otohns.net Conference Coverage AAO-HNSF & OTO Expo 2000

otohns.net Conference Coverage
Annual Meeting of the AAO-HNSF and Oto Expo
Washington, D.C - 2000

"Internet and Medicine"
Barbara Nesbitt, Executive Editor of MediSpecialty.com with otohns.net Advisory Board member, Michael Rothschild, MD
Audio/Video Link
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Barbara Nesbitt: "Hi, I'm Barbara Nesbitt, and I am here this morning with Dr. Michael Rothschild who's on our Editorial Advisory Board for otohns.net. Dr. Rothschild is an Associate Professor at Mount Sinai Hospital in New York, and he does a lot of exciting things with the Internet."

Dr. Michael Rothschild: "Yes, the Internet has been a tremendous boon to my practice and to the practice of a lot of physicians around the country. More and more people are realizing that we've reached the point where the technical infrastructure is there to really provide good quality medical information and outreach to patients, and I found it to be very satisfying. I spend a lot of time communicating with my own patients online as well as providing some information for the Internet community in general.

At this Academy meeting here in Washington, I gave two presentations. One was in the context of the medical informatics committee presentation on electronic medical records, where we presented a variety of talks on how electronic medical records can be useful to practitioners. I spoke on Internet based electronic medical records. This is going to become bigger and bigger over the next few years as a lot of the third party payers are moving to accepting online claims, referrals, eligibility requests, and re-certification. It seems like we're poised to markedly improve the efficiency of communication between physicians and payers."

Barbara Nesbitt: "So you're not talking about somebody having to sit there and get on the telephone and pay and all of this, this is instant."

Dr. Michael Rothschild: "Right, it moves things along. I mean the promise is usually better than the reality. We're sort of in the evolving phase of this but it certainly has the potential to eliminate a lot of wasted hours
of support personnel waiting on the phone to try to get certification or following up on denials with insurance companies. There are a number of vendors out there that are partnering with physicians to make that a
reality.

The other broader application of electronic medical records in medical practice would be to actually keep clinical information online: the actual chart, the information about the patient's illness, the physical
examination, and medical imaging. That's a broader project and obviously can be very useful, in that it provides access to the medical record from anywhere there's Internet access. If you're an Internet based electronic medical record user, this is terrific, if you're practicing in multiple locations or if patients are calling you from home, you no longer have to make decisions without having the full medical record available.

Obviously, there are a lot of concerns about privacy, security, and the government has gotten into the act with the passage of the HIPAA Bill of 1996 which is just now coming into the implementation phase. Over the next two or three years, both large healthcare providers and small providers like doctor's offices, payers, and a number of other health entities are going to have to come into compliance with these standards if they want to use electronic data interchange which is going to be a greater and greater piece of the pie. So over the next couple of years we're going to be looking closely at how physicians and care delivery organizations can comply with these new standards.

The other talk I gave is an instructional course on marketing your practice on the Internet, and there's been a lot of interest in this too especially from physicians who have fee for service practices where the
value of getting one additional patient may be very high, and they're working in a very competitive market. The most common example of that type of practice would be a cosmetic surgeon but most physicians really do benefit from providing practice information online, and it's a good way to sort of underscore what
value added service you provide, and to contact potential patients."

Barbara Nesbitt: "We feel that we've done it, I think, successfully with our other website. I don't think most physicians or most patients or people in general like to see an actual add in a newspaper - come and see me - and all that but the Internet, I think, is a wonderful way for doctors like yourself to give actual information to patients by writing articles. Also having the means of having their website be there so that somebody can then say - well, he's in my area and I respect what he says and I would like to go to him."

Dr. Michael Rothschild: "You're absolutely right, there's a very real perceived lack of professionalism associated with aggressive print or video ads."

Barbara Nesbitt: “Same with attorneys.”

Dr. Michael Rothschild: "But you know for certain practices, maybe that's appropriate. Most doctors want to shy away from that, and that's the advantage of having a good website. It's not just an advertisement for your practice but also provides something useful to the patient, specific information about their child or about their upcoming surgical procedure. It can be a great outreach tool. Patients are looking for good quality information, and it turns out that they trust their own doctors better than anyone, better than any big health portal, so if their own doctor is providing them information online, not only does it help raise the visibility of the practice and market it to potential patients but it also provides an excellent service. The biggest complaint people have with their doctors is that they don't communicate enough, that they don't get enough information from them."

Barbara Nesbitt: "I have a son-in-law that's a doctor, and you only have so many hours in a day to do all the work which you have to do. I think sometimes that being able to have those extra minutes to talk to somebody is a real bonus."

Dr. Michael Rothschild: "This isn't the same as meeting in the consultation room. Obviously, it doesn't replace face to face consultation but it enhances it. It's wonderful to be able to let patients go over what you said when they get home, to be able to read it in your own words, to print it out and take it with them."

Barbara Nesbitt: “I’d print it out. I’d go home and print it out or I’d have them print it out.”

Dr. Michael Rothschild: "Right, and it's available whenever it's needed. Also, I find it a good way to communicate with individual patients too. I'm talking about patients that I have actually seen in my office. A lot of times they'll have follow-up questions. They'll write me directly, if they know it's not an emergency, and it will save a lot of telephone tag. I can print that out and keep it in the chart which complies with the
documentation requirement. Normally with a telephone conversation there's no documentation but with e-mail you can just print it out, and put it in the chart."

Barbara Nesbitt: “You’re right. We also believe because otohns.net is a website for your specialty that by having people like yourself involved in this website, then it’s a place for you to - we’ll call it - hang your website. People that come in here have the same interest as yourself and I think the Internet makes a wonderful place for everyone.”

Dr. Michael Rothschild: “Yes, I think this Internet thing is really going to catch on.”

Barbara Nesbitt: “When doctors like you have information and if somebody’s in Kalamazoo, they can print it out and bring it to their doctor. I always say that their doctor then is happy that they got your good information.”

Dr. Michael Rothschild: "Probably one of the biggest concerns is the quality of information, and it is very difficult to police this. You know that no good thing is entirely a good thing, and there's a lot of bad information out there, and there's a lot of people with ulterior motives trying to sell something or just giving bad information. It's very important we educate patients how to identify quality sites. Just as we teach residents and medical students, we want to be able to teach them what a good healthcare site is, and there are several organizations that are attempting to come up with standards. There's the Swiss based Health On the Net Foundation, the Internet Healthcare Coalition (E-health), Hi-ethics (which is a consortium sort of health oriented dot coms). These organizations that are trying to define the qualities that make a medical Internet site appropriate or fair or non-biased or without conflict of interest. So it's very important to identify that but there's no way that any entity will ever be able to "police" the web."

Barbara Nesbitt: "This website, I'd say, is good because of people like yourself, Ron Kuppersmith, I can't run through all the names right now, and your contributions of informative content."

Dr. Michael Rothschild: "Trust is a very important thing, a tremendously valuable commodity. If people don't trust the content of a site, they won't go there. That's especially true in healthcare. It's a good quality for, say, an entertainment site or a marketing site. However, for a healthcare site to be truly useful, there really has to be a tremendous level of trust.

Patients aren't sure how to know which sites are worthy of that trust and so one approach is to try to have some external regulatory agency tell them what to to look for. But as I said before, patients tend trust their own physicians. If you ask patients "do you want to get health information from Medscape, from DrKoop.com, one of these big sites, or from your own physician?"- they'd usually say that they would rather get the information from their own physician. They've already established that relationship and they know them and usually trust them. It's a real person, it's not just a website."

Barbara Nesbitt: “Thank you very much.”

Dr. Michael Rothschild: “Thanks for having me.”

Barbara Nesbitt: “It’s a pleasure meeting you.”