Large group practice can have edge in providing patient-friendly services

Regarding "Turning theory into practice" (Article, Nov. 8): The practice at Renaissance Health in Boston looks to have some interesting features, but it is not so revolutionary. Of the services provided for $480 a year, most are already available for no additional fee to my patients in Northern California Kaiser Permanente.

My internal medicine patients are able to e-mail me, electronically schedule their own appointments, book into same- or next-day appointments most days, attend group classes on topics from hypertension to weight management, go to other health classes from a series on diabetes to tai chi provided through the medical center, and access quality online health information through my personal home Web page, including personalized plans for weight loss, stress or quitting smoking.

I am electronically charting at the point of care, with access to that electronic record (and ECG and radiology images) available throughout Kaiser Northern California (and soon to be available to Kaiser nationwide), and even for me at home.

My patients do not have access to an online health record but will in the future.

I do not give out my personal number, but I do have a call center with nurses and physicians available 24 hours a day if needed. My colleagues can chose to do more or less of the electronic charting or e-mail at this stage.

My practice also offers innovations that Renaissance Health appears to lack. One innovation available to us is a "roaming dermatologist" available for immediate consultation in my exam room, saving patients another visit to the office.

I have a team of other providers down the hall on my adult primary care module of doctors and nurse-practitioners to help care for all our patients.

Two diabetes RNs are available, usually immediately, to meet with patients. We have a behavioral medicine specialist to provide a short course of counseling and referrals.

We have a full-time clinical health educator to offer one-on-one counseling on topics from stress to asthma medication use.

Our chronic conditions RN coordinates the care of frail and demented elderly patients. Our physical therapist can often provide same-day appointments. Our medical center also provides disease-management clinics for a variety of conditions.

All these benefits are available with an integration of care between the hospital and outpatient care and among specialties.

When my patients arrive at our emergency department, those doctors can read in the electronic notes what I was thinking a few days before.

All the innovations in the world will not be much use if others in the medical system do not have access to it.

T. James Lawrence, MD, San Francisco

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/12/27/edlt1227.htm.