If you've got a modem, you've got a doctor.
Dr. Scott Rifkin, the entrepreneurial physician who helped assemble the largest physician group in the state, is launching America's Doctor, which will provide users with live, private, one-on-one Internet chat with a doctor.
The service is scheduled to begin on America Online, the country's largest Internet service, with about 12 million members, by fall.
America's Doctor joins a vast and bewildering array of Internet health sites. (Entering "asthma" into an Internet search engine produced 110,980 responses.)
"People are very hungry for this type of information, and there's room for plenty of players," said Bob Pringle, president of InteliHealth, a Johns Hopkins-affiliated business that also provides health information on the Internet.
Rifkin said he hopes to eventually get people to seek out America's Doctor, rather than just stopping by as they cruise the World Wide Web. "We want to be the destination, not part of the travel," he said.
Like InteliHealth, America's Doctor will be an "anchor tenant" on America Online's health channel. That means the America Online health page will connect users directly to both. When they click on the America's Doctor button, they will be able to link up with doctors working from a call center in Southern Maryland.
As the largest Internet service, America Online "has a very good foothold" and "seems like a good place to start" with a service aimed at a broad audience, said Janice Young, a senior analyst in the healthcare segment of the Gartner Group, an international information technology consulting and strategic planning firm.
Rifkin is paying a substantial amount to America Online for the prominent positioning. The service will be supported by advertising and hospital sponsorships.
America's Doctor will provide much that is similar to other health sites, but a live ask-the-doctor service is a new twist.
One Web-based service, run by publicly traded Mediconsult.com Inc., maintains a list of dozens of medical specialists. Patients can fill out a questionnaire and get a customized report from a specialist in two to five days -- for $195.
There are other ask-the-doctor features, for example, a question-and-answer with Hopkins doctors on InteliHealth and an "ask Mayo" feature on Mayo Clinic's World Wide Web site. Dr. Andrew Weil, the alternative health guru, has an "Ask Dr. Weil" site sponsored by the Vitamin Shoppe, which lets users shop for vitamins online.
All of those follow a similar format. They limit questions to perhaps one a week (although old ones are archived). Questions are selected if there is thought to be general interest, and the answers are posted for the public.
"We had an ask-the-doctor feature up for six months. But most of the questions were too personal, with not enough general interest," said William A. Spencer, president of MedSurf, another online health information company.
Demand may exist
Though MedSurf dropped its feature, its experience indicates there might be demand for Rifkin's, in which doctors can answer specific questions one-on-one.
The challenge, Spencer said, is "What can they say? They can say, 'Go back to your doctor.' They can't really take on the responsibility of treating someone they can't see."
Rifkin said he is aware that his online doctors will not be practicing medicine. "We're not diagnosing, we're not prescribing, we're not keeping medical records," he said, describing his service as "a guided consumer research tool." The doctor will answer questions about medical conditions and might direct the user in downloading medical information, such as a fact sheet on diabetes.
If necessary, the online doctor will tell the "patient" to see a doctor in person and might be able to recommend one affiliated with a sponsoring hospital. Users will see information on hospital sponsorships keyed to their ZIP codes.
So why use doctors at all, rather than nurses or other lower-paid staff members?
"In the health care world," Rifkin said, "physicians are still the stars."
America's Doctor grew out of an invitation to an Orioles game from Rifkin's friend and neighbor Freeman Hrabowski, president of University of Maryland, Baltimore County. Hrabowski said he would be sitting with Steve Case, chief executive of America Online.
Rifkin couldn't go that night, but he said he told Hrabowski to ask why AOL didn't offer advice from live doctors. Hrabowski reported back that AOL would be interested, and Rifkin went on to negotiate the deal.
Rifkin will remain chairman of Doctors Health System, a large medical group he has put together over the past four years. But as Doctors Health has shifted from signing up physicians to negotiating contracts with managed-care plans, Rifkin said he is spending less of his time there, leaving him free to to focus on Doctors Health.
"One of the things I love to do is figure out how to make a concept work," he said.
Delicate issues
Online health information services have to deal with a number of delicate issues, including patient privacy, distinguishing objective information from sponsors' messages and judging the reliability of information provided by others.
About privacy, Rifkin said his service might send information to people who request it, "but we're not going to push anything without permission" or require any personal information other than ZIP code.
Health Web sites often link users to information provided by others, but some make no attempt at verification. For InteliHealth, Hopkins reviews the information. MedSurf's Spencer said, "We tend to stay away from supplements, herbal-type things, claims of miracle cures, things that are founded in anecdotal information."
Rifkin said America's Doctor will take a relatively conservative approach, aiming to provide information that is "not necessarily the most cutting edge, but safe."
And, though there will be advertisements, Rifkin said, the medical information will not single out particular products.
Ads in the 'chrome'
InteliHealth's Pringle said, "That's a real important issue for everybody out there. We take a real hard line as far as separation of church and state." InteliHealth's pages, he said, have content surrounded by a border he calls the "chrome." He said, "The ads are only in the chrome."
Some sponsors, Rifkin said, are happy to present information about a class of products without mentioning their own, figuring that if general use goes up, they'll get a share of the business.
He has sponsorship commitments from several hospitals and a large pharmaceutical manufacturer, he said.
Like other Web start-ups, however, the challenge is not technical -- can the service be delivered? -- but financial -- will there be enough sponsors to pay for it?
InteliHealth, which is owned by Aetna U.S. Healthcare, Hopkins and private investors, is "ahead of our plan, and our plan is to break even this year," Pringle said.
Spencer said MedSurf has had more trouble attracting sponsors and venture capital than it had expected.
"They think we're too niched-out," he said. "They want to go for mass-market big hitters."
Rifkin said he expects to raise at least $6 million. Other equity owners will include Medical Advisory Services Inc., a Southern -- Maryland company that operates the call center; Premier Research Worldwide, a Philadelphia-based research firm; and two venture capital firms.
He plans to achieve profitability in six to eight months.
There will be about 40 employees when the service is operating. Many functions, including sales and computer programming, will contracted out.
Young, of the Gartner consulting group, said America's Doctor is likely to face competition over the next few years, as HMOs and hospital systems offer patient advice over the Web. Many currently offer referrals and triage by telephone, she said, and "the Internet is not that far away from a phone service."
Some patients, she said, may want to go to a source independent of their own HMO, creating the potential for America's Doctor to function, in effect, as "an online second opinion."
Pub Date: 7/19/98