The Life Ledger

Fitness is a way of life.

photo credit: john-norris

I recently read an interesting article on Medical News Today reporting health insurers will begin covering online physician visits:

Health insurers Aetna and Cigna have announced that they will pay for online physician visits, and patients will be required to contribute a copayment for the visits, the Philadelphia Inquirer reports. Aetna on Jan. 1 expanded a pilot project in California, Florida and Washington state to the rest of the country, and Cigna said it would begin paying for online visits in January 2009. The insurers believe that members will like the service because it can improve efficiency and could prevent more costly problems, the Inquirer reports.

Of course, my initial reaction is - is anyone actually offering online physician visits? Apparently so, if heavies like Aetna and Cigna are getting in the game. Physicians don’t (typically) obtain technology degrees or have the programming skills necessary to open up their practice to an online community, so the first step is supplying physicians a “web visits” framework. Cigna and Aetna both partner with RelayHealth, a company that enables “web visits” through services including online medical chart storage, online appointment scheduling, automated interviews that serve to triage the patient before communication to the physician begins, online prescription center, and a payment/collections/insurance filing center. RelayHealth maintains an entire page describing the benefits and features available to patients, which can be summarized by these two FAQ answers:

What is a webVisit®?
A webVisit is an online consultation between a doctor and an established patient about a non-urgent healthcare matter. When conducting a webVisit, RelayHealth guides you through an interactive interview process appropriate for your specific symptoms, and then builds a succinct message to the doctor based upon the answers you provide.

How do I send a message to my doctor using RelayHealth?
Once you successfully register with RelayHealth and your doctor agrees to communicate with you through the service, easy-to-use, structured templates allow you to consult your doctor about specific health symptoms (we call this a webVisit consultation), request a prescription refill, request appointments, receive lab or test results, ask a simple question, or access health education information — depending on the types of RelayHealth services your doctor offers.

Apparently, companies that assist in enabling physicians to offer medical services online are stating to sprout up. But are any physicians actually offering online services? Recently, ReadWriteWeb reported on the Health 2.0 conference, part of which was dedicated to the “web visit” phenomenon:

Jordan Shlain founded the San Francisco On Call Medical Group, a group of doctors who make house calls almost anywhere their patients want to see them (home, office, even cruise ships) using a souped-up, hi-tech version of the doctors’ venerable black bag.

Jay Parkinson is aiming to be the “small town doctor of Brooklyn ,” using video camming, text messaging, email and chat to help treat his patients.

Both Jordan and Jay showed how different the standard model of health care can be — but also revealed the huge gap between the existing system of health care and the state-of-the art technology that potentially could be harnessed to serve patients at an ordinary level. In the end, this gap is the core dilemma facing the Health 2.0 efforts to transform the industry.

We’ve come a long way from using the Internet to display office hours and send X-rays to other countries for analysis. It appears that soon, patients will have true 24-hr access to non-emergency health care. Add Second Life to the mix, and things get even more interesting - take, for example, this Flickr slideshow demonstrating some interesting possibilities. And soon, with services like Carol getting a start, we may have access to a-la carte style healthcare, where patients purchase “care packages” and receive the care at any participating location.

With all these changes afoot, the real question is - will patients use the services? What about you - are you excited by the possibility of receiving healthcare with an instant-messaging client and web-cam, or will you always expect on face-to-face treatment?

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A friend recently had an interesting problem - he wants to promote the use of podcasts to instructors as a component of courses taught online, and identified the excellent, open-source Audacity as their Windows tool of choice. However, as he began writing documentation for installing and using Audacity, he realized many instructors would be immediately turned off by the complicated installation process required to set Audacity up for exporting projects as mp3 files - many instructors who could otherwise be taught how to record and save projects would not understand how to unzip LAME, copy the DLL file into Audacity’s folder, then point Audacity to the lame encoder. Instead of writing thorough documentation that would likely daunt non-savvy instructors, I suggested an alternative - creating our own installer. It worked so well, I thought others might benefit from the idea.

First, a word about licensing.
I originally wanted to provide the one-step Audacity/LAME installer as a downloadable file, but started reconsidering after looking into license issues. Audacity and LAME are themselves covered by GPL/LGPL and therefore are re-distributable; however, I can’t tell what the SetupStream license terms are, and the patent mess covering the mp3 format may prevent distributing a package that installs Audacity with built-in mp3 output. Since I can’t really tell, I listed the steps required to make your own installer, and you can choose how you use or distribute it.

Step 1
First, I downloaded the tools I’d need. Since I was creating a custom installer, I needed the zipped version of Audacity, not their installer. Additionally, I needed LAME and an installation creator with the ability to insert registry keys. After trying a couple install creators, I chose SetupStream - it’s easy to use, freeware and offers a wide array of features, including all those I need.

• Audacity 1.2.6 - look under “Optional Downloads” for the zipped version
• LAME 3.97 - I used the 3.97 bundle available at RareWares (direct download link)
• SetupStream 2.082

Step 2
Next, some preliminary steps: unzip Audacity into its own folder, then unzip the file lame_enc.dll from the LAME zip file into the the same folder that contains Audacity.exe. Install and start SetupStream, select Create New Setup and click Next.

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