HMO Web site offers discussion groups
Appointments, advice in place, Rx refills coming
More than half of adults who are Internet-active use the Web for health care services. That’s a total of 40.9 million U.S. adults, according to Cyber Dialogue, a New York City-based research company providing businesses with consumer data for marketing (www.cyberdialogue.com). The company’s studies also reveal that while only 3.7 million U.S. adults have e-mailed a physician’s office, an additional 33.6 million are interested in doing so. Four years ago, Kaiser Permanente responded to a persistent demand by members for on-line services. Kaiser Permanente, based in Oakland, CA, is the country’s largest not-for-profit HMO. It has 8 million members in 11 states.
When Kaiser piloted a Web site for its 1,000-member Santa Clara, CA, medical office, "members said this is what we want and more,’" says Ann Carlson, manager of Kaiser Permanente Online. In 1999, the site went live in each of Kaiser Permanente’s regions. The site consists of four components:
1. general information on privacy, security, registration, and navigational instructions;
2. in-depth educational resources, including health assessment forms and a 29,000-page health encyclopedia;
3. communication opportunities, including feedback from an advice nurse or pharmacist, discussion groups, and nonurgent appointment scheduling;
4. information about Kaiser’s facilities, locations, classes, and physicians.
Complementing the members-only offering is Kaiser Permanente’s public site (www.kaiser permanente.org). It attracts 108,000 hits a day. Featured are preventive medicine tips, a free Webzine (on-line magazine), healthy recipes, and children’s educational materials.
For some time, members have asked for Internet prescription refills. And as QI/TQM went to press, that service was going live in the system’s northwest regions of Oregon and Washington. Northern California comes next, followed by the rest of the system in 2001. Also planned are electronic access to lab reports and e-mail communication between members and their personal physicians.
Services popular with consumers, providers
Currently, 250,000 Kaiser Permanente members are registered users. An additional several thousand sign up each month. "The number of registered users is a more important measure to us than the number of hits a day on our members-only site," Carlson explains. "The need for provider contact comes and goes as health problems come and go."
The providers are "incredibly supportive" of cyber services, she observes. They appreciate the patient access to advice and nonurgent appointment bookings. "To them, it’s an enhancement — not a replacement — of their relationships with patients. We’ve had no resistance to this project. In fact, the providers have been eager to put their hands up and participate in on-line discussion groups."
One physician who’s become involved is pediatrician Mark Groshek, MD, in Kaiser’s Denver region. He volunteers one to two hours a week. While he doesn’t log on every day, at least one physician from one of the regions checks into each discussion group each day.
The groups attract members from around the country. Groups form and disband according
to member requests. Besides pediatrics, topics range from women’s health to parenting, from arthritis to alternative therapies and stress
management.
While the groups are interactive, "it’s not a real-time chat room," Groshek says. Members post their questions and responses at their own convenience. Some issues discussed are purely clinical, such as food and drug interactions. The moderator might say "Here’s what to look for. Talk about it with your doctor," he stresses. "As moderators, we’re trained to participate in ways that add to the care provided by a member’s personal physician. We’re not there to take over."
On psychosocial issues, the moderator shares opinions along with other group participants. For example, the member whose children clash with her new husband receives tips and reassurances from the group as well as the moderator.
"This is another opportunity to care for patients," Groshek explains. "In a caring business, it’s rewarding to get feedback that a discussion group is helpful to our members."
The involvement also feeds Groshek’s personal interest in computers. "It’s satisfying to integrate the technology of the Web site into our clinical information system. We also can link people to other resources that we trust." In a discussion on feeding a toddler, for instance, Groshek could suggest that the member click on a related heading within the site’s on-line encyclopedia.
He explains that Kaiser Permanente is evaluating whether the Web site leads to more efficient use of its resources, but it’s still too early to know for sure. In his discussion group, for example, there are fewer than 100 members.
The opportunity for electronic communication with health care providers makes sense in many ways, Carlson notes. "People work in [cubicles].
If they call their doctor or pharmacist, their cube mates can probably hear the conversation. For
privacy and convenience, nothing beats putting your question into the computer and coming back to find the information you need." However, she warns, "If you don’t have a tightly integrated health care delivery system, it won’t work."
If patients e-mail an advice nurse or pharmacist and get no reply for a week, credibility falls apart. "It’s absolutely critical that a health care organization have the backup systems in place for its Web site to work," Carlton stresses. "The piece that makes our web site successful is what Kaiser Permanente established 50 years ago — integration." On that note, she advises organizations considering on-line services to start with their most tightly integrated components, for instance, nonurgent appointments or advice from a nurse or pharmacist.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content