Is There a Doctor in the House?

April 13, 2000

By Joanne Kabak
drkoop.com Health News

Related Articles: Point-and-Click Medicine Understanding Telemedicine The Problem With Prescriptions Is There a Doctor in the House? Between You and Your Doctor? A Summery of Online Prescription Issues Tips From the FDA Online Resources

With the kind of revolutionary change that the Internet brings, the reality of what's possible keeps changing. What is becoming clear is that privacy is an issue and there is the need for strong ethics and appropriate protections.

Some steps are already underway to create voluntary action. One of them is to provide physicians with a digital ID.

"We think that health is one of those online areas where it's really critical that you understand in a real-world sense who the parties are on both ends of an online transaction," said Mariah Scott, general manager of Intel Corporation's Internet Authentication Services, in Portland, Ore.

Intel is working with the AMA to identify doctors and issue digital credentials to them -- an ID that a doctor can use online for identification in a secure interaction. Each time a doctor uses his or her ID, it goes through Intel's data center to confirm that it is still a valid digital ID and that the person using it is a doctor. In fact, Intel has just announced that it has joined with the American Pharmaceutical Association (APhA) to develop a digital ID for doctors to use when prescribing online and communicating medical information.

According to a projection by the investment banking firm, Warburg Dillon Read, automated transactions such as online prescriptions and lab order services will create a $10 billion services market segment over the next five to 10 years.

The ID is designed to be a cryptographically armored piece of software that gets downloaded to a physician's personal computer when he or she enrolls. Before the ID is issued, there is a process to identify that person through the AMA. So, if you have a conversation with Dr. Mary Smith online, you know that she is really Mary Smith and she is really a doctor.

On any site with which the doctor is affiliated and which accepts the digital credential, the doctor can then perform tasks, such as write prescriptions, receive lab reports or access personal medical records. For example, if you went to a doctor for an exam and he wanted to prescribe medication for you to be filled online, before the site would let him do that, it would check his digital ID.

Scott said about 70 percent of all prescriptions require a call back to the doctor because there's a mistake, the writing can't be read, etc. And 50 percent of prescriptions are never even filled. If you could streamline that process of filling prescriptions online, there's benefits to be had, at least in the time it takes. "A lot of people are working on doing that. But one of the key gatekeepers is knowing the identity of the physician that you're dealing with once you go to an online environment," Scott said.

Much of the Internet use right now, Scott said, is generic information. "While I think that's great as an entree, the higher-value uses of the Internet for health are when you can actually interact with a physician -- when you can do a personalized transaction. But the minute you get into personalization, you have concerns about privacy and confidentiality. Is the information you're transmitting really going to a doctor? If someone sends you lab results, how do you know it really came from a lab? How does the lab know it was really you who got them? You get into all these kinds of concerns."

She said that's why Intel is working on this type of authentication service, which is now in the testing phase with a closed group of physicians to test usability, confidentiality, security of the system, and ease of use. Scott said she expects it in more general use soon.

What's next, she said, are consumer IDs, for example in the creation and use of personal medical records online. Now that consumers are increasingly able to track their medical records, confidentiality is an important concern. The end result would be that, by using the ID, only a consumer could get access to his or her own medical record.

"From Intel's perspective, we see an opportunity to find the technology or a service to fill the need and make those medical services possible in a secure, confidential way," Scott said. There are still many policy decisions to be made, "and that's something Web sites have to take ownership of." The technology is increasingly there to do it.

Joanne Kabak is an established free-lance writer. She has an MBA and specializes in health and business-related articles. She lives in Connecticut with her husband and two daughters.

• Medem (Peer-reviewed medical information)
• Epstein Becker & Green
• Jacobs & Associates
• American Pharmaceutical Association