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Hawaii tries out online health care

Starting on Thursday, anyone in the state will be able to pay a flat fee for a 10-minute Web or phone visit with a doctor.

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor. American Well

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii's largest insurer, HSMA (which operates the state's Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday's launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn't a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

"That doesn't necessarily need to be done on a face-to-face basis." Shimizu said. At the same time, she doesn't see traditional visits going away.

"I don't think this situation can completely replace one-on-one doctor's visits," she said. "It's an adjunct to that."

She's found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

"The $25 has been received tremendously," said HMSA marketing Vice President Michael Stollar. "They think the fee is very fair," he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians' downtime fills a critical need. "There are not enough primary care physicians," he said. "It really allows us to capture 'care opportunities' out of the same number of physicians that were out there."