October 25, 1999

FINALLY! THREE E-HEALTH COMPANIES FOCUSING ON CLINICAL MANAGEMENT PREPARING TO GO PUBLIC! 

A first wave of e-health companies went public earlier this year. These e-health companies focus primarily on 1) Automating back-office TRANSACTIONS (Healtheon, CareInsite, Claimsnet.com) or 2) Patient and/or physician CONTENT (DrKoop.com, adam.com, Mediconsult.com, Medscape).
We're gratified to see funding ready to flow to companies focusing on care management opportunities. Within about the past two months, three care management companies have filed S1 statements with the Securities and Exchange Commission, a required step in taking a company public. The companies (and citations to their S1 statements) are:

1) OrganicNet
    citations to S1 statement  
 
2) Landacorp 
    citations to S1 statement

3) MedicaLogic 
    citations to S1 statement 

What are these companies doing? From the summary of the prospectus of each:

OrganicNet. "We are an application services provider (ASP) that develops software solutions for healthcare clinics and physician group practices using our proprietary technology platform. Our customers can access and use our solutions over the Internet or their local or wide area networks. We are developing integrated solutions designed to manage all elements of the business and clinical processes of our customers within a single system. We currently have developed and implemented solutions in three areas: disease management, clinical drug trials recruitment and workers' compensation. We charge our customers a monthly subscription fee for our solutions."

Landacorp. "We offer business-to-business e-medical management solutions to healthcare payers and providers that are designed to help our clients control the cost and improve the quality of healthcare delivery. Our applications automate and streamline administrative and business processes and facilitate real-time interaction among various healthcare participants. We enable our clients to deliver consistent and appropriate medical care utilizing their chosen clinical guidelines and business process rules. We are also marketing e-medical management solutions that add functionality to payers' Web sites in order to attract repeat visits by members. We refer to Internet-based solutions that generate repeat visits as sticky applications."

MedicaLogic. "Our business is connecting physicians and patients through the Internet. For physicians, we offer a line of enterprise and Internet-based electronic medical record products and services for use at the point of care in the exam room, with configurations suitable for practices of all sizes. For patients, we will provide a Web site that will allow them to access certain healthcare information from their physician-generated medical record, enter personal medical information and effectively communicate with their physician. For both physicians and patients, we will provide focused healthcare content and commerce opportunities, keyed to information in a selectively shared database that unites physicians and patients. Together, these products, services and databases will comprise our Internet Health Services Center. We believe we can increase the efficiency and quality of healthcare and enhance the physician-patient relationship through our Internet Health Services Center."
We wish these companies well! Please let us know if you are interested in commentary or analysis on similarities/differences in their clinical and business models.


HARRIS POLL AFFILIATE CONDUCTS FIRST MAJOR ONLINE STUDY OF THE CHRONICALLY ILL

Harris Interactive is studying attitudes and health care patterns of 10,000 chronically ill patients. 
Initial findings:

1) Non-compliance among patients is rampant, but varies dramatically. Only 43% of those using prescription drugs have taken them properly, as prescribed by their doctor, for the past 12 months. All the rest have in some way been non-compliant, and for some disease groups the story is far worse. Those with diabetes (50%) and hypertension (49%) report the highest levels of compliance, while those with back problems (36%), asthma (34%), depression (28%) or migraines (28%) are having the hardest time taking their drugs as prescribed.

2) Insurance coverage is a big factor in drug use, especially for the elderly. Those people without drug coverage are more likely to not fill a prescription or be in some way non-compliant, as compared to those with some or full drug coverage. Seniors show the biggest discrepancy. 52% of those over 65 without drug coverage have in some way reduced their drug use, compared to only 30% of those with at least some coverage.

3) The chronically ill are active in online health; but commercial Web players, not traditional health care stakeholders, are winning online. 87% of the chronically ill who are online have looked for health care information on the Internet. 59% of the chronically ill who have looked for health care information online have looked at commercial Web sites-health pages or vertical portals ("vortals") such as drkoop.com or AOL's health channel. These types of sites are far more popular with the chronically ill (and for that matter all Internet users) than sites provided by traditional health care stakeholders - hospitals, pharmaceutical companies, insurance plans, or even patient advocacy groups.


"THE RISE OF THE INTERNET HEALTH CONSUMER: IMPACTS OF THE INTERNET ON THE DOCTOR-PATIENT RELATIONSHIP"

Cyberdialogue has released a 9-page summary describing changes in doctor-patient relationships due to the Internet. The research examined impacts on doctor selection, on doctor-patient roles, and on patient education. A few interesting findings: 

50% of online users would be interested in using a web site operated by their doctor's office. This contrasts with the 4% of offices who have web sites.

48% of online patients would like to be able to communicate with their doctors offices via e-mail, but only 3% are doing so. 11% are aware of their doctor's e-mail address. 

74% of online patients agree that a doctor's recommendation would make them more likely to trust a web site; however, only 4% say that they currently use doctor recommendations as a means of finding sites they use. 

The report concludes: "...the question is whether physicians will participate themselves or leave (the Internet) as a medium for others to control."

DOCTORS WORKFLOW AND EMOTIONS DAMAGED BY PAPERWORK

A group of "anthropologists, psychologists, communication scholars and engineers" sponsored by Intel conducted an ethnographic research project with 100 health care practitioners. (Ethnographic = they hung out, watched, and asked questions of the doctors and their staffs.) The researchers observed daily frustrations in physician offices and considered possible technological solutions.

Key findings focus on three areas:

1. Doctors feel increasingly powerless in the midst of the changing organizational and business environment of medicine. This sense of powerlessness extends even to daily scheduling. Technological implications: 

	Better tools for sharing information on treatments and outcomes, allowing doctors and managers to reach consensus on optimal practices.
	Tools for sharing patient loads and communicating accordingly, including triage systems.
	Better tools for automating such routine tasks as patient referral status, patient eligibility, and other tasks that typically occupy medical staff for hours on the telephone.

2. Doctors feel that administrative overhead, especially paperwork, has sharply reduced both the time and the quality of interactions with patients. Technological implications: 

	Computing power which will allow practitioners to create, access or manipulate digital information more "naturally" in the course of patient encounters. This means new form factors, new modalities including voice input or audio output, and new means of connecting technologies and integrating data.
	New types of services, including such things as Internet transcription services, or research and reference services to place the right content at one's fingertips at the right time.

3. Doctors are unable to access the people, information or other resources they need in order to provide quality care in a time-constrained environment. Technology implications: 

	A secure, reliable system whereby patient records can be shared among appropriate practitioners, particularly needed are standards for data sharing and security systems for ensuring patients rights of privacy.
	A means for physicians to identify and/or locate experts, specialized providers or others with whom they need to collaborate (both short term and long term) to provide better quality of care.

PROMOTING PATIENT/PHYSICIAN PARTNERSHIPS: 
10 CHALLENGES FOR THE INTERNET AGE

A recent article in the British Medical Journal describes 10 key challenges that must be met to allow optimal partnerships to develop between patients and clinicians:

	Collaboration between consumers and professional organizations
	Understanding how patients and clinicians use the Internet
	Systems need to be easy to access and use
	Rapid access to information
	Easy access to relevant, ready to use information
	Integrating information
	Balancing virtual and face to face interactions
	Redefining the roles of patients and clinicians
	Balancing privacy and connectivity
	Ensuring equitable access to technology and information

E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

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