Your Vital Signs Online

By Rebecca Winters

Cindy Seikkula Peterson has reached that point in her life at which managing her family's health care takes more than an overstuffed file folder. With a newborn baby, her recovery from a caesarean section and her mom's high blood pressure on her mind, Seikkula Peterson, 41, monitors the family's prescriptions, immunizations, tests and doctor visits online using a service called WellMed. "Keeping track of everybody's health history in one spot, on the computer, makes it manageable," she says.

WellMed, at www.wellmed.com and at health portals including IntelliHealth.com and AllHealth.com is one of a few new, online health services that go beyond providing a place to research medical questions and news. The new services help users act on their research by tracking personal health histories, managing bills and claim forms, and communicating with physicians about prescriptions and other issues that might not be adequately addressed by the average doctor visit. Free to consumers, the services get their revenue in several ways, including charging employers and insurance companies for using the services. "These developments are very empowering to the health-care consumer," says Charles Inlander, president of the People's Medical Society, a health consumer-advocacy group in Allentown, Pa. "From the patient's point of view, we've been practicing medicine in this country as if it were the 19th century. Now we're skipping straight to the 21st." In fact, in an age when the consumer is king, health care remains the one industry in which customer service rarely extends beyond offering the patient an 800 number and a lollipop. But with the help of e-health--and with a consumer who abides by some smart rules of online health-care management (see box)--the plight of the patient saddled with frustration and inconvenience may finally be addressed.

WellMed is designed for anyone who has ever answered the question "When was your last tetanus shot?" with a sheepish shrug. Registration and setup are about a 10-minute process (more if you have a lengthy medical history), in which you provide information about your emergency contacts, allergies, blood type and primary-care doctor and are assigned a log-in name and password. WellMed organizes the data into what it calls your WellRecord. This doesn't replace your physician's record, but it becomes your personal storage and communication tool. Doctors, far-flung family members, insurance companies and laboratories can also get access to your health records if they are registered on the site and granted permission by you on your account-options page.

For most users, the service will simply be a convenience, like Quicken, the software that allows you to manage your finances in one spot. But in some cases, it can be a lifesaver. One WellMed service is designed to handle emergencies when the patient can't. An information card that users keep in their wallet prompts medical personnel to call WellMed, which then verifies the health facility's authenticity and makes the patient's history available.

Another site that is trying to improve the patient experience is eMD.com eMD also has a health-records function, as well as a service that allows doctors to write prescriptions electronically that their patients can fill at a participating online pharmacy. The doctor is then able to log on and learn when the patient filled the prescription and what drug he was given. The goals are to guard against potentially dangerous drug interactions or allergies, to eliminate the errors caused by a doctor's poor handwriting and to ensure that the patient is following through by filling the prescription. The site also helps patients with instructions on how to use medical products, such as an asthma inhaler. "Usually the patient or a parent gets a quick demonstration in the doctor's office, is afraid to ask questions and then goes home," says Timothy Moses, CEO of eMD. "We have certified pharmacists who will do the training over the phone and online as many times as a patient needs it." The doctor is given a log of these calls as well.

Often it isn't the medical care that makes a doctor's visit so unpleasant but the mountain of bills and forms that a patient has to wade through afterward. In February 1999, David Karabinos, then an executive with the accounting firm Ernst & Young, visited his mother, who had recently been hospitalized. "My mom had bills and paperwork spread out over two whole countertops," says Karabinos. "She just threw up her arms and said, 'That's it. I'm not going to the doctor anymore.'" The experience of seeing his mother so frustrated by her medical expenses inspired Karabinos to create an Internet business that helps health consumers understand and manage their bills, benefits and claims. Karabinos founded eHealthclaim, a website that will be available in March that uses software to track and reconcile patients' medical bills and claims with their insurance-company statements.

Like WellMed and eMD, eHealthclaim is intended to make the consumer's day-to-day management of health care easier. The vast majority of eHealthclaim users, at least initially, will be employees of companies that offer the site as a benefit. For these companies, eHealthclaim creates a customized portal in which employer-specific benefit information is kept and managed. It's expected that employees will use this service much as they might use the human-resources department at the office, though now they will have 24-hour access and be able to have questions like "Does my plan cover knee surgery?" answered immediately at home. If employees have a bill for medical services and want to know what it means, they type in some key information from the bill, and eHealthclaim will interpret the medical codes, estimate reasonable charges for the care received and match the employee's bill to the insurance company's statement.

Companies pay for this tailored service, which helps them cut human-resources costs, but eHealthclaim is making parts of its site free to individuals and expects those most likely to use it will be caregivers, senior citizens and those who suffer from chronic illnesses. These users won't have access to the full suite of tools unless their health insurer offers the service. But they will be able to use several tools on the site, including a medical-procedure fee estimator. Users can enter a question like "How much does a liver biopsy cost in Glendale, Calif.?" and be armed with the answer so that when they meet with their doctor or talk to their insurer, they are in the know. Other tools are a physician's directory that includes doctors' experience and background, and a decoder for those cryptic codes on medical forms that describe the treatment for which you're being billed.

Each of these services is designed to help the average person better navigate the often confusing, frustrating world of health care. The next step, says People's Medical Society's Charles Inlander, is the growth of far-out-sounding, but already possible, techno-enabled interaction such as doctor-patient videoconferencing, remotely performed surgery and computer-monitored home health care. As medicine marches ever forward, health consumers may find that there's a lot more to customer service these days than a few chairs in the waiting room. Someday soon there may be no need to wait at all.