Media Coverage

The Oregonian
September 3, 2001

Firms Prescribe Internet to Doctors

Authored by Joe Rojas-Burke

Teaching can be a powerful weapon against disease. And dozens of controlled clinical trials have shown that multimedia -- the combination of text, graphics and sound -- can make a more lasting impression than a doctor's spoken advice or printed instructions.

But health education remains underused in many medical offices. Among other reasons, doctors typically can't bill an insurance company for extra time and office overhead spent on teaching patients. Now a handful of technology companies, including a new one in Portland called Wired.MD, are trying to make patient education more cost-effective. They are seizing on a convergence of recent developments: Software and hardware advances are making it cheaper and easier to distribute multimedia content.

Doctors are taking it upon themselves to wire exam rooms with Internet-connected computers Medical caregivers are seeking ways to boost efficiency to cope with cost-cutting pressures from insurers.

The field is dominated by traditional publishers of printed handouts, such as market leading Krames Health & Safety Education in San Bruno, Calif., a unit of Paris-based media giant Vivendi Universal. Those companies are moving to online formats. Upstarts such as Wired.MD say their technology and pricing will give them an edge.

Wired.MD claims its proprietary software can deliver streaming content at Internet connections as slow as 56K modems, making it accessible from home for many patients. The software also gives the company the means to quickly transmit updated materials to subscribers at low cost. The subscription charges to physicians range from $50 to $500 a month, depending on how many modules an office wants available. The charges are comparable to what many offices spend on pamphlets and videocassettes for patients, according to Wired.MD.

Company co-founder Mark Friess started thinking about the technology during his second year of medical school. The need struck him after witnessing many lost opportunities to educate patients during typically hectic office visits. "Doctors were providing excellent care, but they were time-constrained," says the 28-year-old chief executive. In 1999, Friess took a leave of absence from his training at Oregon Health & Sciences University to launch Wired.MD.

His 25-year-old brother, John Friess, joined the venture and now serves as vice president in charge of marketing. He had done similar work in Los Angeles and Portland for Kozmo, the Internet delivery service that went out of business earlier this year. They convinced Paul Biskar, an internal medicine physician with the Portland Veterans Affairs Medical Center, to serve as medical director. Biskar, who has begun using the service, and an advisory board of physicians, oversees the accuracy of the health information.

"The problem is creating an inventory of material," says Stephen Hanson of The Patient Education Institute, a competitor in Iowa City, Iowa. "We have a huge lead and we're building 'em like crazy," Hanson says. He declined to give sales figures for the privately held company, which began business in 1995 as a producer of medical advice on CD-ROM. Like Wired.MD, the company is now pushing hard to make all of its materials deliverable by a low-bandwidth Internet connection.

However, the field lost a significant player last year when InLight International of Northbrook, Ill., ran out of money, joining the list of dot-coms gone bust. A former employee is trying to revive the business under the name MyDoctorNet. Patients, doctors benefit Health educators see an increasing role for computer-assisted teaching in the doctor's office.

"Multimedia is most helpful in complex decisions where patient preferences should have a central role and where a good grasp of the issues involved is needed for the patient to make a fully informed choice," says Dr. Elizabeth A. Phelan, an assistant medical professor at the University of Washington. Phelan recently studied the impact of a video disk presentation on back pain and surgery. Video learners retained more information than patients who received the same material in print. The video learners also were less likely to choose surgery as a treatment option. Graphics and sound can convey difficult concepts to people who are poor readers or who can't read at all. The Patient Education Institute pitches its lessons at a sixth-grade reading level, allows users to set the pace, and includes narration of all text, with versions in English and Spanish. To maximize Internet reliability, the company chose to eschew video images and to limit the use of animation.

Wired.MD, seeking an edge, acquired a system for delivering streaming video over slow Internet connections from a San Diego company called IceBase. Wired.MD also has hired medical translators to narrate scripts in six languages other than English -- Spanish, Vietnamese, Cantonese, Japanese, Mandarin and Russian. The company's sales pitches to physicians stress time-savings, patient satisfaction, and, of course, health benefits. Right now, a large fraction of patients fail to follow medical advice. Various studies of asthma patients have found rates of medication misuse or underuse ranging from 30 percent to 70 percent. Studies have shown that multimedia programs improve compliance with doctors' advice.

But doctors remain a hard sell, says Hanson, director of business development for The Patient Education Institute. Cost-cutting health insurers and government programs such as Medicare have whacked doctors' incomes. Hanson says many physicians view education programs as an added expense that the office can't bill to an insurer. He tells doctors that informed patients ask fewer and better questions, getting the most out of a doctor's limited time.

Wired.MD began selling earlier this year, and so far five medical practices in Portland and Salem have ordered the service. Dr. James Heder, with West Salem Family Practice, thinks the technology has the potential to make office visits more efficient for him and more satisfying for patients. He runs the modules on laptop computers in two of his exam rooms. Patients can go through modules while waiting for the doctor. "I've had most of my patients say they enjoy watching while they are waiting, instead of reading People magazine," Heder says.