When Julie Swanson needed a doctor’s advice about shoulder pain last year, she didn’t want to take time during the workday for an office visit.

So the 57-year-old Burnsville resident used an online video connection to talk with a physician through her computer. The doctor reviewed her pain medications and showed her some new stretching exercises, all within a 10-minute visit that cost $45.

“When you think about the time that it takes to go, make an appointment and sit in a doctor’s office – something like this is invaluable,” Swanson said.

It was a similar experience for Shaun Steffen, 45, of Hugo, who turned to an online health service earlier this year when a urinary tract inflection flared up.

After filling out a questionnaire about her symptoms, Steffen received a treatment plan and a prescription that did the trick – all in about four minutes.

“I was really impressed with the speed,” Steffen said. “I definitely would recommend it.”

The testimonials sing the praises of a trend that can be dubbed “online care” or “telehealth” as doctors, nurse practitioners and physician assistants start to provide medical treatment through the Internet and mobile devices.

The Twin Cities market appears to be an early adopter of online care services, with offerings from Eagan-based Blue Cross and Blue Shield of Minnesota and OptumHealth, a division of Minnetonka-based UnitedHealth Group. Forms of online care also come from the medical group at Bloomington-based HealthPartners as well as a St. Paul-based startup company called Zipnosis.

But as health care providers begin to dabble in online care, it’s unclear exactly what form of web medicine will prove the most popular with patients. Swanson and Steffen, for example, used two very different services – one provides a chat with a doctor on a wide range of topics, while the other guarantees a treatment plan from a nurse practitioner for a limited number of problems.

It’s also not clear whether insurers, entrepreneurs or health systems will drive the trend. The St. Louis Park-based Park Nicollet Health system said this month, for example, that after completing a one-year pilot project with Zipnosis, it plans to go in a new direction with online care.

“This is the very beginning stages of this industry,” said Tom Charland, a health care consultant with Merchant Medicine LLC in Shoreview. “The thing you have to remember is the acceptance factor….Not everyone is going to be willing to receive medical care through their home computer.”

MN Community Measurement, a health care quality group in Minneapolis, said that about 13 percent of medical clinics surveyed in the state – 152 out of 1,198 – said they were offering electronic visits in 2010. this year, the number doubled as 334 clinics of 1,313 surveyed – 25 percent of the total – said their clinic or organization offered e-visits.

It’s likely that many of those clinics were providing online care through one of the four prominent services.

“I am not personally aware of any physicians or other professionals who are providing online care independent of (those) large organizations,” wrote Dr. Patricia Lindholm, president of the Minnesota Medical Association, in an email. “It is not likely a profitable line of business in and of itself and liability insurance is one of the costs.”

When it comes to e-visits, Blue Cross got the ball rolling locally in 2009 with a program called Online Care Anywhere, a virtual clinic that initially linked employees of the health insurance company with providers from Minneapolis-based Fairview Health Services.

In spring of 2010, the insurance company began making the service available to employees of several large national employers that do business in the Twin Cities, said Sig Muller, the company’s vice president of business development. Then, late last year, Blue Cross opened up the service to anyone in Minnesota.

Now, people who use Online Care Anywhere do so in one of two ways: Either they log on and pay $45, or they have free access because their employer has purchased a subscription that’s independent of the health insurance plan. Muller said the top health complaints handled through the system so far include sinusitis, urinary tract infections and upper respiratory infections. Doctors can offer advice and prescriptions through the system.

The Twin Cities could lead the online care trend nationally, Muller said, much as it did with MinuteClinic, an operator of health clinics that are located in retail stores. MinuteClinic was based in Minneapolis before being acquired by Rhode Island-based CVS Caremark.

“It certainly is never going to completely replace visits to the physician’s office,” said Muller, who would not say how many patients have used online care through Blue Cross. “The intent is really to complement it.”

Blue Cross wasn’t alone in developing the online care model last year.

Zipnosis announced in 2010 its pilot project with Park Nicollet to treat 10 simple medical problems for patients who submit answers to a confidential online interview about their condition. If the responses suggest the patient can be treated through Zipnosis, a clinician then makes a diagnosis and suggests treatment options that can include a prescription. Patients are notified with an e-mail or text message.

In the past year, more than 5,000 patients have used Zipnosis, said Jon Pearce, the company’s chief executive officer. More than 40 percent of those who used the service are Park Nicollet patients, Pearce estimated, but he said the health system’s recent decision to not continue the pilot project is not a setback.

“Having a big provider group behind us gives us a little more velocity in the marketplace,” he said. “But we have plenty of high-quality medical providers that can provide care.”

In addition to Minnesota, Zipnosis now is operating in conjunction with medical clinics in Washington state and Colorado. The company has been backed financially with $600,000 from angel investors and has drawn on former leaders of MinuteClinic for executive talent.

“In the next 10 years, we’ll leapfrog retail care,” Pearce predicted. “There are a lot of macro-economic factors that will give a lot of financial incentives for patients to use online care….They’re becoming much more cost-conscious.”

The Virtuwell service from the medical group at HealthPartners also launched in 2010 and has many similarities to Zipnosis. Patients provide information about their illness through a secure website that’s designed to screen out those who might have more serious health problems.

So far, Virtuwell has handled just more than 7,000 cases. But the system has evaluated another 21,000 cases where it referred patients elsewhere for care – neither Zipnosis nor Virtuwell charges patients in such cases.

About 70 percent of people who’ve used Virtuwell have paid for the service as part of their health insurance, said Kevin Palattao, a company vice president. in those cases, a patient might pay their typical copayment for an office visit or convenience care visit, depending on the health plan.

About 30 percent of users pay the flat $40 fee for Virtuwell, which offers online diagnosis and treatment of about 40 common conditions. as with the other online care services, patients with uncomplicated urinary tract infections – where antibiotics can quickly provide relief – have been frequent users of Virtuwell.

“If you have had a urinary tract infection and you develop symptoms again, most women are spot on – they say, ‘This feels exactly like it did the first time,’ ” said Gwen Verchota, a nurse practitioner with Virtuwell. “I don’t think we’ve had a night when we haven’t treated a urinary tract infection.”

The OptumHealth division of UnitedHealth Group opened its NowClinic online care service to workers at Delta Air Lines in June 2010. That gave Minnesota-based employees of the airline “access to quality care when they’re on a layover in Poughkeepsie,” said Chris Stidman, a vice president with the firm.

Later last year, the company made the service available to all residents of Minnesota regardless of their health plan affiliation. as with the Blue Cross program, patients using NowClinic can ask to talk directly with a physician about any number of health issues, but doctors make the call about whether the consultation can be provided online or should instead involve a face-to-face visit.

Women have been the primary users of the system, Stidman said, especially women with children. The company’s data suggests “about 10 to 12 percent of the care that was delivered in either urgent care centers or emergency rooms could have been delivered in a clinically appropriate way via a telehealth solution,” he said.

Like the Blue Cross service, NowClinic provides a 10-minute visit for $45. whereas the Blue Cross online care program is open for business only during certain hours, NowClinic is always open. Stidman noted, however, that doctors using NowClinic in the middle of the night might respond by phone rather than through a web camera.

Similarities between the Blue Cross and OptumHealth systems aren’t surprising because both companies use a Boston-based information technology company called American well.

Many telehealth visits through the company’s system are for minor illnesses of the sort treated in retail clinics, said Dr. Roy Schoenberg, the co-chief executive officer of American well. But many others are for patients with chronic conditions who need better access to doctors to manage their ongoing health problems, he said.

Health insurance companies have led the charge with online care because they recognize the potential for savings, Schoenberg said. But American well has tried to differentiate itself by focusing on the central role that doctors play in providing care.

“When you ask people what health care means to them, to most of them health care is talking to a doctor,” he said. “That’s fundamentally the health care transaction that most people are carrying out.”

Doctors say they are closely watching how all this plays out.

Lindholm, the president of the Minnesota Medical Association, said her group does not have an official position on online care. But most doctors think e-visits should be provided in the context of a patient’s established relationship with a physician office, which could have better access to medical records.

Lindholm noted that patients might be able to get the same services they find online without a fee by calling their clinic’s nurse line. in some ways, online care is similar to the “telephone care” that doctors have tried to give patients over the years, Lindholm said, but the experience suggests a few cautions.

“We do feel somewhat handicapped and at-risk by not being able to examine the patient,” Lindholm wrote in an email. “Things may sound more serious or less serious than they actually are over the phone and misjudgments are a greater risk.”

Christopher Snowbeck can be reached at 651-228-5479.

My husband asked me to post this question, to see if anyone knew anything about the symptoms of liver stones. the word appears on Google listing, but I can't get any further information about it there. these are supposed to be another kind of "stones", separate from kidney and gall stones. Would anyone have any information about this? Thanks in advance for your comments.

Perhaps he means gallstones? the Gallbladder is under the liver and stores the bile. Stones come from either heredity or high cholesterol. They are calcium deposits that can block the flow of bile. Shoulder pain is common and sometimes there are no signs at all. have hubby see a dr if he feels there is an issue.

I was told i have a cyst and was not that concerned until i started having some symptoms. Really dark brown discharge or blood, shoulder pain and a fever a times. should i go to the doctors again?

When i had a cyst i had a sharp pain on my side like close to the hip. And one time the pain got to bad i went to the hospital and they found blood in my urine and i was told that it grew. if you are having a pain on your lower side like hip area then yeah, if you are having blood discharges and if you notice it in your pee( kind of hard to detect) but if you do get to the ER they may need to surgry to remove it, thats what they did with me. good luck and hope everything is ok. Prayers with you!

I have been given that as a result of tests but with no help as to what course the disease is likely to take thank you Babs

Neck and shoulder pain are the most common symptom. Types of neck and shoulder pain include:
stiff neck, most often one of the very first signs. Neck stiffness tends to grow progressively worse over time.
Radiating pain to the bottom of the skull and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.2
Along with pain, cervical spondylosis can be accompanied by parathesias and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands”. in cases of cervical spondylosis with myelopathy, the legs may be affected, leading to an interruption of stability while walking. Loss of balance might also occur. when myelopathy is present, incontinence may become a problem. Muscle wasting also accompanies cervical spondylosis with myelopathy.

Unfortunately, cervical spondylosis is a condition that gradually gets worse. in very advanced cases of this condition, often mobility can only be achieved with a cane or walker.

Here is a site you can go on.

spondy "Greek for a slip..losis=Greek for colum.but here in America we simply call it a slipped disk.I had one,not in the neck but in the lower back "L-5 S-1"area,they say it has i think 3 stages it's judged on 1,2,3 I think stage 3 is the worst,not a doctor and not sure.they fixed mine by a spinal fusion. best advice I can tell ya search cervical spondylosis on the web site,try only looking at the sites the end with .gov
.gov sites are the most dependable..you will probably need a fusion,if so spend all your time looking up spine fusions on the web,find the one's that offer video/pictures of how it's done.the more info you get the less you'll be afraid of the surgery.