Someday soon you will call your doctor’s office for an appointment and will be offered a “video visit” instead. A scheduled video appointment with your doctor using your computer or smart phone. An 11:30 a.m. appointment that you can get ready for at about 11:28 a.m. No rushing to the office, no fighting traffic, no sitting in a waiting room, no butcher paper covered bench in a freezing exam room.
That could be reality tomorrow, or even today. In fact video visits have been available for over a year in some Bay Area practices.
Video visit technology, also known as telemedicine, is “the provision of medical care remotely by means of audiovisual technology,” and it is happening all over the world as we speak. Most major insurers are offering telemedicine including the company I work for (although — full disclosure — I have yet to have a patient take me up on it).
Telemedicine is also being used in the hospital setting — bring virtual specialists to the Emergency Room or even the Intensive care unit.
But the most promising use of telemedicine is replacing the traditional doctor office visit. Technology improvements including broadband availability and the near ubiquitous availability of home video technology via laptop computers and smart phones make telemedicine an option for almost everyone. For those living in remote areas, or disabled individuals, telemedicine may be the only option for routine care.
But what are the challenges and how do we overcome them?
According to a recent New England Journal of Medicine Perspective piece, there are five major challenges:
- Is telemedicine effective and cost effective? It is too early to tell. Video visits are a patient pleaser, but it is not clear that telemedicine is as effective as “in person” medicine. Certainly some types of problems need to been seen in person. You can’t exam an injured knee over video. But other complaints that don’t require an exam, including mental health visits, lend themselves to telemedicine. But are the outcome of those video visits as good as office visits? We just don’t know yet.
- Where we do have data on telemedicine, the findings are quite mixed and there is no good roadmap on how to make video visits more effective. The technology exists, but the best use for telemedicine is still unknown.
- We don’t have legal and regulatory rules on telemedicine yet. That may sound like a good thing, but consider issues like privacy, cross-hospital or cross-state video visits. In the future you could even have a visit with a doctor in another country. Most would agree there should be some regulation over provision of health care from a foreign country, but such regulations are nonexistent. There is also no licensing or credentialing, important issues for providing in-person care in this country.
- Are there unintended consequences of telemedicine? Could telemedicine actually be more expensive than traditional visits? By expanding opportunities for care, will there be an increase in demand? And how will doctors and insurance companies get compensated?
- And most important, how does telemedicine affect the doctor-patient relationship? Will there really be a relationship without that personal connection?
Our job is to tackle these issues head-on because telemedicine will be used extensively in the next few years.
My own take? Make sure you see your doctor or health-care provider at least once in person. If you are over 65, you may even want to do that once a year. But for minor issues — rashes, medication mix-ups, colds, travel advice, etc — consider a virtual visit (that can include email, texting, telephone or video).
It’s time for even the most ancient dinosaur doctors — present company included — to join the 21 st century.
Date: May 11, 2015