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INTERNET MEDICINE ? PART I: The New Concierge Practice.

By Greg Piche'

President Obama?s strong support for the proliferation of Electronic Medical Records (?EMR?) notwithstanding, there remains enormous residence to the digitalization of medical documentation by many physicians who have been in practice over ten years. That resistance is based on cost, complexity, utility, inertia and fear.  The array and diversity of systems available on the market are intimidating. There is always the concern about selecting a ?Betamax? system over a ?VCR? or a ?HD? over ?Blue Ray.? When is the right time to invest in expensive technology when change is unfolding with such rapidity?  Are the ?bells and whistles? useful or a distraction?  Will it make a physician?s life easier or more difficult?   What is the paradigmatic practice model to adopt to maximize the efficient utilization of the potential of telemedicine?

While serious health care reform has yet to leave the dock and nobody is quite sure in which direction it will sail, there are fascinating new applications of health care delivery systems already out on the water. The complexity of current reimbursement requirements has encouraged some physicians to sign on to ?concierge? medicine, fee for service with no insurance accepted, thank you. What you receive is access and service for a fee ?maybe even a house call. A small group of doctors operating out of Williamsburg, New York using a new EMR plus platform called the Myca Platform have developed a model utilizing the concierge concept while melding it with EMR, artificial intelligence and telemedicine.

The practice operates under the moniker ?Hello Health.?  One of the physicians Jay Parkinson, M.D. is also the Medical Director for the Myca Platform. Nathaniel B. Findlay is the founder of Myca. His previous rollout was a nutritional cell phone application ?Myfoodphone? which permits subscribers to photograph their meals with a cellphone and forward them to nutritional experts for analysis and advice. The Hello Health model and platform is fascinating and would appeal mostly but not exclusively to the Facebook generation ? those born after 1985 that have never known life without the internet. The applications are user friendly and easy to manage. A patient can dial in on line and view a webpage of easy options. She can request an appointment and list her symptoms and her availability for an appointment.  The platform, already loaded with her medical records, can provide a sophisticated interplay and analysis that alerts the physician to a probable diagnosis and potential alternative diagnostic consideration that spans the gulf of modern medical complexity. 

The platform also puts the patient information into a medical context and alerts the physician to recommended modalities of treatment in a priority based upon her prior medical history, her drug interaction history, and evidence based treatment protocols that are built into the program. The platform offers many connections that are not unlike the brain mapping programs currently available on the market that aid in thoughtful idea development. The physician can make a preliminary determination as to whether an office, home visit or online appointment visit is appropriate. On line visits provide a video interface. Patients pay a monthly subscription fee of $25.00 and a fee of $75 to $100.00 per visit through an on line credit card or Paypal. High efficiency, enhanced effectiveness and low overhead.

This kind of practice is particularly attractive to the sole called ?invincibles? who are young, computer savvy, with little or high deductible insurance. This model may well evolve into the private health care model of the future for those who for a variety of reasons wish to opt out of any national health care plan. For more information on this practice there is a wonderful article by Chuck Salter, ?The Doctor of the Future,? in the May, 2009 edition of Fast Company.  www.fastcompany.com/magazine/135/the-doctor-of-the-future.html?page=0%2C1 - 44k ?. There is also an interesting video (YouTube, of Course) of Dr. Parkinson at www.myco.com.

Full post as published by Healthcare Law Blog on April 19, 2009 (boomark / email).