Doctors will make Web calls in Hawaii

American Well, a Web service that puts patients face-to-face with doctors online, will be introduced in Hawaii on January 15.

Its first customer, Hawaii Medical Service Association, the state's Blue Cross-Blue Shield licensee, will make the Internet version of the house call available to everyone in the state, the company said.

The service is for people who seek easier access to physicians because they are uninsured or do not want to wait for an appointment or spend time driving to a clinic, said Roy Schoenberg, co-founder and chief executive of American Well Systems, which is based in Boston.

Dr. Schoenberg, a physician, said American Well had piqued the interest of policy makers in Washington who want to expand access to health care. Insurers in other states will soon offer the service, he said.

Patients use the service by logging on to participating health plans' Web sites. Doctors hold 10-minute appointments, which can be extended for a fee, and can file prescriptions and view patients' medical histories through the system. American Well is working with HealthVault, Microsoft's electronic medical-records service, and ActiveHealth Management, a subsidiary of Aetna, which scans patients' medical history for gaps in their previous care and alerts doctors during their American Well appointment.

The Hawaiian health plan's 700,000 members pay $10 to use the service. The insurer also offers the service to uninsured patients for $45. Health plans pay American Well a license fee per member and a transaction fee of about $2 each time a patient sees a doctor.

Hawaii is particularly well suited for online medicine because the islands are remote, it takes time to travel among them, and it is difficult for the state to recruit doctors to rural areas, said Mike Stollar, vice president of marketing for the Hawaii Medical Service Association.

However, some critics of doctor visits via Webcam worry that doctors will miss important symptoms, if they do not see patients in person. Others doubt that the poor and uninsured will have the broadband connection and Webcams to use the service.

"It's a tool to help doctors do better, the way a stethoscope is a tool," said Robert Sussman, a family practice doctor on Oahu. "You still have to use your common sense, your medical knowledge."

Certain diagnoses, such as whether a sore throat is a virus or a strep infection, are difficult using a Webcam, says Dr. Sussman, who has been testing the service for several weeks. He predicts the service will be useful for patients who need medication refills or follow-up consultations after surgery, or who are elderly and homebound.

It can save valuable time in the case of a serious condition, he said, because an online doctor can recommend that a patient visit an emergency room or specialist immediately rather than waiting a week to see a general practitioner. A doctor can see, for example, whether a baby with a fever is lethargic and needs to visit a physician, or is active and just needs rest.

"It's a better iteration on, 'Take two aspirin, and call me in the morning,'" Dr. Sussman said. "We can't lay on the hands, but we can lay on the eyes and get a better feel."

Patients and doctors can use American Well with one camera or with text chat. A study last November by Forrester Consulting for the California HealthCare Foundation found that about two-thirds of uninsured patients used broadband at home and that almost all medical professionals did.