E-health, your workforce and you

The future is already here

Contemplating the health care applications of the Internet can leave you breathless with possibility. All of these "killer apps" are technologically feasible or actually operative.

By Robert McCarthy

The house call is of course dead, but might the office visit become a relic as well? The technology is already here. Imagine a television set equipped with a video camera. The video equipment links at-risk patients with physician offices. Other devices digitally record and store symptomatic information relevant to diseases like asthma and diabetes. The patient performs a blood glucose test or uses a peak-flow meter to measure airway capacity. The readings are stored in the device, which is plugged into a computer with Internet access, then downloaded to a central processor that stores medical histories and treatment algorithms.

Patient readings are analyzed. Perhaps the diabetic's blood sugar level has spiked. The disease algorithm recognizes a potential problem, compares the current reading with past results and recognizes a pattern of spikes. The software "understands" this is a concern and notifies both patient and physician by e-mail. If the problem looks more serious, the software might generate two phone calls, instructing patient and physician to contact each other. At this point the two-way video comes into play. Doctor and patient can interact without an office visit—and before a medical emergency arises.

Science fiction? Nope. There's already a device called "Health Buddy," made by a Mountain View, Calif.-based com-pany called Health Hero Network. It's a terminal connected by phone lines to a central server. Every day, even several times a day, the Health Buddy flashes a series of questions: "How are you feeling?" "Have you taken your medicine?" Responses are downloaded to the Health Hero Network, where case managers assess the data and implement interventions as needed.

And this is just the tip of what's happening in e-health. Consider as well:

The office visit, virtually revived: Net meeting software and audiovisual teleconferencing are being used to monitor elderly stroke victims. Wireless sensor devices measure vital signs, including brain-wave activity, and data are transmitted to a central processor for evaluation.

Panasonic in Secaucus, N.J., is developing the "Tele-Homecare System," which comprises three devices: the Patient Terminal, the Active Server and the Doctor Terminal. The Patient Terminal measures vital signs with a thermometer, blood pressure cuff/pulse taker, blood sugar monitor, oxygen saturation sensor, stethoscope and an electrocardiographic device. It also has an interactive touch screen, a video camera and a voice/picture navigation system. The terminal's alert functions remind patients of scheduled measurements of vital signs. The Active Server connects the Patient Terminal to the Doctor Terminal, where the provider can check stored patient data. The system notifies the physician or nurse if vital signs are abnormal. The provider can communicate directly with the patient through the Doctor Terminal's videophone system or e-mail advice and information.

Virtual communities, created: Medical information sites are rapidly adding interactivity applications, offering forums where patients with the same interests or conditions can read each others' postings or participate in chat rooms and on-line symposia. Members of the virtual community can share information and experiences, learn from and support one another. A First Consulting Group report (Where Will the Road to e-Health Lead?) claims that some of these communities have even begun to sponsor outcomes research on their conditions.

Actual communities, wired: You remember the CHINs (Community Health Information Networks). They were supposed to link up providers, plans, hospitals, pharmacies and patients in ways that would make health care delivery more effective and communities healthier. CHINs never really fulfilled their promise, perhaps because the linkages were never robust enough. Winona, Minn., is betting the Internet has solved that problem. Under the aegis of the town's hospital, Community Memorial, Winona Health Online is setting up medical home pages for each Winonan. On their home pages, citizens can interact with their physicians, schedule appointments, get drug refills, preregister for hospital admissions, access and augment their medical records and get health care information. As patient data accumulate, public health officials and hospital clinicians will be able to do townwide outcomes studies and devise finely targeted public health interventions.

Virtual health agents: PricewaterhouseCoopers, the health care consultancy, last year published a report on pharmaceutical marketing in the future. Of particular interest is a section called "In 2015, Virtual Health Agents?" It describes a typical morning of Elliott Carter, a 40-year-old professional. Every morning Elliott has his coffee . . . and an at-home medical scan and consultation with his on-line "physician," Dr. Franklin Thomas, who is actually a personalized piece of medical software. Elliott sticks his finger into a wall-mounted digital terminal, which quickly determines his blood pressure, circulation, blood glucose and the presence of any harmful pathogens. A small probe under the tongue checks his temperature and scans for viral antibodies. Pulmonary function is assessed with a peak-flow meter; an instant saliva assay determines Elliott's food and liquid intake.

All these readings are instantaneously transmitted to Elliott's "health agent," a proposed successor to today's health plan. Software compares them to past readings and to Elliott's medical history and stores all the data. At that point, Dr. Franklin appears on the digital monitor. "Elliott," says this doc literally in a box, "you've got a slight cold and you overindulged in food and drink yesterday." The doctor then prescribes a cold remedy and suggests a meal plan to maximize Elliott's energy level.

Unless Elliott is acutely ill, he never sees a flesh-and-blood physician—their services are thus reserved for the acutely ill. When he does need a real doctor, his health agent (essentially, a packager of Internet services) makes a list of providers with the best outcomes and invites them to bid. Together the health agent and Elliott determine the best combination of excellence and price.