Implications for circumventing studies too costly or unethical for clinical trial

PHILADELPHIA – For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease.

In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study appeared online last week in the British Medical Journal.

“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper — this can work.”

In January 2009, President Barack Obama unveiled plans to implement electronic medical records nationwide within five years, arguing that such a plan was crucial in the fight against rising health care costs. Of the nearly $900 billion in Obama’s planned stimulus package currently before the United States Senate, $20 billion is proposed for electronic health records.

Tannen says he and his group recognized that the large EMR databases containing compiled medical information could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials. However, such databases contain observational information, which critics argue do not offer the same level of control as randomized trials.

“Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage healthcare,” Tannen says.

To address criticisms of observational studies, Tannen’s group had to first determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid.

Beginning six years ago, Tannen’s team selected six previously performed randomized trials with 17 measured outcomes and compared them to study data from an electronic database — the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death.

After using standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes.

In the other eight outcomes, Tannen’s group used an additional new biostatistical approach they discovered that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new biostatistical method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the randomized clinical trials.

Though Tannen warns the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, he says the results of his study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies.

“An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen says. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose an opportunity, an enormous health opportunity.”

Mark Wiener and Dawei Xie from Penn are co-authors on this study. This research was funded by a grant from the National Institutes of Health.

Above Information published originally by University of Pennsylvania School of Medicine.

Electronic medical records are the wave of the future, and Chicago area hospitals are already on board.

Hospitals with more advanced record-keeping technology have fewer complications, lower mortality rates, and lower costs, according to a study released last week by Johns Hopkins University. The study looked at more than 40 hospitals with digital record systems and more than 160,000 patients in a six-month period.

“It’s the right thing to do and we’re going to see a lot of studies like this in the next 5-10 years that attempt to measure the benefits of electronic medical records,” said Dr. Mike Kelleher, chief medical information oficer at Children’s Memorial Hospital.

Most of Chicago’s top medical institutions including Northwestern Memorial Hospital, NorthShore University HealthSystem–Evanston Hospital, Glenbrook Hospital, Highland Park Hospital, Skokie Hospital, and 75 doctor’s offices–, University of Illinois Medical Center at Chicago, Rush University Medical Center and Children’s Memorial Hospital have either already made the leap to digital records, or are in the process.

Former President George W. Bush laid out the goal of having electronic records nationwide by 2014, a goal that was quickly adopted by President Barack Obama.

Wired In

The study findings are no surprise to Chicago-area hospitals, well versed in digital technology.

“What we did was transformational–it changed the way we do things and the way we think,” says Mark Neaman, president and chief executive officer of NorthShore University HealthSystem.

“Patients can even have a Blackberry conversation with their physician or order a prescription online,” Neaman said.

NorthShore University HealthSystem, one of the pioneers in digital records, went completely digital in 2004.

Digital records can even prevent mistakes from being made.

“We have seen measurable improvements in the quality of our outcomes, reduced medication errors and become generally more efficient,” Neaman said.

The complete transition at NortthShore $took 15 months from launch to finish in April of 2004 and cost an estimated $42 million, according to Neaman.

“We applied the big bang theory,” Neaman said. “We wanted to have everything up and running quickly.”

Almost all Chicago-area hospitals have some digital record keeping system in place or are in the process of implementing one.

Security, however, becomes a major concern with personal information in digital form.

With electronic records, it is much easier to track who has accessed a file—an important security feature—but making sure the right people have access can be time consuming.

“It’s a big concern,” Kelleher said. “You have to make sure that the people you give access to are properly vetted.”

“Before electronic medical records, files were continually being misplaced,” said Dr. David S. Channin, radiologist at Northwestern Memorial Hospital and chief of imaging informatics at Northwestern University Medical School. “We relied on loose pieces of paper with illegible writing, and human memory.”

Northwestern Memorial has used electronic records for more than a decade now for nearly all of their services.

More Benefits

The benefits of digital records aid in many different aspects of patient care.

One key benefit is allowing doctors to find information on patients more easily.

While it may take physicians or nurses more time to enter information into the system, the ability to find it and search for it with ease is invaluable according to Kelleher.

Patients and doctors can also have their information readily available at the touch of a keyboard without having to dig through extensive files.

Digital Divide

Despite the many advantages there are still countless hospitals that are falling behind with this technology.
After years of recording information manually, some doctors are hesitant to change to a new electronic system.

“The older physicians are more likely to be unwilling or uncertain about using the computer system,” said Kelleher.

“The catch is that there are tradeoffs between quality and efficiency and independent tradeoffs within each one,” says Dr. Channin.

There is also a steep cost of investment as far as equipment and training.

NorthShore University HealthSystem invested an estimated $42 million in the new technology, $5 million of which went to training staff, according to Neaman.

They are foreseeing an estimated return of 17 million dollars per year in savings related to the new system, but the return is very long-term and small in comparison.

Originally Published by Vanessa Handand and Chris Kelly, Northwestern University.

The Healthcare Information and Management Systems Society (HIMSS), representing more than 20,000 individual members - of which 73% work in provider settings - and 350 corporate members, today announced its support for the health information technology (IT) provisions in the American Recovery and Reinvestment Plan of 2009 proposed by Congress. HIMSS believes the inclusion of funding for health IT is essential if we are to meet President Obama’s goal of computerized health records for all Americans by 2014.

HIMSS cites three reasons to support the investment in health IT:

1. The economy will benefit from an investment in health IT

According to research by IBM and the Information Technology and Innovation Foundation, investing $10 billion in Electronic Health Records (EHR) and other health-related IT projects would create 212,000 jobs.

Furthermore, multiple independent studies have shown substantial return on investment for health IT, which could help lower healthcare costs.

• Deloitte LLP reported this month that investing in e-prescribing and electronic medical records, along with better coordination of patient care through primary-care doctors, would result in 10-year savings of $530 billion.
• The RAND Corporation reported in a 2005 study that widespread health IT adoption (90 percent of hospitals and physicians) could save $77 billion annually. In testimony presented before the Senate Finance Committee on July 17, 2008, RAND forecast that during the 15-year adoption period, cumulative net savings would be about $510 billion or approximately $34 billion per year.
• The Center for Information Technology Leadership estimated in a 2005 study that full implementation of health IT could yield annual savings of $77.8 billion.

2. Patients will benefit from an investment in health IT

When used properly, EHR systems can help keep patients safe by alerting clinicians to harmful drug interactions or allergic reactions to prescribed medicines and helping clinicians manage the health of patients with complex chronic conditions.

Evidence of improvements in patient health associated with IT has been shown:

• The Jan. 26, 2009, issue of the Archives of Internal Medicine includes a study by Johns Hopkins School of Medicine that found a 15 percent reduction in patient mortality rates during hospitalization at centers that use computers instead of paper.
• A 2002 study reported in the Journal of the American Medical Informatics Association suggests that health IT could reduce the average length of a hospital by reducing delays associated with certain hospital functions and by avoiding costly errors.

3. Doctors will benefit from an investment in health IT

While many physicians realize the positive impact successful EHR implementation can have on a practice, the Congressional Budget Office reported in May, 2008, that as of 2006, only 12 percent of physicians and 11 percent of hospitals have adopted all or most recommended health IT functionalities. Survey results published in the July 3, 2008, issue of The New England Journal of Medicine found that 66 percent of doctors who have not adopted an EHR system cited cost as the biggest barrier to adoption.

In the 2008 study, the vast majority of physicians who have adopted an EHR system are satisfied with the product: 93 percent of physicians who use fully functioning EHR systems reported being generally satisfied with the systems. The same survey results showed that 82 percent of physicians who had fully functional EHR systems reported positive effects of the system on the quality of clinical decisions.

An added benefit for physicians could be lower malpractice insurance costs. The Congressional Budget Office reports that multiple physician liability insurance firms offer discounts to practices that have adopted EHR systems.

“The state of the economy and the healthcare system warrant a significant investment in health IT, especially in light of President Obama’s calls to computerize all health records within five years,” said H. Stephen Lieber, HIMSS president and CEO. “We support the health IT legislation that has been recently introduced and believe it will allow the industry to take important steps toward delivering better quality healthcare more efficiently and at a lower cost.”

In December 2008, HIMSS released A Call for Action: Enabling Healthcare Reform Using Information Technology, outlining specific priorities and recommendations for the Obama Administration and 111th Congress in regards to health IT. The recommendations were developed by more than 100 HIMSS member volunteers and represented necessary measures to develop and sustain a robust health IT infrastructure. The report is available online at www.himss.org/2009calltoaction.

For more information, visit www.himss.org.

About HIMSS

The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States and the globe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

Contact(s):

Joyce Lofstrom

312-915-9237

If you’re like the majority of physicians, you don’t prescribe electronically and you don’t see why you should. After all, what’s wrong with the old prescription pad that has served you well over the years? But citing safety, quality, and efficiency, the government, private insurers, and some medical societies want you to change your mind.

This month, a CMS initiative will start adding 2 percent to your Medicare payments if you prescribe electronically. The incentive drops to 1 percent in 2011 and 2012 and to 0.5 percent in 2013. Starting in 2012, CMS will pay you 1 percent less than its fee schedule if you don’t e-prescribe; that penalty will rise to 1.5 percent in 2013 and to 2 percent in 2014 and every year thereafter.

Speaking at a recent conference in Washington, D.C., CMS acting administrator Kerry Weems said he was confident that the incentive “changes the business case enough that we’ll see investments made in e-prescribing. We also think some private payers will come along with us.”

But with standalone e-prescribing systems priced at around $3,000, plus monthly maintenance fees, observers are divided on whether the CMS incentive alone will be sufficient to get doctors to adopt e-prescribing. Bruce Merlin Fried, a Washington, D.C., healthcare attorney and health IT policy expert, is one of those who think that it will: “The incentive will have an enormous impact on doctors moving toward e-prescribing.” The penalty on the back end, he adds, will convince many other physicians to do the same.

Representatives of primary-care medical societies, however, are less optimistic. Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology, which has been promoting e-prescribing for years, says, “I don’t think the 2 percent incentive will be enough for most family physicians. It will accelerate the thinking of people who are close to making the decision for their practice; but for those physicians who don’t think they should be e-prescribing or aren’t ready, this 2 percent — which, for a family physician, is about $1,400 a year — is not enough to change their decision.”

The incentive is prompting some physicians “to take a harder look” at e-prescribing, says Michael Barr, vice president of practice advocacy and improvement for the American College of Physicians. “It’s not something people are taking lightly. Some doctors are wondering, ‘If I’m going to invest in technology, is now the right time for me to go the EMR route, or should I go to e-prescribing?’”

Both the investment and the work flow changes are much greater with an EMR, he admits. “But if your practice has been thinking about an EMR, and hasn’t been able to create a business case for it, and if you’re on the fence, the e-prescribing incentive might push you over.”

Other help

Of course, you’d be more likely to adopt e-prescribing if all of your payers, not just Medicare, were providing incentives. Don’t hold your breath: Waldren says such a widespread move is unlikely, noting that most plans doubt that they’ll see a return on investment. But Blue Cross and Blue Shield of Massachusetts will require physicians to e-prescribe by Jan. 1, 2011 in order to participate in the plan’s incentive programs. Highmark Blue Cross Blue Shield and Blue Cross Blue Shield of Delaware are helping doctors switch to e-prescribing, and several other Blues plans have agreed to support a service offered by Prematics, a Vienna, Va.-based firm that gives e-prescribing technology to practices for free. Insurance companies also fund the PocketScript e-prescribing service of ZixCorp, based in Dallas. And the National ePrescribing Patient Safety Initiative, a coalition that includes technology companies and plans such as Anthem, Aetna, and Horizon Blue Cross Blue Shield of New Jersey, is offering physicians free e-prescribing software.

As for hospitals, most have been slow to offer a helping hand, despite a 2006 relaxation of Stark self-referral rules that was supposed to encourage them to subsidize information technology for private practices, according HIMSS Analytics, a healthcare IT research firm. They seem even less inclined to offer assistance with e-prescribing, according to Dave Garets, the firm’s president.

Online only

Further change is coming even for those physicians who have already adopted e-prescribing via their EMR’ s, most of whom are computer-faxing prescriptions to pharmacies. Starting this year, CMS prohibits computer-faxing of electronic prescriptions covered by Part D drug plans. Kevin Hutchinson, president of Prematics and former president of SureScripts, the firm that connects physician offices with pharmacies, says he thinks this will have a big impact on increasing the percentage of online scripts. All that most physicians with EMRs have to do to prescribe that way, he notes, is to get their vendors to upgrade their systems to the latest version.

According to SureScripts, the number of online prescriptions is rising fast. In 2007, 35 million online prescriptions were written, with 6 percent of office-based doctors prescribing online. In 2008, SureScripts expected 100 million prescriptions to be written and sent electronically. They projected the number of physicians e-prescribing online would jump to 85,000, or 15 percent of office-based doctors.

Many physicians will continue to hold off on e-prescribing, partly because of federal and state rules that forbid electronic prescriptions of controlled substances. Nobody wants to have a dual paper and electronic workflow in their office. This is also a problem in areas where only some local pharmacies accept electronic scripts. While nearly all chain pharmacies do, many independent drugstores continue to hold out. At the end of 2007, 70 percent of all community pharmacies accepted electronic scripts, but only 27 percent of independents did.

Still, there’s no doubt that the e-prescribing train is gathering steam. And, while it’s doubtful that there will be a federal mandate to e-prescribe, you should probably start taking a close look at the pros and cons of moving in this direction yourself. When most of your colleagues have made the leap, and your patients expect it, do you want to be the last doctor using an old-fashioned prescription pad?

Ken Terry is a New Jersey-based freelance writer and the author of the book “Rx for Health Care Reform.” He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.

In a recent comment by Tom Hamilton, he gave a nice review of a wireless microphone that can be used with Dragon Naturally Speaking Medical. I figured I’d been covering enough EMR politics and implementation lately that it was about time to mingle a little bit of technical content in the middle.

I’ve been told a number of times that if you want to use Dragon Naturally Speaking medical, then finding a high quality microphone is absolutely essential to a quality voice recognition experience. Check out Tom’s review of the Samson Stage 5 Wireless microphone. Wireless is definitely the future.

Samson Stage 5 Wireless Microphone With Dragon NaturallySpeaking Review:

We’ve just completed Phase 3 testing of the new Samson Stage 5 wireless microphone [$99 on Amazon] and you can read our complete review by clicking Samson Stage 5 Review but the short version is that the new Samson Stage 5 wireless VHF microphone combo includes both a lapel microphone and a headset microphone, costs $99-$105 and is as accurate as our best (starting at $115) theBoom “O” [$149.99 on Amazon] and $145 Sennheiser ME3 wired microphones [$135.83 on Amazon] which cost more and are not wireless. The Stage 5 even includes a three-year warranty. With the exception of end users who require extreme portability, we can’t imagine why anyone would want to pay extra for a wired microphone with a one or two-year warranty. Now everyone can afford to cut the cord!

KnowBrainer, Inc. Support Staff – Tom Hamilton
A Nuance Gold Certified Endorsed Vendor
ALWAYS Ask If Your Speech Recognition Vendor Is Nuance Certified

Thanks Tom for the review.

Check out the following prices for the various versions of DNS on Amazon:
Dragon NaturallySpeaking 10 Preferred - Currently $151.49 with $50 rebate ($101.49 after rebate)
Dragon NaturallySpeaking 9 Preferred - Currently $92.97
I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

Source from emrandhipaa.com

I recently read a really interesting and informative article called “Five Reasons Why EHR Implementations Fail.” My only problem with this post is that it focuses too much on the negative. Too many doctors (and all clinical staff) are looking for reasons to have their EHR fail and not enough of them are looking at the reasons why an EHR implementation will succeed.

Therefore, here’s my 5 reasons why your EHR implementation will succeed.

Amazing Trainers
There are amazing trainers out there that have gone through hundreds of successful EHR implementations. Make the time for staff to utilize one of these trainers and you’ll see amazing results in implementing an EHR. Soon after implementing your EHR you’ll wonder how you practiced medicine without an EHR.

Realistic Implementation Schedule
Create a realistic implementation schedule and stick to it. Be open to modifying the schedule as needed, but don’t let excuses get in the way of your plans. Everyone is always busy. Staying on schedule is more about making the EHR implementation a priority. Make it a priority and you’ll have no problem staying on schedule. Also, remember that you don’t have to bite everything off at once. Take it in stages and celebrate the milestones you achieve.

Succeed Despite Challenges
Tons of unrealistic expectations exist around the benefits of EHR implementations. One clear expectation is that every EHR implementation has unique challenges. However, thousands of doctors have faced these challenges and successfully implemented an EHR despite the challenges. There’s no reason you can’t overcome your own unique challenges as well.

Forget About Timing
Certainly there are some times that are better than others for implementing an EHR. You know your practice and should schedule your EHR implementation during a slower time for the practice. However, once you’ve made the decision to implement don’t dwell on the timing, but instead focus on ways you’ll overcome whatever challenges happen because of timing. Reminds me of a common phrase said about marriage, “Before marriage keep both eyes open. After marriage keep both eyes closed.” Apply the same conviction to implementing an EHR and you’ll be amazed by the results.

Create Clinical Buy-In
Each situation is unique, but don’t be surprised if some of your most ardent opponents turn out to be some of your most powerful users. The person complaining about an EHR implementation are probably the same people that are complaining about finding paper charts and illegible charting. An EHR does amazing things to solve these problems. Focus on these types of benefits and it’s very likely that you’ll have more clinical buy-in than you’d have every expected.

Summary
We too often focus on the challenges of an EHR implementation that people easily ignore some of the many reasons why your EHR implementation will succeed. I guess my point is that the glass is half full if you want it to be.

Source from emrandhipaa.com

Researchers at the University of Pennsylvania School of Medicine have discovered that electronic medical records can be used to test drug efficacy.

Richard Tannen, MD, a professor of medicine at the university, was the lead researcher in the study to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials when evaluating drug therapies.

“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen said. “That’s the real message of our paper - this can work.”

Tannen said his group recognized that large EMR databases could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials.

“Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage healthcare,” he said.

Some critics have argued that these databases contain observational information, which does not offer the same level of control as random trials. To address this criticism, Tannen’s group had to determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid.

Tannen’s team selected six previously performed random trials with 17 measured outcomes and compared them to study data from an electronic database - the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death.

Researchers used standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information and found there were no differences in the database outcomes compared to random clinical trials in nine out of 17 outcomes.

In the other eight outcomes, Tannen’s group used an additional new biostatistical approach that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the random clinical trials.

Tannen said the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, and the results of this study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies.

“An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen said. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose … an enormous health opportunity.”

Source from HealthcareITNews

Considering the tremendous amount of political talk about EMR and EHR systems, you’d think that the number of EMR companies would continue to grow.  It makes sense that entrepreneurs would chase after the $$’s that they see being invested in EMR, EHR and health care IT.  However, I personally believe that the number of EMR companies will decrease in the next year rather than increase.

The number one reason that EMR companies will descrease over the next year is that we’re going to see an amazing number of EMR companies failing.  The current economic climate is not the best time to be an EMR company.  Those EMR companies who require sales of EMR software to survive are going to have major troubles surviving.  Many EMR companies gain most of their revenue through the upfront initial cost of the EMR.  It will be interesting to see how many EMR companies have enough financial reserve to survive the current economic crisis.  Within 6 months I expect to see a plethora of EMR companies shutting down their business.

I think we can also expect a number of EMR companies to consolidate.  Sometimes this will happen because of the previous point.  Other times it will just be a natural part of the growth of the industry.  Either way, we can expect to see a major consolidation in the industry.

Understanding what’s going to happen is really important for those using and selecting an EMR.  Expect support times to really slow down if a merger or acquisition occurs to the EMR software you’re using.  Also, if your EMR software company shuts down, how will that impact you?  Might be a good time to talk with your EMR company and try your best to measure their future viability as a company.

I have been learning about the Web 2.0 for more than a year. Since February I have been writing about it in this blog. The purpose is to share with others what I know, to get more and more people involved with it. Not all my colleagues I have talked to about it really understand the concept or why it is so important to learn about it though.

That is why I have been thinking how to teach my colleagues in the health care community about the importance of Web 2.0 and Medicine . But without complicated terms or definitions. Why is important to learn about it? For me it is really clear that these concepts and technologies of the web 2.0 applied to medicine are going to change how the flow of medical information is created. With the use of these “new” tools we are going to go back to basics, and we will have the chance to learn medicine in a Socratic way again. We will have more time to spend with our peers to talk about the humanistic side of medicine. Learning about Web 2.0 and Medicine is as important as to learn about writing . All of us recognize the importance of knowing how to write. I think all of us can recognize the importance of writing in the mankind history.

I going to quote The British Library Board . Why to write: “For thousands of years human beings have used marks, symbols, drawings and signs to communicate with one another. In order to share knowledge, we need to be able to store information and pass it on to future generations. Memory is our first resource, but, over the centuries, we have developed many other ways to store and transmit information.”

You know how to write in paper format and you know all the advantages it has. But do you know how to write on internet ? How much do you know ? Can you imagine all the opportunities the learning of these technologies can generate? That is why to learn about Web 2.0 and Medicine is important.

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor. (Credit: American Well)

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii’s largest insurer, HSMA (which operates the state’s Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday’s launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn’t a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

“That doesn’t necessarily need to be done on a face-to-face basis.” Shimizu said. At the same time, she doesn’t see traditional visits going away.

“I don’t think this situation can completely replace one-on-one doctor’s visits,” she said. “It’s an adjunct to that.”

She’s found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

“The $25 has been received tremendously,” said HMSA marketing Vice President Michael Stollar. “They think the fee is very fair,” he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians’ downtime fills a critical need. “There are not enough primary care physicians,” he said. “It really allows us to capture ‘care opportunities’ out of the same number of physicians that were out there.”

form CNET Health news.