USA Today examines online second-opinion services

USA Today on Monday examined the use of online second-opinion services, which allow patients to receive consultations from specialists based on medical records that they fax, mail or send through the Internet.

The Cleveland Clinic, Johns Hopkins Medicine and Partners Online Specialty Consultations -- the three leaders in remote second-opinion services -- each say they serve about 1,000 patients annually. Average upfront cost of the services ranges from $500 to $1,500, depending on the number of radiology or pathology interpretations required.

Online second-opinion services affiliated with specific hospitals list participating physicians and may allow patients to request consultations with specific specialists. All of the services use case managers, who help determine which specialists are best for each individual case and communicate with patients about what records are needed. Some of the services also consult with the patient's local physician.

According to USA Today, the services have "evolved and improved with technology." Doug McClure -- corporate manager of the Center for Connected Health, POSC's parent company -- said, "When we first started, in the late 1990s, it was all about documents being faxed to us," adding, "Today we have the Internet. We can encrypt Web traffic for security, and we can also increase the speed and availability of the service. Nothing can be the same as going in to see the doctor, but in some ways it can be better because of how much more time you can take to craft your questions and think about what your follow-ups would be."

Jonathan Shaffer, managing director of e-Cleveland Clinic, said, "In about 5% of the cases, we actually change the diagnosis of the patient. In 85% to 90% of the cases, we alter the treatment," adding, "What we are able to do is give the patient more treatment options and hopefully give the patient more peace of mind."

"A limiting factor" in the use of online second-opinion services is that most health insurers do not cover such consultations, USA Today reports. However, Cigna Medical Director Lyndon Laminack in April announced that the company will become the first major insurance provider to cover the service. In July, Cigna will begin a two-year trial offering remote second opinions to select patients through e-Cleveland Clinic (Fricks, USA Today, 6/23).