E-doc program succeeds; UAMS may form company from link with Acxiom.
Dr. Charles W. Smith is working with the Arkansas BioVentures program at the University of Arkansas for Medical Sciences (where he is an associate dean), examining the possibility of spinning the program into a company.
The program differs from other health information and medical advice now exploding on the Internet because it is set up on a contract basis between the participating physicians and Acxiom Corp. Also, officials stress the program is not to be used as a substitute for a relationship with a primary care physician.
Since January, Acxiom's 2,000 or so Arkansas employees have been able to ask medical questions or obtain health information through the "e-doc" program. Employees e-mail their questions to the doctors and are guaranteed a response within 24 hours.
"Doctor," writes one Acxiom employee, "I'm a little concerned about a possible ear infection."
The employee lists the symptoms, including the "little popping sounds when I swallow" while traveling by air. The question was e-mailed to e-doc creator Smith, who is medical director at University Hospital.
Within 24 hours, Smith sends back a reply, saying the problem does indeed sound like an ear infection, which can result from either the residual effects of an upper respiratory infection or nasal allergies. He adds two short-term ways to deal with the problem: a way to "blow" air into the middle ear by holding the nose and swallowing, and also to take a decongestant/antihistamine.
If there is a history of nasal allergy, writes Smith, "you might want to write back and we can discuss other options that are available for treatment." He also includes an Internet link to a health information site by the University of Illinois that explains the purpose of the part of the ear in question and explains how an infection occurs.
No trip to the doctor's office was necessary, no long wait for a five-minute exam that would result in probably the same diagnosis along with a bill. Smith says the program, which allows employees to e-mail him and other participating doctors with health questions, is a way to expand health care access using technology.
In January, Smith and Acxiom expanded a pilot program of e-doc from a select number of employees to all of the company's Arkansas employees. Officials say the program has proven so widely popular with employees and successful, it will be expanded companywide next January.
"At first, I was very skeptical," says Carla Blackwell, who handles health benefits for Acxiom.
During the setup phase, it was Blackwell who worked with Smith to tailor the program for Acxiom. A contract with the company addresses liability, cost and other issues raised by Blackwell, who is now a strong believer in e-doc.
She sees it as a way for employees to make more informed decisions on health matters, including whether to go see their doctor. The long-term goal for the program is to reduce employee health care costs.
Meanwhile, Smith is talking with other companies interested in the program as an added benefit for employees. He has started to work on developing a password-protected Internet site for the program. When completed in the next few months, it will be an extension of the e-mail offering, with links to informative health sites and information on the most common problems.
What It Is
Smith says he started considering the program about two years ago. Noting that he was using e-mail a lot at work, "I began thinking there had to be a way to make medical care more convenient though technology."
Through electronic mail, he reasoned, a person could communicate a problem to a physician and receive advice that could either prevent the need for a physical exam or allow the patient to make a more informed choice about a possible health problem. It simply increases access to health care information, he says, and provides a format for finding out specific answers to health problems before they escalate.
Smith says the most common questions concern the flu or allergies. Some have asked for prescription refill to bridge the time until a doctor's appointment, while others have asked for information about a disease or obscure illness that a friend or family may be suffering.
From the employer's perspective, it allows employees to stay on the job, Smith says. Such a program could also be viewed as a valuable benefit and a tool of employee recruitment.
He took the concept for an e-mail based program to Acxiom. UAMS officials approached Acxiom board chairman Charles Morgan. Blackwell and Smith began meeting to set up the parameters of the program.
For Blackwell, the first issue to be addressed was liability. Employees must sign up to participate in the program and also sign a waiver that addresses the liability issues.
The waiver document stresses that e-doc is not for emergencies. "It is only for problems that can wait 24 hours for an answer," Smith says.
In addition, employees are advised not to send highly confidential information since the program is not yet being carried on a secure server. Smith compares the confidentiality of e-mail to that of a telephone call.
Most importantly, the program was not to be used as a substitute for a primary care physician.
Cost was also a factor. Blackwell says the question was whether one e-mail should be equated to an office visit or should it be handled on a per problem basis since sometimes it takes a couple of messages back and forth to address one problem.
Though other companies might set the program up a different way, Blackwell says, with Acxiom it was contracted to charge on a per-problem basis.
A small test group was set up for the program in 1998. After six months the company surveyed the group to determine usage and whether employees thought the program was beneficial.
"Overwhelmingly, the response was very positive," Blackwell says.
A larger test group came next, with about 500 employees across different sections of the company. Once again the response was positive. Smith says he has received several thank-you notes from employees for his help.
Smith says he receives from three to 10 questions a day, which take him at most a couple of hours to research and make a response. There are currently two other physicians also taking questions as part of the program.
What It Is Not
"It's not our intent to take over the role of a primary care physician," Smith reiterates. "Frequently my answer might well be that you need to go see a doctor."
Smith says e-doc is also not an avenue for people to access inappropriate drugs or medications. The doctors are "very conservative" in refilling a prescription and will not do so without "adequate information," he says.
One major difference between e-doc and many of the health care sites that are proliferating on the internet is the affiliation with the university versus a private company. Also, the program is offered within the context of the company's benefit plan and by contract between UAMS and the company.
Smith and Acxiom are still gathering data on usage and say it's still too early to spot any trends or determine whether the program is saving employees on health care costs. Also monitored will be employee health costs before and after the program was started; time away from work; and disease-specific data about how employees are able to manage illnesses with the information received via e-doc.
Still, Blackwell feels the program has been successful. Asked if she thinks e-doc could succeed at reducing health care costs, she answers, "Oh, definitely."
She notes that she is a bit prejudiced because she has used the program herself. It has been helpful in providing information to her regarding allergies that might be affecting her son, who suffers from asthma.
E-doc was cited by Fortune magazine as one reason Acxiom was ranked one of the best companies to work for in the country.
Smith says he has been contacted by other companies - including a couple of national corporations - expressing interest in e-doc. Officials from a university campus have also expressed interest in providing the program as a benefit for faculty and school employees.
Smith is taking the preliminary steps to create a company around the program through the UAMS biomedical business incubator, Arkansas BioVentures. "We're looking into that right now, but we don't know how long it will take," he says.
Arkansas BioVentures has a process for moving discoveries through the planning and copyright stage to setting up shop in the incubator. At various points, different committees will review plans for a prospective company, analyzing elements such as the potential market and costs of operating.
When patented, UAMS will own the business and the creator can license it from the university. The university is repaid with a cut of the fledgling company's revenue.
The business incubator program has already proved a catalyst for potential biomedical ventures, currently housing six startup companies. The companies are housed in office space at UAMS, where Arkansas BioVentures serves as a kind of "landlord" while the company gets on its feet.
There is Safe Foods Corp., developed by the UAMS College of Pharmacy, which will manufacture, package and market a chemical that greatly reduces most food contamination. Another company, IRV Inc., makes use of a viewing device, developed by Dr. Milton Waner, used for detecting blood vessels.
Under the program, a company would leave the incubator when it either outgrows its office space or is ready to stand on its own, according to Charles A. Cook, a licensing associate for the UAMS Biomedical Biotechnology Center that operates Arkansas BioVentures.
Smith says he is now working with UAMS officials to determine what structure a company would take. At best, he says, it would be early 2000 before a company - which would remain affiliated with the university - could start up.
As it grows, Smith says, he would need to hire additional physicians to handle the increased e-mail traffic.
Smith is excited about the possibilities of e-doc as it grows. "I am absolutely convinced the time is right," he says.