Medical Director Ron Loeppke, M.D., calls PhyCor's intranet his company's "neurological network." That's appropriate, because one reason to use the system is to pick other physicians' brains.
Nashville, Tenn.-based PhyCor is one of the first physician practice management companies to implement an intranet -- a carved-out portion of the Internet that's available only to people within a company.
PhyCor introduced its system in May. It followed Pediatrix Medical Group, a Ft. Lauderdale, Fla., neonatology and perinatology PPM, which introduced its intranet in January. Also, American Oncology Resources, Houston, on June 13 premiered a new, improved intranet after 18 months with its original system.
The companies see their intranets as educational tools for their doctors. In Pediatrix's case, on-line continuing education classes are available. At the least, the sites allow physicians to trade ideas of how to best treat patients, both through discussion and through the posting of clinical data.
At a time when PPMs are criticized for not adding value to the practices they acquire, the intranets are concrete examples of how such companies can give doctors services they couldn't have on their own.
No company requires its doctors to use its intranet, figuring instead that physicians -- despite a reputation for being technophobic -- will be interested in sharing and learning others' clinical ideas.
"It's what we call the economics of intellect," Loeppke says. "It's that we can learn from each other quickly, and we can distill and implement (clinical guidelines and improvements) across this infrastructure."
It may be no coincidence that PhyCor, Pediatrix and American Oncology -- three of the most well-regarded PPMs among stock analysts -- are the first to add intranets. Analysts respect these companies because of their strong management and their ability to integrate practices under their corporate banner -- a task many PPMs have struggled with.
Intranets can help integrate practices, says Ellie Kerns, a PPM analyst at BT Alex. Brown in Boston. Management inattention to intranets is "the biggest barrier to startup," Kerns says. "A lot of these companies have grown rapidly through acquisitions, but many companies haven't done a good job of integrating their practices. It's a matter of taking the time to do it."
The hook for Pediatrix's system is its on-line courses for continuing medical education credit, says Dennis Rhoades, the company's director of technical services. Pediatrix will host four-part courses in which neonatological experts will present classes replete with detailed graphics, including X-rays. Graphics weren't available when the company conducted these classes over the intranet's predecessor, a text-only electronic-mail system.
All the information presented during the courses -- which also include physician discussion groups -- is stored on the Pediatrix intranet so doctors can access it at their own convenience. Meanwhile, Pediatrix also finds World Wide Web sites pertaining to the class topics and links the class site to them.
The intranet also includes detailed clinical reports "based on real data on real babies," Rhoades says. The reports allow doctors to compare their outcomes with similar cases from other Pediatrix doctors.
Every Pediatrix physician has access to the intranet, and the system is installed "day one" for any doctors the company adds, Rhoades says. The new doctors can virtually thumb through Pediatrix's human resource manuals on the intranet, as well as see a list of hospitals where Pediatrix doctors practice.
Pediatrix tested its intranet with little fanfare before introducing the idea to its 300 physicians at the company's December 1997 annual meeting. But the doctors "went wild over it," Rhoades says. As a result, he says, the intranet has "become a real important project to the company."
So important, Pediatrix in 1999 is looking to sell access to doctors not affiliated with the company. The company also is planning to add information from a CD-ROM produced by Joyce Peabody, Pediatrix's vice president of research and education, that prepares physicians for neonatology board tests.
American Oncology Resources has been especially aggressive in getting its doctors involved with clinical trials -- it's involved in 32 trials involving 11 pharmaceutical companies. It's also using its intranet to identify patients who can participate in trials.
Clinicians can enter patient information on the intranet and get an immediate match of that patient to an ongoing clinical trial. The information is coded to protect patient confidentiality, says Bill McKeon, American Oncology's director of marketing.
The system also includes case reports that must be filled out for clinical trials, and sends alerts if those reports aren't filled out correctly, McKeon says.
McKeon says that for American Oncology, getting patients into clinical trials brings more revenue into the company and could help save lives. "Fifty percent of the patients we see die," he says.
American Oncology has had an intranet for 11/2 years, but the system was more of a file-storage area than an Internet-based, interactive program, McKeon says.
By having its doctors on an intranet, PhyCor is hoping to spread clinical information faster and more thoroughly than it has before.
For four years, PhyCor has hosted about 300 physicians for meetings at its Institute for Healthcare Management at the home office in Nashville. The best-practice approaches discussed during these meetings were distributed to doctors four times a year.
The meetings will continue, but for those who don't attend, discussions are posted immediately on the company's intranet site.
Meanwhile, PhyCor also sets up discussion forums on the intranet site and facilitates informal chat rooms where physicians can trade ideas. For example, doctors have discussed, formally and informally, how to track depression in asthma patients.
The intranet enables information dispersal to all the clinics and independent practice associations PhyCor is affiliated with, Loeppke says. "It all boils down to we're trying to empower physicians to improve clinical practice and improve the care that patients receive," he says.
PhyCor's intranet includes access to Medscape, a New York-based on-line disseminator of medical journals and clinical news with 120,000 physician subscribers. Medscape is a free site, but adding it to PhyCor's intranet is designed to make it easier for physicians to find it. The company also is developing its own intranet-based continuing medical education program.
The PhyCor intranet is used by 300 physicians on a voluntary basis, and the channel is expected to include all of the company's 28,000 doctors by year's end. Current users and those who join them pay occasional $100-per-practice fees to help with site maintenance. The frequency of those fees has not been determined.
Loeppke says he senses among PhyCor's doctors "pent-up demand" for such a system.
"I can tell you, this particular enhancement to our technology infrastructure -- and our ability to have content for clinical performance improvement across this neurologic system of communication -- is going to have a compelling impact over time on the practice of medicine and both the quality and cost-effectiveness of medical care," Loeppke says.
