The Doctor is In <i>and</i> Online

Dr. Albert Chan's enthusiasm for using technology and his personal computer to improve medical care and empower patients makes him the perfect candidate to get a behind-the-screen look at a "wired" doctor's office. Dr. Chan practices family medicine at the Palo Alto Medical Foundation (an affiliate of Sutter Health, a not-for-profit organization).

Palo Alto Medical Foundation (PAMF) was one of the first medical groups in the country to connect patients with their electronic health record. Since 2001, they have offered patients free access to a number of secure Internet healthcare services — test results access, appointment scheduling, prescription renewal, and more — via PAMFOnline. A similar service is available to the rest of Sutter Health through MySutterOnline.

Dr. Chan believes that so-called patient portals such as PAMFOnline give the patient more control. "I think it really empowers people because they have better access to their health information, and [healthcare] becomes a collaborative effort with their doctors," says Dr. Chan.

In addition to seeing patients, Dr. Chan also serves as the Medical Director of PAMFOnline, and he is PAMF's resident champion of the use of electronic medical records. "The term e-visit and e-message are quite confusing in the current national discussion," says Dr. Chan. "I like to say we have an online care relationship."

Benefits of Online Health Services

Dr. Chan shares his thoughts on several of the online services available to his patients through PAMFOnline.

Test Results
Dr. Chan says: "Our survey data shows the number one satisfier for patients is the rapid access to test results. I've had patients who've signed up for the service while in the office, and by the time they get back to work after their physical, they can access the test results. Patients can click on their test results, and a little box 'About This Test' pops up. It will explain what the test is. Also, because it is so well integrated with our electronic health records that come into my inbox, it is very easy for me to write little annotated notes for the patients."

Appointment Summary
Dr. Chan says: "Patients have access to information from their last visit with me or any other doctor in the system. For instance, you can look up your last blood pressure reading, or you can even look up instructions that I covered with you in the office. It's really neat because you can go back online and look at what we discussed. I really do believe that because you have this ability to look at data online over and over, you can process it before your next visit.

Health Reminders
Dr. Chan says: "One of our most powerful services is our health reminder screen that allows us to tell people what tests and check-ups they need to have, based on their medical history and age. This is especially helpful for lab tests that some patients need to have frequently. They can look up their old test results, and they can also see when they are due for the next one. As an enhancement, we send a personalized, secure message that not only reminds patients what is due, but tells them an order has been placed. All they have to do is show up at the lab. There is so much for us to do in life. If you have a tool that can help you manage necessary tests or visits, then that is just neat."

Track and Renew Prescriptions
Dr. Chan says: "Patients can look at all their medication online and print a list out if they need to. Or let's say you're taking care of your elderly mother. You can print out her prescription list that includes the reasons why she is taking the medication, and you can share that with other doctors. If you want to renew a prescription, you just check a box to renew it. It is a great time saver. You don't have to call in and leave a message, instead you just go, 'Oh, I need those medicines." Click, click, click and refill. It's magic."

Two-Way Messaging
Dr. Chan says: "For a nominal yearly subscription fee, PAMF offers an enhanced service that is a direct two-way communication with your physician. In other words, you can have an online relationship with your doctor. The term we use is "secure patient message." We make that distinction because we want to emphasize that the patients have a secure place where they go online and no one else can read their information. It's more convenient for the patient. Let's say late at night or anytime of the day, you have a question about something, but it isn't urgent. You can send it to me. Now there are certain things you have to do in person. But the beauty of this is that all of our communication becomes part of the medical record. So if a problem comes up in the future and we can't exactly remember how we dealt with it, we can find the answer. It helps me be more connected to my patients and to know them in ways that I didn't know them before."

Enhancing Doctor-Patient Communication

Dr. Chan is working with others at PAMF to look at new healthcare models for a population that is getting older and living longer with fewer doctors available. "Here at PAMF, we are working on what we call Primary Care Redesign," he says. "We are trying to figure out how to reach people using different media. We are always trying to better use online tools to help people."

As to the whole "wired" doctor's office and online care relationship, Dr. Chan concludes that it is like a puzzle, and all the pieces fit together. "You get the patient involved, you have the care team involved — doctor, nurses, nutritionists, etc. — and then you have technology that connects everyone. You bring everyone together and when they overlap properly, you can get a good outcome."