The Hawaii Medical Service Association is moving ahead with an online doctor service that's being watched by the nation's healthcare industry because its the first of its kind.

Under the program anyone in the state, whether an HMSA member or not, can talk to a doctor by logging in or dialing the service 24 hours a day. If they have a webcam, the users will find themselves face-to-face with a physician. The service will begin Jan. 15.

The new service will be made available under an agreement with American Well, a Boston-based firm that says it is creating a new online marketplace where people can get convenient and immediate care. The agreement with HMSA is the inaugural effort for American Well's service, which has been spotlighted in the New York Times. In addition, virtual doctor visits, including the HMSA-American Well program, were cited in Reader's Digest as being among one of 18 ideas that could potentially help solve the U.S. healthcare system's problems.

"At HMSA we're excited about online care and the many benefits it has for patients, physicians, and the community at large," said HMSA Vice President Michael Stollar.

"We're also proud to be leading the country in implementing this innovative healthcare technology and believe it will go a long way to help improve access to care in the Islands."

Not everyone is as bullish on American Well's service, though. When the Wall Street Journal's health blog noted the arrangement between HMSA and American Well in June, some people posting comments to the forum said giving medical advice via a webcam is risky because it doesn't include a physical examination.

"OK, let's all stop and take a deep breath," said one online post writer. "Because as we all know, Internet makes it supereasy to palpate the lymph nodes, listen to the lungs, examine the throat and ears and do the testicular and breast exam."

Wrote another, "I am sure there are lawyers who are really looking on the outcome of this modern but dangerous technology."

But others on the forum said there are circumstances where the arrangement would make sense, such as follow-up consultations for chronic diseases, or instances where a prescription can be written when a child has a fever and is complaining about ear pain.

"Let's be honest, the traditional model isn't working," wrote a forum poster. "We have to all learn how to use this brave new tool safely and effectively. But it should not be dismissed."

HMSA doesn't see the program as a replacement for face-to-face office visits, Stollar said, but it may be attractive to people who've had a tough time finding the right doctor or scheduling an appointment.

"Because Online Care will be available anytime, it may be used after business hours, on weekends and holidays, and whenever a patient needs to speak with a physician right away," Stollar said.

HMSA has said the new service will improve access to care, especially in rural areas, and may help lower healthcare costs in the state. HMSA members will have a $10 co-pay for a 10-minute consultation, while nonmembers will pay $45 per visit. Payments will be handled by entering credit card or debit card information.

Doctors will receive $25 for each 10-minute visit, with after-hours consultations paying $30.

Members will pay $5 more for an additional 5 minutes; non-members will pay $15.

The system is structured so that patients can grant doctors acess to their HMSA health summary, or make information available from a Microsoft HealthVault account. The system will be available 24 hours a day, seven days a week.

In cases where the patient can't be diagnosed online, there will be no charge. A referral for an office visit can also be made.

HMSA has been looking for ways to lower healthcare costs in Hawai'i and in the past has offered programs outside the scope of its insurance work, including grants to hospitals and physicians for electronic medical records systems and a pay-for-performance program that rewards physicians and hospitals for health care quality, patient safety, patient satisfaction, and efficiency.

It sees the online care program as potentially helping in several areas, including cutting down on the state's 90,000 annual hospital visits that have an average cost of $770. It also could reach young adults who don't have healthcare insurance, but can afford the $45 nonmember fee.

HMSA declined to disclose how much it is spending to promote the new offering, or what it's paying for a licensing fee from American Well, which also will provide malpractice insurance to the online doctors.

The insurer also said it does not mind being the first and only health plan to offer the service though it said that American Well is in discussions with several other health plans. HMSA will pay for the program out of its reserves.

About 50 doctors have signed up to be part of the program. HMSA said it expects more to sign up in coming weeks.