Is this "free" technology worth it?
Video programs and “webpads”—with targeted messages—are being
placed in thousands of physicians’ waiting
rooms. Should yours be next?
By Gail Garfinkel Weiss
Senior Editor
MEDICAL ECONOMICS
Patients who visit internist/pediatrician Salvatore S. Volpe's office in Staten Island, NY, can complete intake forms the old-fashioned way, with paper and pen. Or they can do it via Volpe's recently acquired PhreesiaPads—wireless electronic devices that are roughly the size of an Etch-A-Sketch, weigh just over 3 pounds, and don't require computer literacy to operate.
The handheld "webpads" prompt patients to type their name on a touch-screen keyboard, then answer a series of multiple-choice questions about their history and presenting problem. When patients finish, a report is automatically sent via e-mail to Volpe's back office, where it's printed out so that he can review it before entering the exam room.
At the same time, a summary of the material input by the patient—including gender, age, and symptoms—is directed to Phreesia's central server, which in turn immediately displays drug-company-sponsored educational material for the patient. It discusses his central complaint and indicates which of the sponsors' products might be appropriate for him.
Another company, Cincinnati-based Healthy Advice Networks, has installed digital flat-screen LCD monitors in some 5,000 physician waiting rooms. The TVs are tuned to soundless digital programs that use text and animated graphics to impart patient education, customized practice messages, and pharmaceutical ads in continuous 25-minute loops. Healthy Advice also puts wall-mounted displays containing pharma-sponsored patient education brochures and anatomical flip posters in doctors' exam rooms. Phreesia and Healthy Advice equipment and services are supplied free to physicians; the advertisers pick up the tab.
In bringing direct-to-consumer advertising into doctors' offices, pharmaceutical companies are coupling their pitches with services directed at physicians and their patients. And they're frank about why they're doing it: Patients are more likely to request a drug or device that they learn about at the point of care, plus the ads can be aimed at the people who are most likely to be interested in a particular item.
But do patients find the ads intrusive or instructive? What's in it for physicians? And do these in-office materials represent too-close-for-comfort associations with big pharma?
Influencing patients at the decision point
"PhreesiaPads help physicians gather important, legible information before seeing the patient," says Chaim Indig, CEO of Phreesia, which is located in New York City. "This shortens visits, reduces error rates, and increases office efficiency. Our technology also enables physicians to have comprehensive documentation of intake interviews, so that they can code more accurately. And Phreesia-generated reports can be directly inserted into electronic health records, decreasing data entry costs and saving staff time."
Another advantage, says Indig, is that patients who are given PhreesiaPads can be productive in the waiting room instead of just sitting there and leafing through old magazines. Volpe concurs. "The patient has been prompted to think through the reasons for the visit, and has been given the opportunity to document those reasons. Visits aren't necessarily shorter, but more items get addressed during the same time period."
Patient privacy is protected, Indig continues, because all identifying information—including name, date of birth, and insurance carrier—is stripped from the PhreesiaPad's memory before being directed to Phreesia's server. Phreesia doesn't store any of the information collected from the patient, nor does it share that information with third parties, so no HIPAA rules are broken.
A practice that uses PhreesiaPads needs broadband Internet access, but the company provides everything else, including the hardware and wireless network. Phreesia delivers two or three webpads to physician offices, places the units in the waiting room, and provides technical support.
"I was very impressed with the quickness of the deployment," says Volpe. "I placed a call and sent an e-mail to Phreesia on a Friday morning, and on the following Monday two units had been set up in my office. We already had broadband access, a wireless router, and a printer in place, so the pads were up and running in no time. The product continues to undergo revisions as my staff and I submit suggestions." Two examples: The webpads in Volpe's waiting room now contain an abridged copy of his office policies, as well as the sentence, "This electronic interview will be used in addition to the traditional interview to help address your medical concerns during the current visit."
All Healthy Advice Networks programming is electronically transmitted to doctors' offices via the Internet, and updated every 30 days says Mike Collette, the company's CEO. Customer service representatives are available by telephone during business hours to help practices change the custom messages they want to broadcast on the programming loop. Field representatives also visit client practices three times a year to update the brochure racks beneath the screens.
Healthy Advice will insert up to 18 made-to-order messages into each 25-minute program. These might include a practice's hours of operation, payment policies, ancillary services, employee biographies, reminders (e.g., "If you have a new health insurance carrier, please inform our office staff"), and health alerts (e.g., "Flu season is coming. Be sure to make an appointment to get your flu shot."). The Magnolia Medical Clinic in Fort Walton Beach, FL, which has had two Healthy Advice monitors in the waiting room since 2004, uses the opportunity to customize the content to display information about office policies and procedures, and reminders for patients to ask for script refills and to inform their physician about all medications that they're taking.
Physicians also have some control over Healthy Advice's commercial content. "If a practice doesn't want a specific ad to appear in office programs we'll remove it, no questions asked," says Collette. And the company will remove entire programming segments that practices don't like. "Our mission is to work collaboratively with physicians to improve patients' health," Collette adds, "not to figure out ways to get ads in front of people at a captive moment. The advertising is purely a funding strategy." Similarly, doctors who use Phreesia webpads can veto sponsored messages that they find inappropriate. "Those messages will be removed within 24 hours," says Indig.
Feedback from doctors and patients
How do patients feel about devices such as Phreesia's webpad? "Response has been mixed," Volpe reports. "Patients under 65 seem more interested in it than older patients."
Doctors, too, have mixed feelings about giving pharmaceutical companies direct access to patients. "Exposing patients to commercially oriented drug information might encourage them to request therapies that the physician wouldn't otherwise recommend, thus subtly undermining his role," says internist William E. Golden, chairman of the American College of Physicians' Board of Regents and immediate past chair of the organization's Ethics and Human Rights Committee.
That contradiction is what prevents pediatrician Tammi Schlichtemeier of Coppell, TX, from opening her door to pharma-sponsored technologies. "I'd love to have a waiting room kiosk or webpad that keyed into our EHR for patient check-in. It would free up our front-office staff," she says. "However, it would be frustrating trying to explain why the device in my waiting room suggests one thing while I'm recommending something else."
Phreesia and Healthy Advice's client bases continue to grow, however, and Phreesia has even caught the attention of the blogosphere. In December 2005, Shahid N. Shah, co-founder of Netspective Communications, a software development firm in Lanham, MD, said in his blog, The Healthcare IT Guy, "I've seen devices like this come and go, but this one might have legs because it's not designed for computerizing the physician's work. Instead, it's focused on improving the patient's experience in the physician's waiting room."
Of course, if you want to provide nonsponsored, computer-accessible patient information in your waiting room, you can invest in a waiting room kiosk. That requires a computer with a high-speed Internet connection and sufficient memory, or an appropriate selection of CD-ROMs, or both. A computer consultant with medical office expertise can help you estimate costs, select content, and put the system into place.
About Phreesia:
Phreesia is the patient check-in company. Phreesia automates patient check-in and delivers fully interactive content direct-to-patients, designed to interface with physicians’ existing and future technology. Replacing the traditional patient clipboard with a free wireless touch-screen and swipe-card enabled PhreesiaPad significantly improves the patient experience. Phreesia is backed by premier venture capital firms and draws on the expertise of a leading Medical Advisory Board.