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Right Care, Right Time – Over the Internet

Dr. C. Martin Harris, M.D.

Nearly 90 million American adults now venture online seeking information about their health. This category, in fact, accounts for the single largest slice of the online adult audience. But today’s patients want more than just megabytes of unqualified information. They want knowledge of, and access to, health services that can help and heal. They want the power to participate in and lead their own medical care.

“Patients want to be involved in their routine health care in an interactive way,” says C. Martin Harris, M.D., The Cleveland Clinic’s chief information officer and executive director of e-Cleveland Clinic. “E-Cleveland Clinic is a tool that lets them take control.”

E-Cleveland Clinic is a Web-based extension of the Clinic’s medical expertise and patient care, offering services that provide patients with access to their personal health records, remote second opinions and useful, related medical information. With a secure, user-friendly electronic medical system in place and more patients using the Clinic’s Web site all the time, e-Cleveland Clinic offers a number of virtual health care services to patients.

Dr. Jonathan Schaffer, M.D.

Nutrition Counseling
One of the newest e-Cleveland Clinic features is online nutritional counseling for cardiac patients. Available to Clinic and non-Clinic patients alike, this service allows remote connection to registered dieticians at the Cleveland Clinic Heart Center who can develop personalized, comprehensive nutritional programs shaped around the individual’s specific situation. These dieticians may also help patients create a plan for managing their diabetes, high blood pressure, cholesterol and vitamin supplement usage as it relates to managing their heart disease risk.

Clinic doctors think it’s an especially useful feature amid the cacophony of fad-diet information bombarding consumers these days. “It’s just like seeing a nutritionist, only you don’t have to go into the office,” says Jonathan Schaffer, M.D., managing director of e-Cleveland Clinic. “You can do it from home at 2 a.m. and still receive sound, medically-based nutritional counseling.”

Qualified Information
Even while more and more adult Americans are seeking out useful health information online, the endless volume of medical material found on the Web can be daunting for all but the most cyber-savvy. “Did you ever try to plug the word ‘arthritis’ into Google?” asks one Clinic doctor. “You’ll get over fifteen million entries.” However impressive that number may be, it tends to be less than helpful to someone who’s merely looking for the best rather than the most information. E-Cleveland Clinic tries to ameliorate this problem by including a health information request service in the mix of its online offerings.

As part of the service, medical librarians in the Clinic’s Lerner Research Institute stand ready to find the kind of quality, pre-screened information patients need in order to take an active role in their own care. Available free of charge to former and current Clinic patients, and for a small fee to non-Clinic patients, the service will research the requested topic using all available tools, including thousands of original documents in the Clinic’s Health Information Center database. They will also comb through the many additional nationally-recognized databases Clinic staffers have access to in order to gather the information requested by patients.

Dr. Holly Miller, M.D.

Personal Access
“Patient empowerment is the fundamental issue,” says Holly Miller, M.D., managing director of e-Cleveland Clinic. “We wanted to show patients that we value their time and respect their autonomy by giving them quick and easy access to information and appointment-making at their convenience – not ours.”

By using MyChart®, one of the first services offered through e-Cleveland Clinic, communication between Clinic patients and their health care team is enhanced, not replaced. Through this service, Clinic patients can access parts of their own medical record via the Internet, any time of day or night.

In a fast, easy and totally secure manner, MyChart can display diagnoses, test results and other information released by the patient’s physician. For example, when patients access their records via the MyChart service they can see the individual list of medications they are taking, in what dose, at what frequency and any allergies they may have. Patients also can see reminders for periodic health maintenance tests or preventive screenings, such as mammograms and cholesterol screenings.

Patients using MyChart can request prescription renewals at any time and notify the Clinic of changes in contact information. One note, however: in order to maintain the high standard of security used throughout e-Cleveland Clinic services, MyChart is available only to Clinic patients after they have signed up for the service and received an access code from their participating Clinic doctor’s office.

Second Opinions Around the World
The medical community’s attitude about seeking second medical opinions has always been straightforward encouragement, and it is all the more so now in the current consumer-driven environment. The Clinic has been performing diagnosis re-appraisals since its inception more than 80 years ago.

But the Internet’s reach, coupled with the Clinic’s ever-increasing global reputation, has broadened the possibilities tremendously, leading to creation of the MyConsult® remote second opinion service.

To handle these mounting requests for second opinions, the Clinic’s medical staff, in conjunction with the e-Cleveland Clinic nursing staff in its Clinical Operations Center, has developed protocols laying out the kinds of information doctors will need in order to perform a quality second opinion.

This material, including X-rays, CT scans, MRIs and other imaging studies, is then assembled into a comprehensive patient file that physicians can more efficiently fit into their regular workflow. And what does the patient receive? “They get a copy of the consult report, and 48 hours later they get a call from the Clinic staff, asking if they have any questions,” Dr. Schaffer explains.

Requests for second opinions now flow through the Internet into the Clinic from almost every state in the United States and nearly three-dozen foreign countries thus far. The list reads like a roster of the United Nations - Bahrain, South Korea, Russia and Argentina among them.

The number of electronically-requested second opinions performed at the Clinic increased by 400 percent from 2002 to 2003, and took another 57 percent leap in 2004.

Virtual Visit, Real Care
As Dr. Schaffer reads from a number of warmly appreciative patient letters, some handwritten, sent in the wake of these second opinions, one is struck by how none of the correspondents even make mention of the fact that these consults all happened, not in person, but electronically. That doesn’t surprise the physicians, who have always operated on the notion that the consult is real even if the visit is virtual. “If you do it properly, people don’t distinguish between the delivery methods of care,” says Dr. Miller.

Even insurers appear happy with the result. "After all," says Dr. Schaffer, “the right care at the right time is going to be more cost-effective for our patients.”