HONOLULU - ''The doctor will see you now'' has new meaning.
Doctors in Hawaii will start making online house calls today in the nation's first large-scale program of its kind that some believe could be a groundbreaking step in health care.
The service is being provided by Hawaii Medical Service Association under a licensing agreement with Boston-based American Well. It is available for a fee to all Hawaii residents, including the uninsured and non-HMSA members.
''This is changing the face of how medicine is delivered in a very positive, safe and efficient way,'' said Dr. Patricia Avila, medical director of HMSA's Online Care.
Avila said the program isn't intended to reinvent the house call. ''It's a redesign.''
Computers equipped with a Web camera are used to set up a live, face-to-face consultations where patients describe their symptoms and even show anything from a rash to a wound. They could get questions answered, get advice or prescriptions for anything but controlled substances.
Dr. Roy Schoenberg, American Well's chief executive, calls the launch the ''world premiere'' of his technology that has been in the works for two years and is being offered around the clock, seven days a week. The service will soon be offered in several other states by other health plans, and will become ''very prevalent,'' he said.
Dr. Dale Vincent, director of telemedicine at the University of Hawaii medical school, said there have been similar pilot projects, but nothing close to the scale of the HMSA system.
''It is a glimpse of the future,'' he said. ''This program is going to be computer to computer, but in the very near future it's going to be mobile phone to mobile phone.''
Online Care aims to provide convenient, affordable and instant access that has become increasingly difficult in Hawaii and other states with a shortage of doctors and specialists.
Disabled and elderly, residents in rural areas or people who simply can't get to a doctor's office are expected to benefit from the technology, although some may need assistance logging on.
The system does not replace the traditional doctor visits, Avila said. ''This is to enhance the accessibility in those times when they need answers very, very quickly and need access to care.''
Honolulu resident Paul King said he's eager to try the system.
''More and more, we're getting support in all parts of life online. Why not with doctors?'' said King, who wants to use the system if he has a question about his 78-year-old father's medication or condition. ''I don't think it's going to replace going into the office for a lot of stuff, but it's a good preamble.''
To access the system, users must log on to HMSA's Web site and complete a one-time registration process that includes medical history.
HMSA members can grant access to medical claims data, which provides information such as what medications they are taking and dates from their past doctor visits. Personal health information can also be shared by any one using Microsoft Corp.'s HealthVault.
Program officials say that electronic exchange of medical information before the visit is one of the reasons why Online Care is superior to the traditional telephone call.
Users can review credentials before selecting one of several local physicians. Besides general practitioners, several specialists will be available.
After the visit, patients can leave ratings for the doctors as they would with an eBay transaction and have a summary of the visit forwarded to their primary doctor.
Payment is made online using a credit card.
A 10-minute visit, which can be extended for a fee, will cost $10 for HMSA members and $45 for nonmembers. Administrators believe the majority of calls will be completed within the first 10 minutes.
Medicine has used online video conferencing for years. One of the more common uses is a doctor or patient in a rural areas communicating with specialists in big-city hospitals. Vincent said Web chats have also been successful in the mental health community for follow-up visits because the patient's emotional state can be assessed with a Web cam much better than with a phone call.
The health care industry will be watching Hawaii closely to see if the system answers several lingering questions about its effectiveness, security and liability. Other key concerns deal with misdiagnosing patients, delaying proper care and legal challenges.
Dr. Ronald Kienitz, a member of the Hawaii Medical Board, said he is concerned about prescribing medicine or treatment without establishing a doctor-patient relationship.
The Federation of State Medical Boards adopted guide-lines that say: ''Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.''
However, the Hawaii Legislature in 2006 passed a law ensuring ''telehealth services'' are reimbursed because ''effective and prompt healthcare is extremely important in Hawaii, particularly to individuals residing in rural communities.''
Schoenberg said the biggest misconception is that the system is some sort of ''Doc-In-The-Box,'' where prescriptions and treatments are being sold online.
''This is about brokering a physician's time,'' he said. ''The promise of the system is to get you in front of a credentialed physician.''
Dr. Todd Kubo, who has been trained to use the system, said he believes the system could prevent some unnecessary visits to busy emergency rooms.
But he said physicians must use caution when assessing patients online. ''You can't listen to their lungs. You can't listen to their heart. You can't look into their ear,'' he said.
So far, about 60 doctors have been trained and more than 100 have signed up. They will earn about $25 to $30 per patient, a little less than half what they get for a typical in-office visit.
Without the costly overhead of a doctor's office and malpractice insurance, the actual earnings from the online visit will be comparable, Schoenberg said.
''They can wake up in the morning, get in front of computer, provide care to patients that need it, and money will show up in their bank accounts, he said.
Hawaii is seen as ideal for the service because the islands are separated by miles of ocean. Despite its isolation, Hawaii is one of the most wired states, serving as a hub for six undersea fiber-optic trans-Pacific cables to Asia, Australia and the continental U.S. The state also has among the highest in residential broadband penetration rates.
Hawaii also has a severe shortage of physicians and specialists. The problem is worst on the less-populated islands, where there is a higher percentage of uninsured and low-income patients. Many are forced to fly to Honolulu for medical care.
HMSA, an independent licensee of Blue Cross and Blue Shield, also has the reach and resources to roll out the program. With nearly 700,000 members, HMSA covers more than half of the state's population and has 90 percent of the state's physicians in its network.
On the Net
* HMSA: www.hmsa.com/
