E-Cleveland Clinic e-deploys to Persian Gulf

Buildup in the Persian Gulf is not restricted to military forces. A more benign deployment is the online second opinion agreement signed between the Cleveland Clinic and King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, Saudi Arabia.

The agreement, announced at the January International Arab Health Congress, the Middle East's largest medical conference, gives Saudi patients with life-threatening and life-altering diagnoses a chance to obtain second opinions from the 1100 medical specialists at the Cleveland Clinic, the second largest group practice in the world.

The service, initiated last year, is available to any patient, anywhere in the world. Patients engage the service online and are guided through the process based on the required written first opinion.

"The relationship with King Faisal is just them recognizing us as their preferred provider for this service," said Dr. Martin Harris, Cleveland Clinic CIO and executive director of e-Cleveland Clinic.

Direct access to the Cleveland Clinic is becoming more and more challenging for international patients because of visa requirements and travel restrictions, Harris said. The $565 online service gives patients an opportunity to receive professional opinions they may otherwise have flown to Cleveland for at considerably greater expense.

The principals might also prefer that the arrangement included an apparatus to handle digital diagnostic images, but such a facility exists only in visions of the future.

"I would imagine that (the ability to handle digital images) will become a staple, but at this point sufficient standards do not exist," Harris said. "For the patient in this model, (transmitting studies) would be a little challenging."

Since second opinions are initiated by the patient, it remains the patient's responsibility to arrange to have imaging studies shipped to the clinic. Because PACS lacks a mechanism for consumer-driven image transmissions, the e-Cleveland Clinic second opinion service, therefore, is based on hard-copy film delivered via express mail.

Cleveland Clinic has many point-to-point electronic relationships with other institutions, but if consumers find the Cleveland Clinic randomly, their local hospital may or may not have the capability of transmitting images outside the enterprise.

"There is also the issue of image alteration when it's transmitted," Harris said.

Lack of a consumer-driven image transmission standard reflects the overall immaturity of online medicine. Patients are beginning to seek medical care online from physicians they have never met, from one-time second opinions to ongoing psychotherapy.

"These practices call for a new regulatory paradigm to ensure accountability, establish acceptable parameters for online medical practice, and distinguish online healthcare delivery from online health information," attorney Tracy E. Miller, general counsel to Catholic Health Care System in New York, said in an article in the July/August 2002 issue of Health Affairs.