BOSTON – The patient portal launched in July 2007 at the Mayo Clinic was running smoothly until bedlam broke loose last December.

The Medfusion system was on overload due to the software company's rapid growth, and for a month or so, online access was sporadic.         

Such are the growing pains as doctors embrace the technological revolution.

Mayo's experience with its first ePatients was the topic of an Oct. 14 presentation at the annual scientific assembly of the American Academy of Family Physicians in Boston.

John Bachman, MD, a consultant in family medicine at the Rochester, Minn., group practice, detailed Mayo's switch from on-site appointments to online visits, highlighting the experiences he faced as lead coordinator. Bachman wore a Star Trek costume to underscore the warp speed changes in store for family practitioners.

"Traditional family medicine is merging with the technologies and processes of the 21st Century," he noted. More than 2,200 Mayo patients have used the pilot program so far, he said.

Medfusion, Inc., of Cary, N.C., offers Web site development, clinical solutions and front- and back-office needs, such as patient pre-registration and online payments. Images can be digitally transmitted via cell phone to the doctor's office, where conditions such as skin rashes are treated remotely for a fee. Medicare will not reimburse, but several private insurers will.

Training staff to use the online system was a cultural shift and counter-intuitive process, said Bachman. Classroom lectures flopped, he said, but when staff delved in, they mastered the learning curve.

"It was sink or swim," said Bachman. "They all swam."

Through a secure portal, patients can request prescription refills and communicate with practice staff. The documented correspondence legally protects the physician from the vagaries of a conferring phone call, said Bachman.

"If it's online, you've got proof of what you did and didn't do," said Gordon E. Riddle, MD, a family physician from Bracebridge, Ontario.

The system can handle online credit card payments, reducing statement delivery and collection costs. Mayo collected payments on 50 percent of the visits through insurance or directly from the patients, Bachman said.

To resolve the overload crisis last winter, Medfusion "deployed new critical infrastructure while redeploying and distributing applications in its production datacenter," said Yvette M. Cole, the company's marketing manager.