The Hawaii Medical Service Association's much-advertised online health initiative appears to be on a slow-growth curve, with fewer than 10 people daily in April using the heavily promoted program.

HMSA yesterday released results from the first 3 1/2 months of the groundbreaking service, showing that about 800 consultations had taken place since it started on Jan. 15.

HMSA said it was happy with the response to the Online Care initiative, which is the first of its kind nationally and is being watched by health groups across the country. The program allows people to link up with doctors over the Internet or through telephone calls no matter what the time of day.

Patients using the program online can use just text messages, or talk via a Web cam, in real time with doctors. If they have health information available through Microsoft's HealthVault service, doctors may also glimpse health history in a real-time consultation that is offered over a secure system.

"We're pleased with the numbers," said HMSA spokeswoman Laura Lott, noting there almost 300 consultations in April and that the numbers continue to grow. "It's a building process."

About 4,000 people have signed up to use Online Care, or about 0.3 percent of the state's population. Patients who have used it give the system a thumbs up, with HMSA reporting 85 percent say the service is excellent or good.

Others still have reservations about the program, which makes available an online consultation system developed by Boston-based American Well.

Dr. Josh Green, a Kona emergency room physician who also serves in the state Senate, said any system that doesn't involve a face-to-face encounter has the potential for error and abuse in the practice of medicine.

"I have grave concerns about the safety of Online Care," said Green, who also serves as vice chairman of the Senate Health Committee.

"HMSA has developed and implemented this Mainland system without regard for the standard of care established by Hawai'i's medical community."

140 DOCTORS

HMSA has said the system isn't a replacement for face-to-face office visits and may be attractive to people who haven't had the time to make a doctor's appointment. Moreover, it sees the program as being an alternative to the 90,000 annual emergency room visits that are costly, but sometimes occur because no doctor's offices are open.

Lott said 140 doctors locally have signed up to offer consultations through the program and that one could argue the program has already saved a couple of dozen emergency room visits, or has been used in a couple of dozen cases where someone might have ignored a condition that was extremely serious.

"We look at it as a long-term tool for physicians to provide access to affordable, quality care," Lott said.

HMSA has spent heavily to promote the program, advertising on multiple evening television news broadcasts and morning programs, as well as online advertising, some print ads and radio spots. Lott would not disclose how much HMSA has spent so far, saying it includes proprietary expenses paid to American Well along with the advertising dollars.

Funding for the venture comes out of HMSA's reserve fund and not member dues. The program is open to all residents of the state, not only HMSA's more than 700,000 members.

FLU 'SPOT' CRITICIZED

One of the radio spots alarmed Green, who said HMSA was seemingly using the swine flu outbreak to direct people to online doctor consultations. HMSA's Web page for information on the H1NI flu includes four paragraphs that talk about the influenza followed by two that tout Online Care.

"If you're not feeling well, you can talk to a doctor right away instead of delaying care and possibly spreading a virus," the Web page says.

Green said that contradicts how the flu should be diagnosed.

"It is deeply irresponsible and reckless for HMSA to use the swine flu crisis to promote Online Care in their recent announcements, which falsely imply that it is safer for a patient in Hawai'i to use the Online Care system than to see a doctor in person," Green, a sometime HMSA critic, said in an e-mail.

"These assertions are medically unsound and undermine the professional standard of care established by the medical community in Hawai'i."

TV AD WITHDRAWN

Dr. H. Roger Netzer, a Kaua'i physician who heads the Hawai'i Medical Board, said the regulatory group did have a concern with a tele- vision commercial that seemed to indicate a child's ear infection might be diagnosed online.

Netzer said HMSA agreed to pull the ad after the medical board raised concerns.

"We felt that was emphasizing the wrong type of problem to be solved by the Internet," Netzer said. He said the board has worked with HMSA on the program in discussing peer review and quality assurance and continuing medical education for doctors who participate in Online Care on what's appropriate to be diagnosed through the consultations.

He said face-to-face consultations are still preferred for diagnosing ailments.

But both Green and Netzer said they believe the program could be an asset for healthcare, including those consultations where the patient has an existing relationship with the online doctor.

"It has potential," Netzer said.