Doctor builds Web care system

Sitting before a laptop in a loft-style office in Brooklyn’s Williamsburg neighborhood, he talks about what ails the US healthcare system - skyrocketing costs, excessive use, bureaucracy - and why the cure is not the universal insurance Democrats are talking about on Capitol Hill, but rather “disruptive technology.’’

He means technology that jolts systems into making dramatic progress or the Facebook-style software he is developing for Hello Health, a national franchise of clinics he is building where patients can e-mail, text, or videochat with doctors over a secure website.

“We have in-person relationships with patients in our neighborhood, and we communicate the way we all communicate nowadays,’’ he says.

Fast Company magazine has hailed the 33-year-old Parkinson as “The Doctor of the Future’’ because he aims to bring to medicine the kind of easy relationship to technology that most doctors have not yet embraced.

An ad for the company promises: “No more frantic Googling, no more whole days away from work, no more long waits, and no more unnecessary ER visits, or scary receptionists.’’

The simplicity and visual appeal of demonstrations of the Hello Health software platform have made him a celebrity in the health technology world.

Whether Hello Health will be able to live up to the hype remains in question. The three-physician demonstration clinic he opened last July has treated 700 patients, 400 of whom have become regular patients. The average primary care office has perhaps 2,500 patients per doctor, the average concierge practice has 800 to 1,000.

The company plans to add clinics in New York and elsewhere this summer.

And Parkinson, who was trained as a pediatrician but no longer practices because he is working full time on developing the company, and Nat Findlay, the firm’s Canadian cofounder, are both optimistic about their chances.

The Hello Health website, to be launched this summer, will give patients access to a secure website where they can exchange messages with their doctor in a blog-style format. Specialists could eventually join the conversation (imagine your family doctor meeting with your neurologist, and you get a written record of what everyone said.)

In an early version, patients can pay bills, schedule appointments, or view medical records and lab results in a couple of clicks.

At the Williamsburg practice, a quick visit with a doctor, in person or online, costs $100; more complex visits cost $200. Simple e-mailed questions are covered under the $35 per month membership fee. Hello Health does not accept insurance, though patients who are insured can send the bills to their insurance company for reimbursement.

Most insurers will not pay doctors for answering simple questions from patients by e-mail; reimbursement usually depends on an in-person office visit. Less than 20 percent of doctors e-mail their patients, and even fewer talk with them on Skype, said Steven Waldren, director of the Center for Health Information Technology of the American Academy of Family Physicians.

“Right now, in most of the current insurance plans, all I can do is see you in the office. . . . That’s the only way to get reimbursed,’’ Waldren said.

Medicare and some insurance companies have begun to provide incentives for using technology to improving quality, he said, but it is not anywhere near the same money as an office visit.

Hello Health has invented “a financial model that allows them to step outside those constraints and experiment and innovate,’’ Waldren said.

Hello Health is targeting the small group of patients in the $2.5 trillion-a-year US healthcare industry who pay most of their bills in cash or by credit card, mostly those without insurance or with high-deductible plans. But Congress, as part of a massive health overhaul, is strongly considering a mandate that everyone have insurance.

Parkinson says it doesn’t matter. The national shortage of primary care doctors is getting worse, because doctors are not paid enough and have too little time with patients.

If everyone has to have insurance, waiting rooms will get more crowded, as they have in Massachusetts, he reasons. Thus, many people will be willing to pay up front for the convenience of being able to videochat or get a question answered by e-mail or just to get an appointment in a reasonable amount of time.

But even many of Hello Health’s admirers wonder about its prospects if a national health insurance program is adopted. Dr. Paul Heinzelmann, a primary care doctor from Boston, has closely watched the company’s development over the last year. He likes the technology and loves the focus on creating a better experience for primary care patients and doctors and is seriously considering using the Hello Health software platform in his part-time housecall practice.

But he questions the business model. “When health insurance is mandated, it’s more difficult to see how Hello Health can create a scalable model of healthcare and actually keep a doctor employed full time,’’ he said.

“I think if Hello Health can have a working sustainable model, I think more and more doctors will jump on board,’’ said Heinzelmann. “But it’s too risky, in my opinion, to completely switch over to a system that hasn’t proven itself yet.’’