the internet
Coordinate health care services
Became risk adverse
Has become another health information website –

15. Financial Models for Non Visit Care
Shift of telephone to (time saver, $neutral)
Reduce unnecessary visits (more $ in high demand office, less $ in lower demand)
Payment for virtual care (e.g. Relay Health)
Prepaid service fee (monthly ($30) or annual ($360))
Capitation and prepaid insurance!
Pay for Performance incentives
Group Visits, how to bill

16. Kaiser Permanente HealthConnect
24 Hour Access to Accurate and Comprehensive Health Care Information and Services

17. Health Care Will Become Continuous
Health Care Over the Internet Will be the Greatest Disruption of our Age
Patients Will Drive the Innovation
Patients Will Have Their Medical Records
Patients Have Access to All Medical Information
Patients Will Communicate Far and Wide for Care
What Will They Get From You?

18. A New Vision of Family Medicine
Responsibility for a Population of Patients
Manage Needs and Demands (Relationships and Knowledge)
Prioritize Conditions and use a Team Approach
Take the Time to be Effective (Time to Heal)
Change our Concept and Application of Productivity

19. A New Model of Office Practice
50% more caring interactions each day
10-12 unhurried office visits each day
Advanced access – do today’s work today
Patients get all the time they need
Patients receive the latest treatments

20. How?
An interactive practice website is a new platform of communication
40-60% of patient needs handled online
Electronic health records with imbedded knowledge management tools
Great service

21. Wise Words from Dee Hock
Substance is enduring, form is ephemeral. Failure to distinguish clearly between the two is ruinous.
Success follows those adept at preserving the substance of the past by clothing it in the forms of the future.
Preserve substance; modify form; know the difference.

22. Relationship Centered Care
What is the 21st Century Application?