“Frankly, 90 percent of what we do is not based on physical assessment, it’s based on history,” said Dr. John Butler, an internist at the HealthPartners clinic in Arden Hills, and a leading proponent of e-visits, at least for many common ailments.
Dr. Joseph Scherger flew to Minnesota from his home in California, checked into a hotel in Brooklyn Park, and took care of 12 of his patients. All by e-mail.
That is the future of medicine, he told hundreds of doctors from Park Nicollet Clinic last week: Caring for patients without face-to-face visits.
So far, e-visits -- the e-mail alternative to office visits -- have yet to make much of a dent in Minnesota.
But Scherger, a health care reformer from the University of California at San Diego, says it's only a matter of time. Minnesota, he says, is on the leading edge of a transformation that could spell the end of the old-fashioned office visit, at least for many common ailments.
"This is really revolutionary," said Scherger, 57, who was invited to share his vision of the future with the Park Nicollet medical staff.
The Web is finally catching up with, and transforming, the practice of medicine, he said. "Medicine kind of has lagged behind by a decade. But that is over."
In some parts of the country, a growing number of doctors are shifting large parts of their practice to e-visits.
One innovative clinic, Greenfield Health in Portland, Ore., now treats 40 percent of its patients by e-mail. And it charges an annual fee of $395 for the privilege.
Scherger argues that many people run to the doctor for problems that, with today's technology, could be treated without a face-to-face encounter. That can range from simple ailments, such as colds and stomachaches, to chronic conditions that need ongoing monitoring, such as diabetes, heart disease and high blood pressure.
"Frankly, 90 percent of what we do is not based on physical assessment, it's based on history," said Dr. John Butler, an internist at the HealthPartners clinic in Arden Hills, and a leading proponent of e-visits.
If he can get the information he needs with a few e-mail exchanges, he said, he's comfortable making certain medical decisions such as switching medications or ordering tests.
A slow start
In Minnesota, many clinics started offering patients e-mail and other Internet features in the past few years. Park Nicollet, HealthPartners and Fairview clinics all created interactive websites, where patients can find test results, make appointments and send confidential messages.
In practice, the e-visits, which cost about $35, have been rare: roughly 1,600 in the last year at Park Nicollet, HealthPartners and Fairview combined.
"It's a trickle," admits Dr. William Davis, a Winona family doctor who started offering e-visits in 2002.
Scherger, though, argues that they can be much more efficient than sitting in crowded waiting rooms to see a doctor for a few precious minutes.
"You can't do complex work in short visits," he said. "That delivery system is obsolete."
With e-mail, he said, patients can take time to ask their questions, and doctors can answer them in a less-hurried fashion. They can also use Web technology to help patients care for themselves: to remind them an exam is due or renew a prescription.
"We're not going to stop seeing patients," Scherger said. Obviously, e-visits are not for emergencies or problems that require a physical exam. "I always say, if in doubt, see the patient" he said. But they can save time and money.
In one pilot project, Kaiser Permanente reduced patient visits by 20 percent by enhancing its online services, he said.
A few obstacles
Still, many doctors worry that they could miss something without eye contact.
"E-mail doesn't convey voice inflections or body language," said Dr. David Hutchinson, a Duluth physician and president-elect of the Minnesota Academy of Family Physicians. It can seem too impersonal and "doesn't offer the same cues to help us recognize misunderstandings."
Even supporters concede that's a risk.
"That's where having a basic relationship with the patient comes into play," said Butler of HealthPartners. At the same time, he said, some subjects -- such as sexual abuse or depression -- might be easier to disclose via e-mail.
One of the biggest hurdles, for now, is money.
For patients, the co-pay is usually the same as an office visit. Some insurers pay for e-visits, but not as much as for an old-fashioned encounter.
"The thing that's holding us back from that kind of future is our current reimbursement system," said Dr. Samuel Carlson, Park Nicollet's chief medical officer. "[It] only pays for what we call the tyranny of the visit."
Patients like convenience
Some patients, though, say they don't mind paying for e-mails.
"It's a time saver if I don't need to go in and take time off of work," said Jennifer Williams, 35, of Eagan, who has used e-visits with her HealthPartners doctor.
David Gimpl, 66, a retired teacher in Sandstone, said he was able to save a round-trip to the Twin Cities by e-mailing Butler about a lingering cough. Butler studied his medical records and ordered some tests -- all online. "It's just like an office call," Gimpl said, only more convenient.
At the same time, Butler warns that patients need to be realistic about e-visits.
"It's not instant messaging," he said. "You can't expect an immediate response." Most clinics aim to reply within 48 hours. Yet it is less frustrating than playing phone tag. "They can send messages at 2 a.m. if they want," he said.
In five years, Scherger predicts, e-visits will be commonplace. "I think that Minnesota is a ripe place for Web care," he said. "It's cold in Minnesota. Why should you have to go out in the cold just to get a little bit of health care?"
Maura Lerner • 612-673-7384
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