Boston hospitals collaborate with American Life and WorldCare in electronic second opinion network

Boston 10 May 2000The telemedicine movement has taken a giant leap forward since a Cambridge company and several Boston hospitals have closed an agreement to provide second opinions for what is one of the world's largest insurers, via the reviewing of patient records on the Internet. WorldCare Inc. of Cambridge signed the contract with the American Life Insurance Corporation, which will allow American Life's customers, for a fee, to seek electronic second opinions from specialists at Massachusetts General Hospital, Brigham and Women's Hospital, the Dana Farber Cancer Institute, and three other hospitals in the United States.

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It is illegal in the United States for doctors to offer medical advice to out-of-state patients over the Internet. But the telemedicine director for the Boston hospitals stated his doctors will not communicate directly with the patients, all of whom live overseas. Instead, they will consult with their regular doctors.

"It's a question of doing it in a way that promotes the highest quality of care and ethics", stated Dr. Joseph Kvedar, director of telemedicine for Partners HealthCare, the parent company of Massachusetts General and Brigham and Women's. "Some companies promote doctor-to-patient chats online", he added. "To me, that is offensive. What we are talking about is doctor-to-doctor."

Critics of on-line care argue that it is inappropriate for doctors to advise and conduct ongoing relationships with patients they've never met. And they say that's particularly true when the doctor is not licensed in the patient's home state, and therefore not subject to state standards and oversight.

Dr. Kvedar commented that doctors charge WorldCare a fee, which he would not disclose, for the consultations. But, according to him, the programme is not a revenue centre for physicians. WorldCare, founded in 1992, has helped arrange second opinions to more than 10.000 patients and doctors.

The Partners hospitals have provided about 600 second opinions a year to patients in 30 countries for WorldCare and other on-line organisations for several years. The agreement with American Life is expected to significantly expand the programme and increase the number of countries where it is available.

It also will make the practice less expensive for the insured, who now pay about $1000 for a second opinion from a United States hospital. American Life will charge patients $5 per year for second-opinion coverage. Of the 600 second opinions that Partners provides annually to overseas patients, about 60 patients end up coming to one of the Boston hospitals for treatment, and this may be the real financial benefit.

"Our goal is to raise the standard of care around the world, Dr. Kvedar stated. But, as he added, "it does get our name out." American Life Insurance will provide the second opinions to patients in 16 countries in Latin American, the Middle East, and Eastern Europe.

Using secure digital technology and a private telecommunications network, WorldCare will transmit medical records to the hospitals. Also participating are the Cleveland Clinic Foundation, Duke University Health System, and Johns Hopkins Medicine.

WorldCare's telemedicine coverage includes analysis of the patient's MRI, X-ray, ultrasound, CT scan, and other radiology studies; analysis of pathology slides; treatment plans recommended by a top subspecialist in the field; and a conference call, if needed, between the attending doctor and the United States specialist.


Leslie Versweyveld

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