Dr. Fabius identified the "value propositions" of the Internet for these constituencies-namely, connectivity, streamlined processes, content, commerce opportunities, and self-service. Electronic connectivity, he maintained, will lead to administrative efficiencies, which in turn can provide the resources for improving the effectiveness of care and worker productivity.

He acknowledged that the viability of e-health in the marketplace remains questionable. He categorized the five ways that new economy companies can make money on e-health care sites: by advertising /sponsorship, commerce, hosting sites, subscription fees, or by licensing content. "But the new economy has it backwards," he said.

Instead, he noted, the old economy companies have a huge advantage in e-health, because they already know how to make money on their present products. Even if these companies cannot profit from one of the five "new" ways, they can reap the benefits of administrative efficiency.

Building trust among consumers is critical to the continued development of e-health, Dr. Fabius noted. Recently, Aetna, in a coalition with 19 of the most widely used Internet health sites, created a Web Site called HI (Health Internet) Ethics. This coalition has developed 14 ethical operating principles to help consumers find reliable health information and services on-line, and will establish criteria for accrediting sites that fulfill these principles.

Dr. Fabius used Aetna's electronic initiatives to illustrate the many applications of the Internet in health care. Aetna has recently developed an online tool, known as Aetna Navigator, that combines resources and health information from a number of its programs. Through this tool, Aetna subscribers can find a provider (DocFind®), search for health content (Intelihealth®), and browse various disease management and patient education programs. "DocFind® is so popular that during open enrollment we're getting over 1 million hits a week," Dr. Fabius said. InteliHealth® features consumer health information from Harvard Medical School and receives more than 1 million hits per month.

The promise of an integrated platform for improving care is enormous, Dr. Fabius added. It can draw in information from data warehouses, link data with patient information and health content, and direct patients to programs they need. Providers could get clinical information, in real time, to help them manage care. Large employers can pull out, in an aggregate form, information about their employees to improve the amount and shape of the benefits package they offer.

Aetna, along with six other health plans, has formed "MedUnite," a company charged with designing a universal transactional platform for plan and provider interactions. "It's the ATM concept for health care delivery," Dr. Fabius said. If MedUnite succeeds, he claimed, providers may be able to receive payment for an office visit before the patient leaves.

He encouraged his audience to think broadly and creatively about Internet space, and its possibilities for changing the way health care is delivered. At its most basic level, the content of most e-health sites is "informational"; that is, like an encyclopedia. The next phase of development adds interactivity to sites; in its simplest form, this can be a search engine to navigate through the encyclopedia. But in the future, e-health sites will be interventional, meaning that they can do something to affect health status. For example, parents may be able to enter a child's age and receive his or her immunization status; if the child needs any immunizations, an appointment may be made with the pediatrician, all over the Web. Finally, the Internet may be able to actually deliver certain therapies, for example, psychotherapy. "In the not-too-distant future," Dr. Fabius predicted, "there will be products that give you the opportunity to meditate, or relax, or deskercise."

Biosketch:
Dr. Fabius, chief medical officer, oversees the company's collection of information, services and features. Before joining InteliHealth, Dr. Fabius served as senior corporate medical director of national accounts of Aetna U.S. Healthcare. Prior to the merger of Aetna and U.S. Healthcare, he was the corporate medical director of patient management, disease management and quality management for U.S. Healthcare. Before holding that position, he was medical director of CIGNA Health Plan of Pennsylvania, New Jersey and Delaware and was president of an eight-doctor private pediatrics practice of about 16,000 patients. The author of two books for physician executives, Dr. Fabius sits on the Accreditation Standards Committee of the National Committee for Quality Assurance and is a faculty instructor for the American College of Physician Executives. He has held faculty positions at several Philadelphia area medical schools. Board certified in pediatrics and medical management, Dr. Fabius received his medical degree from Hahnemann Medical College in Philadelphia and completed his pediatrics residency training at Children's Hospital of Los Angeles