Matthew Holt

The Hawaii Health 2.0 Chapter meeting

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Indu & Matthew traveled to Hawaii (tough gig but someone’s got to do it) to take part in the Hawaii Health 2.0 chapter on Online Care, held on Thursday March 26. The chapter meeting was rather more fancy than the average Health 2.0 local meeting, with the dolphins in their own lagoon at the Kahala resort being a few steps away from the meeting.

HMSA, American Well and Kaiser Permanente hosted the meeting which focused on online care. David Kibbe kicked off the meeting with a little reprise of the Great American Health 2.0 Motorcycle Tour. Jay Sanders “father of telemedicine” gave a great presentation going back to future showing the “radio doctor” in a picture from 1924, which looked pretty much like what online care looks like now! Jay was very provocative about the potential of telemedicine and the role of physicians in the future—for example, if you have a physical and you don't check the doctor's hearing first, how do you know that they’re reporting is correct? Indu & Matthew followed with the introduction to Health 2.0 and putting online care in place within the wider technology change….but you’ve all heard way too much about that (slides to come)

The morning had two great panels. For the physician panel, Ron Dixon
showed some of this data from his clinic at Mass General showing that
patient and physician satisfaction with asynchronous &
video-conference (via skype web cam) was very good. Michele Shimizu is
a community doctor in Hawaii on the big island who is now seeing
patients online using the HMSA/American Well system—she’s been seeing
both HMSA members and uninsured people online. Peggy Latare, the chief
of family medicine at Kaiser Permanente, explained the roll-out of
HealthConnect in Hawaii—the setting where they’ve shown that the
introduction of asynchronous care has resulted in a 25% drop in office visits.
All three physicians are tremendous advocates for online care, and all
had great stories of really advancing patient outcomes from both
synchronous and asynchronous online care.

The other panel moderated by David Kibbe looked at policy.

Roger Netzer, the Chair of the Hawaii Medical board was admittedly skeptical. He wanted to make sure that online care was safe, and challenged the group to consider whether it was as effective as physical examination. But he also said that he was learning about these new possibilities. State Senator Rosalyn Baker has been the champion of remote health & telemedicine in Hawaii—not least because her constituency in Maui is a plane ride away from the specialists in Honolulu. Margaret Laws (from CHCF) explained her vision of how innovative technology could deal with access disparities.

The last burning question was about how online care & telehealth relates to “meaningful use” of an EHR as defined in the HITECH act. David left us with an appeal that we all make sure that the monies in the act are used to improve outcomes, rather than just be used to buy technology—and that should include online care as part of that definition of meaningful use. Rosalyn Baker also said that one concern was how quickly the money in HITECH had to be spent—which was a real challenge to get anything new considered.

After lunch Art Wilmes and John Semmens from actuarial firm Milliman introduced some new data about online care. It included an estimate that using online care to replace some ER visits and other routine care could save overall about 1% of total medical costs. They also developed some guidelines for what care was safe to deliver online, and what needed to be re-routed to in-person.

Mike Cheng from HMSA told us that they got the online care process with American Well up and running in 7 months, including syncing members claims data with system. The system’s up and running since 15 January. Suzanne Fields from Kaiser Permanente described how the HealthConnect system is now a basis for “9 cool tools” which help Hawaii employers (who all have to provide insurance) improve their employees health. Interestingly their outreach via newsletters cause big bumps in online enquiries on that topic. In addition, now they have HealthConnect, NPs can visit the workplace and take their laptops can have all the information about the members from the system.

The session ended with some work groups considering several different aspects of online care, and reporting back. Inevitably issues of licensure come up, not that they were resolved. Finally, Drs Kibbe, Schoenberg & Sanders took part in a looking ahead panel. Roy Schoenberg stressed that this was about convenience, and that it was demanded by the consumers—which is why it would happen quickly. Jay Sanders agreed. David Kibbe was also optimistic, but continued to appeal for recognizing that a combination of patient registries, ePrescribing & online care might be better than simply spending the $40,000 on an EMR—and ought to cost a whole lot less.

At the end of the day many many physicians and other attendees came to comment to me about how valuable the information had been for them. But everyone was very cognizant that for online care, this is a beginning–but a serious one.

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1 reply »

  1. As a practicing physician, my biggest concern would be the lack of a physicial exam. Patients will sometimes minimize their symptoms because they don’t want to hear bad news, thus not receiving appropriate treatment in this online system.