Massachusetts Hospitals Develop Program to Offer Online Second Opinions

Massachusetts General Hospital and Brigham and Women's Hospital will enter the "controversial and legally tricky" area of offering second opinions over the Internet to patients across the country, the Boston Globe reports. For $600 per case, doctors at the hospitals will review a patient's history and test results from a primary care physician but will not personally see the patient. Partners HealthCare, the insurer whose network includes the two hospitals, will offer the telemedicine program to patients on its Web site, but will not market it, as it cannot legally advertise second opinions in other states. Doctors participating in the program will require patients to work through primary care physicians in their home state. Under the "econsults" system, a primary care physician will request the second opinion for a patient, as it is legal for doctors to consult one another across state lines. This allows the specialists in Boston to get around state laws that prevent them from practicing medicine in states where they are not licensed. While a patient's primary care physician will be "ultimately responsible" for treatment decisions, the Globe reports that Partners doctors will share liability as if they were making an in-person second opinion. Partners has offered the telemedicine service internationally for six years and has provided second opinions online for more than 10,000 patients "employed by overseas companies and governments." Through its international program, doctors changed the "care plan" 70% of the time and "revised the diagnosis" in 15% of the cases. The Globe reports that the Cleveland Clinic in Ohio, which plans to offer online consultations by the end of the year, is taking a "different tack." In lieu of working through a primary care physician, the facility will obtain licenses for its doctors in any state where they provide a second opinion online. Offering second opinions online is a way for hospitals to expand their services without bringing more people into already crowded facilities, the Globe reports (Kowalczyk, Boston Globe, 8/16).