Health plans prepare for `potential revolution’ on Web
Guy Yarden, a Manhattan musician, recently received a letter from a doctor asking him to press his health plan to pay an outstanding bill. By going to the insurer’s World Wide Web site, Yarden could review the payments to his doctors, saving time on the phone for both himself and the health plan.
Propelled by the soaring popularity of the Internet, plus the shifting economics of health care, the medical industry is rapidly going online.
The Internet is already a popular place to search for general information about medicines and treatments, but now a growing number of insurers and doctors are also using it to provide members and patients with personal medical information, from lab results to payment records.
“A potential revolution” is brewing in “how the consumer interacts with the health plan and, down the road in a different way, with the providers of care,” said Jim Hudak, a managing partner with Andersen Consulting.
And Yarden, who describes himself as a “big online user,” said he hoped that what was available now would be only the beginning. “They should be offering a lot more information,” he said, “like the doctor’s diagnosis and prognosis.”
All this has the potential to be a huge benefit for consumers, doctors and insurance companies, who can become bogged down in mountains of paperwork and, when seeking information, often face clogged phone lines.
But it also raises serious questions about the privacy of such highly personal information wafting about the digital world. A person with AIDS, for instance, might not want his employer to know, and a politician or an executive up for a promotion might want to keep a serious illness secret.
The issue thus fits squarely into the broader debate about privacy and security on the Internet, whether it involves protecting credit card numbers or keeping children from offensive information.
For while the variety of Internet offerings has exploded, privacy has limped far behind. Medical privacy was a factor recently when the White House backed away from the idea of assigning every American a medical identification number. The notion was shelved, the administration said, until Congress passes legislation to protect patient privacy. The current version of that bill has faced criticism for not going far enough.
Yarden said the privacy issue “doesn’t worry me,” adding, “I change my passwords regularly.”
Carol Haberman, who works at the National Library of Medicine, noted, “If you pay a doctor on your credit card, your privacy is gone right there.”
But Dr. Donald Palmisano, a trustee of the American Medical Association, is skeptical. “If vandals can break into a CIA Web site,” he said, “it doesn’t make the AMA feel real secure that some vandals won’t break into a health plan.”
Managed care companies say that they are eager to safeguard members’ privacy and that their security systems can protect the electronic information, sometimes more effectively than with paper records. One Blue Cross plan even invites subscribers to dial in tips when they suspect fraud.
In California, the Kaiser Permanente health plan says it will provide laboratory results next year to patients over the Internet using a personal identification number. Oxford Health Plans has similar safeguards.
“We are continually walking a very fine line” between preserving the confidentiality of patient records and using the information to improve care, said Aetna Chief Executive Richard Huber.
Its subsidiary, Aetna U.S. Healthcare, says it hopes to have “a significant percentage” of information for consumers on the Internet soon, including benefits data, the status of claims and a way to get approval for referrals to specialists.
United Healthcare said it also planned to test an Internet project in October, though it gave no details.
Doctors, for their part, are starting to exchange messages, typically about nonurgent matters, with patients in remote areas and computer-savvy patients everywhere who are willing to risk having some hacker eavesdrop on their cholesterol reports.
Dr. Paul Tang, an internist and researcher at Northwestern Memorial Hospital in Chicago, said he often received e-mail from patients telling how their blood pressure or allergy medicine was working or describing symptoms and asking whether they should come to the office.
“One hundred percent of my patients would rather have communications with me any time of day or night,” he said, “rather than worry about the small risk that someone would intercept any message.”
Physicians at Columbia University are testing an electronic program that will allow patients with chronic diseases like asthma and diabetes to see and add to their medical records. They type in an identification number displayed on a card that resembles a smarter version of an ATM card. A machine receives and automatically verifies the number, which changes every 60 seconds.
“We’re trying to prove that there are big benefits” to the patients by involving them more deeply in their treatment, said Paul Clayton, chairman of the department dealing with computerized medical information at Columbia.
Half the respondents to a survey in Boston said they would be interested in communicating with their doctors by e-mail. This could pose hazards for the doctor. Michael Ackerman, who directs computer research contracts for the National Library of Medicine, said he had heard warnings from “malpractice insurance persons that a written document by a doctor might show up in a court and bite you.”
But he noted that the same could be said of a tape of a doctor’s advice by telephone. “How far are you going to push this stupidity?” he said, expressing exasperation at the intrusion of litigation.