Physician assistant Jolene Nelson is part of a pilot program at Park Nicollet Health Services for Zipnosis. Patients answer questions on an online survey, which is then sent to a medical professional who diagnoses the problem and, if necessary, writes prescriptions in an e-mail.

Glen Stubbe, Star Tribune

Online medicine in a hurry

  • Article by: WENDY LEE
  • Star Tribune
  • May 19, 2010 - 5:29 AM

Nancy Kjellberg's allergies were insufferable again, with sharp sinus pain and her nose so stuffed up it was hard to breathe.

She didn't want to go to the doctor. This time, she didn't have to.

Kjellberg, 59, simply charged $25 to her credit card and spent a few minutes answering an online survey at Hours later, she received a diagnosis electronically and picked up antibiotics at her pharmacy, without ever talking to the clinician in person or on the phone.

"I would rather be doing other things than going to the doctor's office," said Kjellberg, a retired production planner who lives in Big Lake, Minn. "If you have ever had any of these things, you pretty much know what's wrong with you."

Minneapolis-based Zipnosis thinks it is onto the latest innovation in convenient health care for minor ailments like common colds, allergies or bladder infections. Led by Rick Krieger, who co-founded a company that became MinuteClinic, Zipnosis started a one-year pilot this month with local provider Park Nicollet Health Services.

Already, more than 300 people statewide have used the service. Consumers fill out Zipnosis' survey online, and two nurse practitioners on duty at Park Nicollet's Quick Check center review the answers and send back a diagnosis.

But there are skeptics. Some local doctors say they wouldn't recommend Zipnosis to their patients for fear of misdiagnosis. Dr. Benjamin Whitten, president of the Minnesota Medical Association, said his personal view is that "written information and checklists" can't replace seeing a patient in person.

"I see the absence of a direct communication as a shortcoming and a potential problem," Whitten said.

Zipnosis and Park Nicollet say the service gives patients an option that's affordable and convenient. Zipnosis costs $25 to use, priced to compete with insurance co-payments and cheaper than a MinuteClinic visit. The company estimates a clinician can make a diagnosis and recommend treatment from the survey in 3 minutes.

"There is nothing that can hold water to what we are doing," said Jon Pearce, Zipnosis' chief operating officer and one of its co-founders. "We can lower the cost of health care and still make it profitable for clinicians."

Zipnosis began three years ago. Pearce, an MBA student at the University of Minnesota's Carlson School of Management, came up with the idea along with two others, whom the company declined to name. Krieger joined as CEO at the end of 2008.

With four employees, Zipnosis has about $600,000 in angel funding and aims to be profitable by fall 2011. It is active only in Minnesota for now, but Krieger said the goal is to be in 15 states by fall 2011.

Young adults are a target

One of the company's target groups is young adults ages 18 to 35, who often are not insured, don't get sick often and are looking for ways to save money. Pearce, 31, remembers waiting for four hours in urgent care last year in Kansas and paying $150 for treatment for a sinus infection. He called it "ridiculous."

"Those young adults ... are the urgent-care frequent fliers," Krieger said. "We fit their needs to a T."

The company is also building marketing campaigns for moms, self-insured employers and consumers with high private insurance copayment or deductible plans.

The business model has evolved. Last year, there was a three-month pilot at St. Olaf College in Northfield, Minn., where students used Zipnosis as part of the school's health services. Then the company hired its own nurse practitioners and offered its services to the Twin Cities Pipes Trade Service Association, which manages health benefits for 16,000 union members and dependents.

Under the latest arrangement, Park Nicollet provides nurse practitioners to review the Zipnosis surveys. The nurse practitioners have physicians available if difficult questions come up. For each diagnosis sent, Zipnosis gives a portion of the revenue back to Park Nicollet.

Survey questions address whether a patient has severe medical conditions, and a "yes" will trigger a message to the patient recommending they go see a doctor. A physician's assistant may also send a message out to a Zipnosis user telling them they should go to a clinic.

"This is not medicine by algorithm," said Dr. John Misa, Park Nicollet's chief of primary care. "This is medicine by Park Nicollet clinicians."

Other companies are trying similar approaches. Earlier this month, Blue Cross and Blue Shield of Minnesota rolled out its program, "Online Care Anywhere," for Medtronic employees in the state. Employees pay $20 to set up 15-minute appointments via Web cam or text messaging with Fairview Health Services' doctors. And HealthPartners announced this month it will start offering online diagnosis and treatment for common medical conditions starting this fall.

Although local doctors said they are interested in seeing how the innovation plays out, there are questions.

Some are concerned that online treatments won't make it into medical history files that patients' primary care physicians have access to. Others say they worry online services could prescribe unnecessary antibiotics to treat minor symptoms, which could lead to more health problems down the line.

Pearce said Park Nicollet clinicians will be able to view a patient's history on Zipnosis to check for abuse.

"They treat the patients with the same amount of information as if they were to walk in through the door," Pearce said. "It's up to them to make a clinical decision."

Wendy Lee • 612-673-1712

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