The doctor will see you - log on now

What would happen if patients could visit a doctor at the touch of a button, no waiting, without leaving their home or workplace?

Starting this fall, Blue Cross and Blue Shield of Minnesota hopes to find out.

The insurance company plans to offer its 10,000 employees and dependents the chance to use a "virtual clinic," an Internet site that can connect them with a doctor for a live 10-minute consultation for a flat fee.

Physical exams, of course, are out of the question. But when the system goes live this fall, doctors throughout Minnesota will be able to use a videocam or instant messaging to diagnose and treat anything from headaches to urinary infections in patients they've never met in person.

The virtual clinic, which will be formally announced this week, is just a pilot project at this point. Blue Cross officials say they want to work out the bugs before rolling it out to the public.

To skeptics, it may seem like an iffy way to practice medicine.

But Blue Cross officials are betting that this kind of technology will play a pivotal role in transforming health care -- making it far more convenient than ever, and saving money in the process. In fact, many Twin Cities clinics are trying to reinvent the doctor visit, using the Internet and other technologies to deliver care in new ways.

Today, patients must go to the doctor's office because that's how doctors get paid, said Patrick Geraghty, president and CEO of Blue Cross and Blue Shield of Minnesota.

"We want to change that model," he said. He argues that many doctor-patient encounters could be handled virtually, saving expensive trips to the clinic or emergency room.

10 minutes vs. half a day

"We think there's a productivity impact as well," he added. "If you can have an online transaction, you may not have to spend that half a day where you have to go over and wait at a physician's office. That may be an online transaction that happens in minutes."

Dr. Roy Schoenberg, who created the virtual-clinic software, said he tried to inject new meaning into the phrase "the doctor will see you now."

If a woman needs an obstetrician-gynecologist, he said, the virtual clinic "will get [her] within seconds in front of a live credentialed ob-gyn."

For Minnesota patients, the clinic will only use doctors licensed within state, said Schoenberg, president of a Boston-based software company, American Well (www.americanwell.com). "These are the same ob-gyns that are on the provider network of the health plan," he said. "These aren't just any doctor Joe Schmo."

The software is designed to match patients and doctors automatically. A screen pops up, asking patients if they'd like to talk with the first available generalist, pediatrician or other specialist. If they're not sure, a series of questions pops up on the screen to help narrow the search.

Then a "matching providers" list appears, with photos and short bios on selected doctors, complete with data on their training, location and what languages they speak.

If they're available immediately, a green button says "connect now." If they're busy, there's an amber button to "enter waiting room."

With a webcam, the patient and doctor can watch each other as they talk, or exchange instant messages. In one corner, a digital timer keeps track: "Time Remaining, 3:50."

Schoenberg says that, statistically speaking, 10 minutes are usually enough. "That's typically longer than what you have when you're sitting in a physician's office," he said. The doctor also will have access to the patient's electronic medical record, drawn in part from Blue Cross claims data. And every new encounter becomes part of the permanent record.

Some, of course, worry that doctors may miss something important if they don't see a patient in person.

"How do you deal with the individual who perhaps cannot communicate exactly what is going on with them?" asked Linda MacDonald Glenn, a professor of medical ethics at Albany Medical Center in New York, who studies emerging technology. She said the virtual clinic may, in fact, benefit many patients, but not all. "Sometimes you call the doctor, and the doctor has to ferret out what's really going on. Is it physical, or is it psychological?"

'Come in to be examined'

Schoenberg readily admits that some problems can't be handled online. At that point, he said, the doctor should tell patients "to come in to be examined."

For doctors, it's easy and hassle-free, Schoenberg says; the online system does everything from providing malpractice insurance to depositing payments in their bank accounts. They can choose to log on whenever they have a couple of hours and "want to make money," he said.

So far, only one state, Hawaii, is using the system.

Hawaii Medical Service Association, the Blue Cross affiliate, introduced its virtual clinic in January; so far, more than 140 doctors have signed on, and more than 1,000 patients have registered to use it, said spokeswoman Laura Lott. The doctors receive $25 for each 10-minute session (more if it's after 10 p.m.); patients pay a $10 copay (for Blue-Cross members) or $45 (for nonmembers.) So far, Lott said, there have been "hundreds of conversations," many of them about colds, flus, rashes, muscle aches and strains.

In Minnesota, Blue Cross officials haven't worked out all the details, but they plan to go one step further. They're setting up special kiosks in Blue Cross office buildings in Eagan and Virginia, Minn., to encourage employees to use the virtual clinic during work hours. The kiosks may be equipped with electronic monitors, for example, to take their blood pressure or other simple tests.

"There's a lot of exciting new technologies coming on the market that will allow for monitoring of patients from a distance," said Geraghty.

Maura Lerner • 612-673-7384