The doctor’s online ‘office’

In the Internet age, we beam photos to phones, pick airline seats with the click of a mouse, virtually shop for shoes and have megabytes of information on any medical malady available to research.

In fact, it was making an online plane reservation a few years ago that inspired District physician Howard Stark to revolutionize his practice in internal medicine.

“I thought, ‘If you can pick a seat assignment for a flight four months from now, why couldn’t my patients do the same thing?’ ” Dr. Stark says.

He consulted with Web developers, built a secure Web site and changed the way his business is run. The practice’s 500 or so patients can make appointments, ask for prescription refills and get test results, among other things, through Dr. Stark’s site.

Most important, they can reach their doctor. They don’t have to press “1” to talk to a nurse, spend time on hold or leave a message and wait for a return call. They e-mail Dr. Stark, and he responds by e-mail back, usually within an hour.

“I haven’t played phone tag in years,” Dr. Stark says. “So many things are routine: patients asking for their LDL cholesterol number or telling me how they are doing on a new prescription. These are all easy things.”

Cutting down on ringing phones and paperwork leaves Dr. Stark more time for patient care. He books appointments in 30-minute intervals, allowing about twice as much time as many doctors schedule. There is no nursing staff, so Dr. Stark is the portal to a medical professional. He takes the patient’s history, so he is the one who gets to know each one.

Leni Stenseth, who is on the diplomatic staff at the Royal Norwegian Embassy, says having a Web-based doctor has simplified her life.

“Dr. Stark has a very personal way of dealing with patients,” says Ms. Stenseth, 39. “I was in Norway on summer vacation, and I got a message from him just to ask, ‘How are you?’

“For people who travel a lot, as I do, this system is fantastic. I was in Ethiopia, and I saw a local doctor for something, but I also e-mailed Dr. Stark, who told me to check any medicines there to see if they were expired. With the time difference, I would not have been able to call from Ethiopia and stay on hold for 45 minutes.”

Not all the work at Dr. Stark’s office is done in cyberspace. He requires that patients get an annual physical, so he has a record of base-line information available. Once patients are in the system, they can communicate with Dr. Stark and do other routine tasks online. If he needs a patient to be seen in the office — or in the emergency room — he will communicate that to the patient.

Doctors using Web-based practice management must be sure their site meets the privacy regulations of the Health Insurance Portability and Accountability Act (HIPAA), Dr. Stark says. That means the site is password-enabled and subscribers receive e-mail that says, “Dr. Stark has a message for you,” directing them to the Web site to read it so no personal details arrive in their e-mail inboxes. All messages from doctor and patient become part of the patient’s file.

The American Medical Association’s 2006 position statement on Web-based medical consultations recognizes that technologies such as personal digital assistants and instant messaging will “impact markedly on the way business and medical encounters will be conducted in the future.”

“Anecdotal evidence suggests that for patients and doctors, convenience associated with on-line consultation represents a significant benefit in which a patient can efficiently engage in a secure online consultation that does not necessitate a face-to-face encounter,” the position statement says, adding that the AMA thinks patients may be willing to pay higher fees in exchange for the convenience of online services.

However, the AMA states that online services should be an adjunct to face-to-face care, not a replacement. The online communication also should be available only to patients with an established relationship with the doctor.

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