The doctor&#8217s house call, a thing of the past, is making a comeback &#8212 on your

computer screen.

BlueCross BlueShield of Western New York, one of the region&#8217s largest health

insurers, plans to introduce online care this year, a service that allows patients to connect

with a physician on demand 24 hours a day using webcams for video links, or secure text

messages or telephone conversations.

Patients will be able to talk from their home, workplace or anywhere else with a computer

connection to one of hundreds of primary care doctors. Like eBay.com, the online auction

company, the service also will allow patients to rate each encounter.

Advocates see online care as a way to address a shortage of physicians who provide basic

medical care and the long waits for appointments, reduce unnecessary trips to hospital

emergency rooms and help patients with chronic illnesses and multiple medications better

manage their conditions.

BlueCross BlueShield joins a handful of other health plans that have partnered with

American Well, a Boston-based technology company, to adopt the system in the past year or so.

American Well&#8217s service is integrated with Microsoft HealthVault, which gives doctors

secure access to patients&#8217 health records for the online sessions.

&#8220We have a shortage of primary doctors and a broader issue of access limited by

geography, finances and the need for coordinated care,&#8221 said Dr. Cynthia Ambres, the

Blues&#8217 senior vice president and chief medical officer. &#8220This gives a patient

immediate access to a physician who sees their medical record.

&#8220The service is aimed at the worried well and the gently ill,&#8221 she said.

As a result, Ambres said, the company anticipates a &#8220sea change&#8221 in emergency

room visits for minor ailments.

In a typical encounter, a patient will visit the online care Web site and choose from a

list of available doctors, whose names will be accompanied in many cases by video

introductions from the physicians, professional information and patient ratings.

The doctor and patient will chat, and physicians can prescribe non-narcotic medications. If

the patients don&#8217t consult with their regular doctor, notes from the encounter will be

sent to the appropriate physicians.

HealthNow New York, the parent company of BlueCross BlueShield, plans to start the service

in June in Buffalo with its 1,400 employees here and about 450 physicians and their 35,000

patients.

It plans to expand the service later this year to all of its 500,000 members in Western New

York, hoping most of the insurer&#8217s 1,800 affiliated physicians embrace the technology. It

also will expand to its members in Blue Shield of Northeastern New York, its division in the

Albany region.

The service will open to any state resident in 2011, including uninsured patients who will

pay a fee by credit card for a session, officials said.

The health plans&#8217 members will pay a co-payment similar to an office visit fee, and

physicians will be reimbursed somewhat less than an office visit.

Ambres said the service is set up to eventually allow patients to upload through a USB port

records and diagnostic information, such as blood pressure readings.

In January 2009 American Well began its first service in Hawaii through a BlueCross

BlueShield affiliate. Since then, it has completed similar arrangements with BlueCross

BlueShield of Minnesota; OptumHealth, a division of UnitedHealth Group, one of the largest

health insurers in the nation; and TriWest Healthcare Alliance, a Phoenix-based health plan

for military personnel and their families.

Telemedicine is not new, and there is growing use of the Internet by doctors and health

insurers to transmit X-rays, review lab results, communicate with patients by e-mail and

prescribe medications.

But American Well&#8217s service is considered the next big step in virtual medicine,

giving patients in real time 24-hour access to a large number of credentialed doctors with

connections to the patients&#8217 medical records. The technology also manages the

availability of physicians, freeing them to talk to patients at their convenience.

Dr. Roy Schoenberg, chief executive and the company&#8217s co-founder with his brother, Dr.

Ido Schoenberg, sees online care as a transformative force.

In addition to potentially alleviating a shortage of primary care doctors, a problem for

which there is no quick solution, he said online care can make basic medical services

available to sick or frail patients separated from their doctors by distance or by their

inability to easily travel to a medical office.

&#8220This is not doc in the box on the Internet,&#8221 Schoenberg said. &#8220It&#8217s

woven into the fabric of overall care. We can make services available to people when they want

it and from where it is most convenient for them to receive it.&#8221

Experience with American Well&#8217s services indicates that more than half the online

visits involve issues that family practitioners and internal medicine doctors often deal with,

such as respiratory ailments, migraines, stomach aches, rashes, urinary tract infections,

children&#8217s illnesses, and backaches, he said.

Most of the other cases involve patients with such chronic conditions as diabetes and heart

disease who require frequent consultations about their care.

One of the lessons learned so far is that there is demand for other types of care,

including patients speaking with pharmacists and seeing mental health specialists from the

privacy of their homes, he said.

The introduction of online care poses challenging questions.

Medical boards and associations in different states view online care differently, with some

requiring that doctors establish a relationship with a patient before consulting with them

online. Critics also argue that a video session is no replacement for a physical exam.

But Schoenberg and others said that not all physician-patient encounters require a physical

exam. Much can be gleaned from seeing a person and getting a good medical history.

&#8220If you have diabetes, a doctor doesn&#8217t need to examine you to diagnose

what&#8217s wrong. If you have a migraine, the doctor doesn&#8217t need to feel your

head,&#8221 said Schoenberg. &#8220This is one tier of health care. It&#8217s not the complete

answer. It can deal with some things and not with others. It leaves decisions up to the

doctor,&#8221 he added.

Efforts at telemedicine have shown they can work in the right circumstances.

For instance, Erie County Medical Center for 10 years has operated an emergency

videoconferencing network for correctional facilities. In 9,000 out of more than 25,000

teleconsultations, doctors were able to find an alternative to transferring patients to an

emergency room, said Dr. David Ellis, director of telehealth and health informatics at the

University at Buffalo.

He has concluded that a physical exam isn&#8217t always necessary.

&#8220I now look at physical exams much like deciding whether to order a diagnostic

test,&#8221 Ellis said. &#8220I ask if it&#8217s needed and will it likely be effective.&#8221

Ellis said online care is likely to fill a niche among patients wanting to chat with an

expert at an anxious moment, but long term will have to show it truly can reduce unnecessary

emergency room visits and keep people in better health.