Company pushes online consultations in a visual direction

Videoconferencing isn't just for salespeople and executives anymore. Now, thanks to the plummeting costs of setting up a videoconferencing system, there is a push to make it a tool for doctor-patient interaction.

For example, one company -- MyMD Inc., a Alpharetta, Ga., online consultation company -- is outfitting physicians with free videoconferencing equipment, enabling them to conduct videoconferencing-based consultations in real time over a high-speed Internet connection.

The company is making that move because videoconferencing technology has become inexpensive and good enough that it can now offer telehealth services at the desktop at a fraction of the $50,000 to $100,000 that work stations cost just a few years ago, said Michael Chalkley, CEO of MyMD. Coupled with an estimate by Harris Interactive that 65% of all Internet connections in the country are broadband, inexpensive technology could mean that it is feasible for physicians to jump into telehealth and migrate from e-mail consultations to videoconferencing with patients, experts say.

"Certainly, it's important to recognize that the implementation of distance diagnoses for therapy from a variety of settings is just a reality of one direction that medicine is going," said Michael Goldrich, MD, chair of the American Medical Association's Council on Ethical and Judicial Affairs. "So, the question is to implement that in a fashion that meets the standards of care so that patients continue to get high quality of care and [that] also is done in an ethical fashion."

It's unknown how many physician offices are involved in telemedicine or telehealth but a handful are in part because some companies are selling good-quality equipment for about $500, said Nancy Brown, project director of Telemedicine Information Exchange at the Telemedicine Research Center, a Portland, Ore.-based nonprofit research organization that tracks telemedicine programs around the country.

Telemedicine generally is defined as the delivery of specific health care services via videoconferencing equipment either in store-and-forward or real-time mode, while telehealth is understood to include all the different varieties of providing health care via telecommunication, Brown said.

While the price is within doctors' reach, Brown doesn't expect a boom in telehealth any time soon among physicians. A big reason why is that patients would have to have the same equipment in their homes that doctors use in their offices, she said.

Video mail doesn't require the physician and patient to have the same equipment, although its sound and resolution is generally deemed to be poorer than videoconferencing, and not all companies offering video mail offer real-time chat functions.

Giving it away

Still, MyMD is figuring that giving away videoconferencing hardware is a quick way to get physicians to use it, as well as, of course, make a profit for the company in the process.

MyMD will initially give iBook laptop computers and iSight Web cameras from Apple Computer Inc. to 1,000 or 25% of the 4,000 doctors in all 50 states who now do online consultations via instant messaging software, telephone, or both, using the company's Web site and technology. However, physicians will have to pay for broadband connection.

If patients have a Macintosh computer, they can buy an iSight for $130. Windows computer owners can use American Online's free AOL Instant Messenger program and buy a Web camera that costs as little as $30, Chalkley said. The Windows system will work with MyMD's system but the quality of the resolution will not be as good, he said.

MyMD is a middleman that offers technology and services that enable patients and doctors to do online consultations in real time but does not itself practice medicine, Chalkley said.

Over the years, several online consultation companies have taken the same position.

Some, including Medem, which is partly owned by the AMA, and RelayHealth Corp. based in Emeryville, Calif., have not encountered any legal problems because they facilitate consultations between doctors and established patients.

MyMD has patients visit the office of a company-affiliated physician for a full physical before allowing online interaction.

Sight for sore eyes

When patients access MyMD's services, they must enter a user ID and password. MyMD's system checks its database and automatically routes them to doctors licensed to practice where patients reside. If patients are traveling outside their state, the system will recognize that the Internet protocol address is in a different state and flag the physician handling the online consultation, Chalkley said. Doctors who sign up with MyMD are directed during their training to transfer those calls to physicians licensed wherever the patient is physically at at that time, Chalkley said.

MyMD charges patients $3.99 per minute. Of that, $2 goes to the physician and the remainder goes to MyMD and Ingenio Inc., a San Francisco-based technology partner.

Family physician James Criner, MD, said his two-doctor Atlanta-based concierge practice signed up with MyMD in February because it already offers its patients e-mail consultations via technology from RelayHealth and wants to determine whether to offer videoconferencing as well. Dr. Criner said he believes videoconferencing will help him deliver better care because he will be able to see patients' eyes and facial expressions as he communicates with them over the phone or through instant messaging.

Some professional liability insurance carriers would not say whether their policies cover telemedicine consultations, saying that they would take up the issue when it arises on a case-by-case basis.

"We haven't seen an underwriting application on that [from a physician] so I really wouldn't want to even speculate," said Frank O'Neal, a spokesman for ProAssurance Co., Birmingham, Ala.