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Fam Pract Manag. 2000;7(6):69

A quantum leap in access to information via the Internet has fueled the first phase of eHealth, characterized by business-to-consumer and e-commerce Web sites.

The next phase of eHealth, already underway and potentially much larger in scope, concerns business-to-business Internet applications (see “Expect More From the Internet,” FPM, January 2000). Such health care applications will use Internet technology to streamline the information management processes used by doctors, hospitals, insurers and patients on a day-to-day basis. Examples of business-to-business Internet opportunities include prescription writing, case and disease management, enterprise scheduling, patient medical records and medical practice management.

The Application Service Provider model (ASP) is the key concept necessary to understanding how practice management can be accomplished over the Internet. An ASP is a company that offers individuals remote access to software programs and related services that otherwise would have to be located in their own computers. ASP services are expected to become an important alternative form of software distribution, especially for smaller companies and businesses who want to eliminate the high costs of in-house computer systems.

What's available?

Several companies are beginning to offer medical practice management via an ASP model using the Internet. Here are some examples:

EMedPractice ( Available through Medscape/National Data Corp., EMedPractice is a subscription service currently offering patient eligibility and claims processing. The site guarantees that payers will accept your claims 90 percent of the time or better. It also offers health plan report cards from the National Committee on Quality Assurance and patient education tools such as health-related Web site links and drug directories.

Healtheon/WebMD ( The best known and largest of the ASPs, its WebMD Practice Web Site offers patient eligibility verification, laboratory ordering and results reporting, claims submission and even transcription services (see “WebMD: The Online Future for Physicians?FPM, July/August 1999).

Nuesoft ( This ASP's practice management product, NueMed, includes screens for patient demographics, comprehensive reports, daily encounters, appointment scheduling, insurance and electronic claims, and statement processing.

What does it cost?

ASPs will charge a monthly service fee based on the number of users, in addition to a transaction fee per claim submitted. Your total cost will depend on the volume of transactions and the number of users. However, monthly fees of $50 to $75 per physician can be expected, which means that the total cost for an ASP could easily be just a fraction of the total cost of owning and upgrading traditional office-based practice management systems — approximately $3,500 per physician per year.

All of these vendors are eager for customers, so look for special discounts and price breaks to early adopters. Nuesoft offers a 90-day free trial period, and EMedPractice is waiving claim submission fees for a limited time.

Of course, you'll have to judge the quality of this software the way you would any other practice management application. Will it work reliably? Will you get the customer service you need? And because it's Internet-based, response times will depend on whether you use a telephone modem, an ISDN (Integrated Services Digital Network) line, DSL (Digital Subscriber Line), or other fast connection to the Internet, which I highly recommend to anyone using an ASP. You'll have to feel comfortable about your ASP vendor storing your patients' data on their servers. Finally, be sure to ask your current practice management vendor if they have plans to Web-enable their own software.

Editor's note: This article is the second in a series on eHealth trends. Watch future issues of FPM to read more about Internet software applications and emerging eHealth companies.

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