The recent story in the Los Angeles Times has sparked some helpful commentary about a transformed medical system, which is great. I thought it useful to write about one commentary I read recently on the Health Beat blog. I would characterize the tone on the cautious, maybe negative side about “virtual medicine.”

Health Beat: The Downsides of Virtual Medicine

While the focus of the commentary was on commercial providers of messaging services, there’s a whole other practice of patient-centered care supplemented by technology that is going on in integrated and progressive non-integrated care systems. This was the feature of the Los Angeles Times article, which highlighted a colleague of mine, Christine Calderone, MD, from Kaiser Permanente’s Whittier Medical Office.

On the topic of low-income populations, it’s interesting that the 58 percent figure that is cited for having computers in these households is called low, was actually a very high figure in 2000, when organizations like Group Health Cooperative and Palo Alto Medical Foundation began offering these services. From my perspective, 58 percent is very compelling. I’d disagree with the statement that “those most likely to benefit from the web-doc movement are the young, affluent folks who are already plugged in.” Our experience has shown that there are many non-affluent, non-young folks are plugged in, and receiving great benefit. We shouldn’t assume or build a system around the idea that they will not, and our experience going to practices demonstrates that we don’t have to.

Another issue worth pointing out is the question about whether online visits drive up volume. The excellent study at Kaiser Permanente Northwest answers this question well. They do not. In fact, they are associated with both a drop in face to face visit volume and a reduction in trend for phone calls, meaning that the demand for care that is currently unreimbursed in both fee for service and integrated systems is less.

I applaud the careful critique of the trend to involve patients more in their care. At the same time, I keep coming back to the idea that there aren’t very compelling arguments for limiting patients’ access to their care providers or their medical information. I’ve practiced medicine in both worlds, and now around 2 million patients and counting (if you look at Kaiser Permanente and Group Health Cooperative) have received care in both. For me, I can finally be the kind of physician I hoped I could be, and I don’t plan to go back. Does anyone else?

I just returned from a really outstanding 2 day session hosted by the Robert Wood Johnson Foundation, on informing policy (as opposed to lobbying, which was not a focus of the session). I definitely went with PCHIT on my brain.

One of the thought exercises the facilitators asked us to engage in was, “What would your headline read?” That part was relatively easy for me. It was “Every patient in every health system now has access to their health information and health care team online.” This is a headline, which means it’s narrowly scoped. My professional purpose is a broader than that, as are those of this blog’s readers, of course (See a post on my own blog about this).

The part after that which was interesting was that I began gently shopping my headline around to the other health care leaders at the event with me. It was a little nemawashi, if you will. The responses were varied. Some felt that certain populations didn’t have enough computer access to warrant this investment. Some were very interested in the idea, but hadn’t conceptualized how it would improve care. Very few were already doing this in their practices. Others were excited by it right off the bat and didn’t even know that some organizations were already doing it.

We of course now have good information that many populations believed to be computer inaccessible are, and there were key issues that helped in understanding, like the need for accurate medication reconciliation, involving families in care, supporting a great inpatient care experience.

Besides learning what I learned about messaging and understanding policy, I also ended up conducting several mini-focus groups around the event about this issue. Initially, I felt that I was a bit ahead my time in this population of physician, nurse, and allied health leaders. After having more conversations, though, the message became more understandable to the people I spoke with. Everyone is interested in a high quality, affordable care system. The one thing I picked up with this group as well was that the work showed interest in supporting a health system that shows respect for patients, their families, and their communities. I think that is a great theme for this work, as well.

What would your headline read? Post it below!