Patients who get a lot of medical support tend to be more compliant about taking their medication, says Cosler. As one indication of that trend, Priority Healthcare's call center receives slightly fewer phone calls from patients who are members of the Neighborhood, he says. Such encouraging indications have inspired many physicians (primarily gastroenterologists) to recommend that their patients enroll in Hepatitis Neighborhood, and some doctors even provide links to the site from their own Web pages.
Cosler estimates that Priority Healthcare entices two to three patients a week to sign up for its distribution services. Drug manufacturers pay about one-third of the cost of developing and maintaining the site, says Cosler, although he declines to disclose what the sum is. "As a stand-alone business, the Web site would be brutal," he says. "But we've got a real business behind the Web site."
Heartened by the success of Hepatitis Neighborhood, Priority Healthcare launched Pulmonary Hypertension Neighborhood in November 2000. And this year it plans to unveil Fertility Neighborhood, Hemophilia Neighborhood, and Anemia Neighborhood. Drug manufacturers will help Priority defray the costs of the new sites as well.
Handheld History
As technology allows for virtual visits to the doctor, it's also changing the dynamics of actual medical practices.
Dr. Lloyd A. Hey, an orthopedic surgeon and assistant professor at Duke University Medical Center, in Durham, N.C., wields a Palm handheld with a bar-code reader across the top. He uses the device, which was developed by a company called MDeverywhere, to scan patients' wristbands. That allows him to instantly confirm a patient's identity and also access the person's medical records. Hey carries note cards in his pocket that list common orthopedic diagnoses and procedures. Next to each diagnosis or procedure is another bar code. After Hey comes up with a diagnosis, he scans the bar code on the appropriate card, and the diagnostic information eventually becomes part of the patient's permanent record.
Hey isn't just a client of MDeverywhere, the company that developed the scanner. He's also its founder. Many years ago, Hey, who studied electrical engineering at MIT as an undergraduate, had ample opportunity to observe the inefficiencies in the health-care system thanks to a leg injury he suffered as a teenager. He landed in the hospital for three months and required subsequent doctors' visits over the next two years. Now he's using his experience to help streamline the system for other patients. "I'm trying to lead a compassionate process-control revolution," he says. That means he's developing a system that quickly records technical details and allows him -- and other doctors who use the scanner -- to spend more time focusing on patients.
Hey hopes the bar-coding system will eventually eliminate such hospital errors as prescribing the wrong medication or assigning the wrong procedure -- or, in extreme cases, operating on the wrong patient. For instance, if Hey enters information into his Palm handheld that says he's going to perform hip surgery on a patient who is scheduled for a knee arthroscopy, the device beeps and reminds him why the patient is there in the first place.
Of course, such warnings go off only if a physician is using the device. But the incentive to use it is built right in. Each time a doctor uses the Palm (or another compatible handheld device, such as the iPAQ Pocket PC), the computer records a "patient encounter" -- each of which constitutes billable time. By recording encounters as they happen, the software decreases the amount of time that it takes for a doctor to receive payment. For instance, Dr. David Diduch, an orthopedic surgeon at the University of Virginia, says that his billings have gone up since he started using the device, last September. It used to take two to three weeks from the time he saw a patient until a bill for the visit would leave his office. Diduch would dictate a note; a clerk would transcribe it; Diduch would sign the transcription; then a clerk would assign an "evaluation and management code" to the item and send it to a billing clerk. Now the information goes straight from the handheld to the billing clerk.
While Hey and Diduch are using their handhelds in the data-collection process, in Darien, Conn., family physician Stanley R. Skolnick is sending prescriptions through cyberspace. He's one of some 500 physicians who are using the wireless application PrescriptionCenter, which was developed by LogonHealth, a company based in Morris Plains, N.J. Instead of carrying around a prescription pad, Skolnick uses a tiny Palm keyboard to write up to 40 prescriptions a day.
"It saves me not only time but, more important, frustration," says the 63-year-old physician, who is living proof that the older generation of doctors can learn new high-tech tricks. Skolnick had long ago grown weary of calling in prescriptions to pharmacies, only to encounter busy signals and endless automated menus. It's no longer necessary for him to speak to pharmacists. After he enters a prescription into his handheld and sends it, the prescription is transmitted to LogonHealth, where computers download the prescription and fax it to whichever pharmacy the doctor has selected.
Skolnick has contact information for about two dozen pharmacies already loaded into his Palm. In addition, he has all his patients' names, dates of birth, and insurance providers recorded there as well. LogonHealth updates the computer system at Skolnick's two-doctor practice, Darien Medical Group, every week or two, entering or changing patient information, adding new pharmacies or drug choices, and updating information about insurance coverage. The latter feature has been one of the biggest time-savers for Skolnick. If he tries to send a prescription for a drug that a patient's insurance company doesn't cover, the Palm will alert him, and he can choose another medicine.
As the practice of scrawling prescriptions fades, so too will the horror stories about the illegibility of doctors' handwriting. But that problem may be coming to an end anyway. Several states are considering "legibility laws" mandating that doctors' handwriting must be readable. If passed, such legislation would certainly drive more doctors, with their notoriously poor penmanship, to technology for assistance.
