MINUTES OF THE

SENATE Committee on Human Resources and Facilities

 

Seventy-First Session

May 23, 2001

 

 

The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 2:30 p.m., on Wednesday, May 23, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Agenda.  Exhibit B is the Attendance Roster.  All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

 

COMMITTEE MEMBERS PRESENT:

 

Senator Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Mark Amodei

Senator Bernice Mathews

Senator Michael Schneider

Senator Valerie Wiener

 

COMMITTEE MEMBERS ABSENT:

 

Senator Randolph J. Townsend (Excused)

 

STAFF MEMBERS PRESENT:

 

H. Pepper Sturm, Committee Policy Analyst

Cynthia Cook, Committee Secretary

 

OTHERS PRESENT:

 

Jerry Reeves, M.D., President and Chief Executive Officer, WorldDoc, Inc.

Rahul Singal, M.D., Executive Vice President of Operations, WorldDoc, Inc.

Mary Liveratti, Administrator, Aging Services Division, Department of Human Resources

Bobbie Gang, Lobbyist, National Association of Social Workers

Paul Gowins, Rehabilitation Program Specialist II, Community Liaison, Community Based Services, Rehabilitation Division, Department of Employment, Training and Rehabilitation

John Whaley, Management Analyst III, Division of Health Care Financing and Policy, Department of Human Resources

Donny Loux, Chief, Planning, Research and Program Development, Rehabilitation Division, Department of Employment, Training and Rehabilitation

Robert Desruisseaux, Concerned Citizen

 

Chairman Rawson:

We open this meeting with a presentation by WorldDoc, Incorporated, “Empowering People to Achieve Better Health.”

 

Jerry Reeves, M.D., President and Chief Executive Officer, WorldDoc, Incorporated:

We would like to introduce the committee to what we believe is an innovation to health care.  This approach can empower the citizens of Nevada to share in their health decision-making.  All of us have had the frustrations of not getting answers to our medical questions fast enough.  At the same time, the costs of health care are rising rapidly.  While this is going on, there are great variations in the quality of care.  About 50 percent of patients do not get the care they need, while 30 percent of patients get care that is not helpful.  One hundred million Americans use the Internet for health information an average of three times a month.

 

Chairman Rawson:

A news release this morning stated many of the Internet sources are not reliable.  Can you comment on that?

 

Dr. Reeves:

Much of health information on the Internet is advertising based, aimed at promoting products.  Americans searching for answers are then barraged with references.  Another element is the issue of trust.  When a site is advertising based, Americans are concerned about whether the information is trustworthy.  If you get answers, they only cover about one third of the information you really should get, and about two thirds of the information that would be important is left out.

 

The WorldDoc approach focuses on the specific concern of the patient, and is developed by physicians.  The consumer is in charge.  There is on-line help and support 24 hours a day.  The information is provided at an eighth grade reader level, with photographs and illustrations.  This approach enables early intervention.

Chairman Rawson:

If you came into the system and asked questions, is there assurance of confidentiality?

 

Dr. Reeves:

The security of this site is comparable to that of on-line banking transactions and mutual funds.  The patients have to release information to their physician, and that transmission is a confidential secure transmission.

 

Rahul Singal, M.D., Executive Vice President of Operations, WorldDoc, Incorporated:

I would like to read a couple of case histories.  A 60-year-old female is told she has high blood pressure and needs to take medicine to lower it.  She has heard that blood pressure medicines do not make people feel better and that she does not need to take them.  She wants more information and is not sure who to talk to.  Her doctor seems very busy. 

 

A 45-year-old male has a 2-week history of cough, sore throat, and occasional allergies.  The cough is mostly dry and he has no fever.  He is wondering if he needs an antibiotic.

 

A 70-year-old female has not seen a doctor for many years.  She has frequent urination, worse at night.

 

The library on the site presently includes 400 conditions, and has a full treatment section.  This section is also consistent for each one of these conditions.  It starts out with self-care and prevention, cautions about medications, and lists prescriptions by various classes.  There are other sites with similar libraries, but the revolutionary application is in the personal evaluation system.  Patients are asked some pertinent information such as allergies, medications, and vital signs, if available.  A rotating mannequin appears, and the patient can click on the area of concern.  A possible diagnosis and explanation is then offered. 

 

Another area is, “Ask the Doc,” where we currently have eight specialties out of our fifteen that are available.  We can click on a topic, and there is a list of 50 frequently asked questions that each of our specialists felt were important.  Other sections include pharmacy, an area to target prevention called health helpers, and a 40-question profile, and, finally, a directory with a list of all of the physician-partners using WorldDoc.  An overview of the application helps take people from a symptom to a potential condition. 

 

Dr. Reeves:

More than 600 employees have used this.  They have reported satisfaction with the ease of use of the system, and the fast answers they receive.  More than 95 percent of the patients would recommend WorldDoc to family and friends.  An employer may subscribe on behalf of insured members, who are then able to get answers to their questions faster, are able to start their self-care earlier, and may not miss as much time from work. 

 

User surveys reflect 92 percent of patients found WorldDoc easy to use, and   88 percent would use WorldDoc prior to a physician visit if they could access it at home or work.

 

The proposal we would like to make to the committee is: carry out a test program with approximately 25 senior centers throughout Nevada; collaborate with current providers; develop the results of a 1-year program; and report back to committee.

 

Chairman Rawson:

What kind of equipment do we have in our senior centers currently?

 

Mary Liveratti, Administrator, Aging Services Division, Department of Human Resources:

We have funded a program called NEON (Nevada Elders On the Net) to provide approximately 20 computers at centers across the state.  We also have 12 Web television sites that have access to the Internet, so we do have quite a bit of equipment out there for use by seniors.  Federal grant money, through our State Health and Information Program, was used for the project.

 

Chairman Rawson:

Do many seniors use computers?

 

Ms. Liveratti:

It seems to vary by center.  When we set up project NEON, one of the agreements was that the center would provide a volunteer to help seniors or family members on how to utilize the Internet.

 

Chairman Rawson:

Let me ask, what is the cost to put WorldDoc into a center?

 

Dr. Singal:

We would offer this application for $100 per month, per senior center.          We would also propose a monthly leasing fee, but it sounds as though that would not be necessary based on the testimony by Ms. Liveratti.  The other costs would be for two half-time medical assistants to travel around to the centers, with a net cost of approximately $40,000.  Their role would be to help implement the application, take blood pressure, and staff training.  Including some travel expense and an analyst, the total package cost we are requesting is $140,000.

 

Chairman Rawson:

We are at the end of our session and, basically, our budgets are closed.        We might ask if there is opportunity to look into grants to help with such a program.  If we already have 20 sites with computers, I am just wondering if it is suitable for us to consider applying for some grants.

 

Ms. Liveratti:

We have our tobacco settlement grant funds, if that might be appropriate.  WorldDoc could apply for that.

 

Chairman Rawson:

Could you give Dr. Reeves and Dr. Singal a little direction on that process?  Most of my questions have been answered regarding the program.  I know my way around the medical field, but my sense of the program was that it was easy to do.  I tried to fool it, and it was able to point me in the right direction every time.

 

Senator Wiener:

My sense would be that seniors, once they build trust, become almost dependent on the computer.  Are you anticipating the library will continue to grow?

 

Dr. Reeves:

We have already prepared more than 950 conditions, with 18 specialties.  Health care changes are reviewed by a panel of specialists who give us   constant feedback concerning enhancements and updates.  We see WorldDoc, Incorporated, as a right arm to a physician, not a replacement to physician care.

 

Senator Wiener:

Many senior and disabled persons often wait until their condition requires emergency-room care, which is expensive.

 

Dr. Reeves:

One of the attractions of the site is the warning when a condition requires immediate physician care.  There are some elements to indicate self-care is the appropriate option, there are others that make one realize a doctor is really needed. 

 

Chairman Rawson:

It would seem this has potential for high schools and colleges.  Would it also be helpful for the disabled community?

 

Dr. Reeves:

Because this is so comprehensive, it includes the disabled and the young.  Often the disabled patient will focus on his disability and forget about other conditions that may sometimes be serious.

 

Bobbie Gang, Lobbyist, National Association of Social Workers:

I am curious; is this program limited to seniors only?  I believe there are other grant opportunities available for children and the disabled community.

 

Chairman Rawson:

Are you looking further than senior centers?

 

Dr. Reeves:

Yes, we are.  We believe this could be applicable to the entire population.

 

Senator Wiener:

You mentioned ongoing changes and upgrades.  Is there a built-in internal review that, if something has not been modified after a certain period of time, it is investigated?

 

Dr. Reeves:

Yes, the system has built-in reminders.

Paul Gowins, Rehabilitation Program Specialist II, Community Liaison, Community Based Services, Rehabilitation Division, Department of Employment, Training and Rehabilitation:

Many of us in the disabled community have computer equipment in our homes.  To have access from home would be ideal.  We could monitor ourselves without leaving the house.

 

Chairman Rawson:

That would certainly be desirable.

 

Dr. Reeves:

There are two core models.  A site license, and a subscription model for an individual.  Typically, this could be a part of an individual’s health insurance coverage.

 

Chairman Rawson:

That again is something a grant might be developed around to bring a certain amount of people in.

 

Dr. Reeves:

It does require security, so each household member would have his or her own identification number.  The information could be stored, and each time an individual account is activated, the information is readily available.

 

Senator wiener:

Is there a different rate if all the members of a household are included?

 

Dr. Reeves:

No, right now we want as much use as possible, because the benefits accrue from extensive use.

 

John Whaley, Management Analyst III, Division of Health Care Financing and Policy, Department of Human Resources:

I am wondering what disinterested third party has validated the accuracy of this site.

 

Dr. Reeves:

Signa Healthcare had the medical leadership at the corporate offices evaluate the accuracy of the program, and Sierra Healthcare services had a group of physician’s with multiple specialties independently evaluate this and give us a written assessment.  We have an international medical advisory panel that includes physicians from Canada, Great Britain, and the United States that have looked at this and validated it.  Each subject is referenced related to that condition.

 

Mr. whaley:

If an individual were to make an incorrect diagnosis and becomes worse, what is the liability to the state, if we provide this service within these different areas?

 

Dr. Reeves:

We have had this issue evaluated by legal firms from three different states, and they were of the opinion the risk is the same as for medical textbooks that are presently on-line.  There has not been a rash of lawsuits in those cases.  The program never comes to just one possible diagnosis, it always comes to three.  WorldDoc is an enhancement, not a replacement, to medical care.

 

Mr. Whaley:

It occurs to me that doing something like this might move Medicaid away from being a purchaser of health care services into an arena where we are providing diagnosis.

 

Chairman Rawson:

I can see a managed care contractor using this effectively.  In senior citizen centers we have people on Medicaid, Medicare, and private insurance.  This would be more of a service to direct people to where they should go rather than try to take over treatment.

 

Mr. Whaley:

How many people would use this in place of a physician visit? 

 

Dr. Reeves:

Until we have had more experience, we really do not have an answer.  There is simply not enough history.

 

Mr. Whaley:

What is the downside of WorldDoc?

 

Dr. Reeves:

There has been no downside reported as yet.  The people surveyed are those who used it.  We can only survey those who use it.  Those who do not want anything to do with it simply will not respond.

 

Chairman Rawson:

But the results of the survey do not indicate any negative feedback.

 

Dr. Reeves:

Not to date.  We have asked for complaints in order to make adjustments, and surprisingly have not had any.

 

Senator Wiener:

Could a type of Medicaid waiver come into play for this?

 

Chairman Rawson:

I think that is not a step for us to consider, and I believe our analyst brought that out.

 

Donny Loux, Chief, Planning, Research and Program Development, Rehabilitation Division, Department of Employment, Training and Rehabilitation:

I believe there are some very interesting applications shown here today.  Does the system have an information link to medical equipment and technology?

 

Dr. Reeves:

In the section called health helpers there are a variety of tools that we are developing; things such as support groups, that is, people wanting to connect to each other as a “virtual community.”  This is a suggestion that relates to new technologies and equipment to assist the disabled and serve as a reference point.  We have not yet implemented that, but we are continuing to look at all needs.

 

Robert Desruisseaux, Concerned Citizen:

As a disabled person, I see this as an important and useful tool.  It seems user friendly, and it might give the disabled community access to information that is hard to get.

 

 

 

Chairman Rawson:

I appreciate this presentation, and I think it was worthwhile.  Senator Mathews is requesting cost information to be repeated.

 

Dr. Reeves:

If you own your own personal computer, the cost for an individual subscription from home, is about $40 per year.  We have not yet started that model, but more and more people are asking for it.

 

Dr. Singal:

I just wanted to clarify the cost models.  A site license is about $100 per month, based on use.  The individual subscription we would like to offer through senior centers and, perhaps, Medicaid.

 

Chairman Rawson:

Be sure to talk with Ms. Liveratti about potential grants.  This meeting stands adjourned at 3:20 p.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

 

Cynthia Cook,

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Senator Raymond D. Rawson, Chairman

 

 

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