The virtual doctor's visit -- aging studies don't tell much about its inevitability

Wait, wait, don't tell us. If we are patient, media reports will enable us to fully catch up with attitudes about technology in 2006. No, despite many of them in this blog, that's not a typo. So virtual doctor's visits were recently discussed in a NY Times article that I posted - "Are Doctors Ready for Virtual Visits? -- in which the answer was a definitive "no" based on a study published in the Journal of the American Medical Association (JAMA). 

But as one observant reader checked, that JAMA telehealth study, published in late December, 2009, was based on attitudes of doctors surveyed between 2004 and 2006! So the iPhone launched in 2007, Skype was bought by eBay in 2005 and by 2006, there were more than 100 million users -- apparently now there are more than 300 million users. Google launched video chat for Gmail in 2008. Hmmm -- you think between 2004 and 2006 doctors and nurses (outside of work) had much so-called virtual exposure?

How intriguing -- other surveys after 2006 contradict it.  Massachusetts General Hospital published a study in May, 2009 that separated patients into groups (in person and video-conference) and found that patients and doctors thought the experience was satisfactory.  That study was conducted by Dr. Ronald Dixon, who runs the Virtual Practice Project at MGH. Here's another online survey that showed split enthusiasm of 970 prospective patients about the 'concept' (not the experience).

Since 2006, some insurance companies and states endorse. Several insurance companies already reimburse for online (e-mail) visits with doctors -- as Aetna and Cigna began doing in 2008. And in states like Texas and Hawaii, online interaction with the doctor is now part of some family practices.  And Blue Cross of Minnesota announced the opening of a virtual clinic using American Well software and webcam.   

Forget the JAMA study -- here come virtual visits.  Medical practices, hospitals, clinics are well aware of a much-changed world and consumer health care costs that can be breathtaking. American Well's virtual visit platform use is growing, as are other virtual platforms discussed in our 2009 Calibrated Care report. They have read about transformation of self-care and virtual visits in Denmark. Given the geographic distribution of people -- and the distance required to get to doctors in some states and rural areas, given the availability of technology that was barely known or completely unknown in 2006, these are going to happen, reimbursement has begun, criteria for the use has emerged, and the JAMA study (and its much-syndicated press coverage) is already irrelevant.

 

 

 

Virtual Visits

As an orthopedic surgeon I do lots of virtual visits. New consultation sare often done over the telephone since I have access to medical records and xrays of patietns who live 4-6 hours away from my facility. We can determine if the patient is a surgical candidate, and if they want the surgery. Prior to surgery we see them in the office to do a physical exam and make sure they are set for the upcoming surgery.

Post op many total joint patients need to return annually or every few years. As surgeons we need to know that the patient has no pain, and has good looking x-rays. That does not require a visit. We use secure messaging. About 75% of my patients chose to have virtual visits rather then in person ones - and why not? - it is cheaper, and they don't have to take 1/2 a day off of work.

My prediction is that 30% of all visits to an orthopedic surgeon will be virtual within 5 years - 20% of mine already are (by patient choice!)

Telemedicine and the ICU different than 1 to 1

Laurie, I didn't quite catch in my analyses on Telecare Aware that the study was a little dated. The JAMA study was restricted to ICU teleconferencing and support; the staff were also given the option to take as little or as much remote monitoring as they wanted. And they didn't want it--that old 'big brother over the shoulder' again. See summary here: http://www.telecareaware.com/index.php/telemedicine-telehealth-universit.... Personal opinion: the 'intensivist' culture is far more 'hands on' and will take perhaps the longest to accept telemedicine (our terminology for teleconferencing over at TA.)

Speaking of terminology, you're right to bring up the point that 'virtual' is a misnomer.

All video is not alike. Video consults in the hospital setting (e.g. psychiatric, specialists to remote hospitals) are becoming more common, but the compensation model is still not there. That's not a problem with the VA and the armed forces, which are adopting mobile and video faster than the private sector.

One-to-one video visits I believe have a real future--why leave the house to travel to a 'minute clinic' 45 min. away if you've got a webcam, mike and thermometer? American Well is getting decent takeup on this, with OptumHealth starting with Texas, intending to roll it out nationally--and a flat $45/visit, no insurance needed. http://www.telecareaware.com/index.php/optumhealth-nowclinic-american-we...

Hurray for more up to date studies.

I have worked in the competitive telecom and Data industry for 40 years. Vendors tend to hang on to reports that show thier superiority. Many times these reports may be outdated and some of the products mentioned not even in existance. The past is an excellent measure of the future but we must continue to move forward. Thank you for updating us on today's virtual visit changes.

"Virtual"

I’m always baffled as to why American press articles (like the the one you refer to) keep referring to the Video Consultation process as “Virtual” and Video Consulting as “Video Chat”.

What’s “Virtual” or “informal” about a Doctor consulting with a Patient Face to Face?

Nothing 'virtual' about it -- but accepted terminology -- yes

Excellent point -- what folks call something when a computer is involved and patient is not sitting 3 feet from the doctor. Check out this (relatively recent) definition of virtual:

  1. Existing or resulting in essence or effect though not in actual fact, form, or name: the virtual extinction of the buffalo.
  2. Existing in the mind, especially as a product of the imagination. Used in literary criticism of a text.
  3. Computer Science Created, simulated, or carried on by means of a computer or computer network: virtual conversations in a chatroom.

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