Five reasons virtual doctor visits might be better than in-person ones

By: Jonah Comstock | May 8, 2013        

Tags: | | | | | | | |  |

Vidyo Healthcare PhilipsIn relatively few years, videoconferencing has advanced tremendously, from something that required expensive and complicated hardware setups to something most smartphone, tablet, and PC owners have easy access to. Using video for virtual visits in healthcare is a little more complicated — the connection has to be reliable and the service HIPAA compliant to protect patient medical information — but nonetheless virtual visits are gaining popularity as a new way to deliver healthcare.

Becky Wai, a spokesperson for online video service VSee, told MobiHealthNews on the sidelines of the American Telemedicine Association (ATA) meeting in Austin this week, that of the 900 million doctor visits that took place in the US in the last year, about 50 percent of them could have been done remotely.

Of course, virtual visits can’t do everything that a doctor can do in-person. But in the average primary care checkup, a patient sees a doctor for about 7 minutes. In that context, it’s not hard to see the advantage of cutting out the extra time and making the most of a short visit. Many speakers at ATA said that virtual visits aren’t just a “good-enough” replacement for when a “real” visit isn’t possible. In many ways, virtual visits are actually superior.

1) Convenient for both patient and doctor

Vidyo, which offers device-agnostic HIPAA compliant videoconferencing software, announced a deal at ATA to provide video conferencing services to the Alaska Native Tribal Health Consortium, that will connect 2,500 providers at 200 different sites to patients. Connecting people to care in rural areas is a classic use case where a video visit is much more convenient than an in-person one, but it’s far from the only such case.

Barb Johnston, CEO and cofounder of online clinic HealthLinkNow, said her company’s services come in handy for patients who don’t want to leave their home because of PTSD; patients with a new baby who are being treated for post-partum depression; and patients who are in jail, including patients who could present a risk of harm to their psychiatrist. Her practice also offers up telepsychiatry care in primary care settings.

“We’ve been linking in all over and that has been phenomenal,” Johnston said. “Patients prefer to see a mental health provider in their regular doctor’s office. No stigma. We beam in when needed, and get out of the way when we’re not needed.”

Services like VSee and Vidyo work on a growing number of consumer devices and strive to be quick and easy for a patient to download.

“Patients have said to me, before I had to take a half day off work — now I just leave work early,” said Dr. Ray Dorsey, director of neurology telemedicine at Johns Hopkins Medicine. “We can get to the point where people make decisions about where they live or where they retire without having to think about their care. They can live where they want and the care will come to them.”

2) A virtual waiting room is better than the physical one

Nobody really likes waiting in a doctor’s waiting room. Aside from the general annoyance of waiting, it’s problematic for sick people to surround themselves with other sick people, especially for the elderly or those with weakened immune systems.

“It seems like an assembly line,” said VSee’s Wai. “You can wait in your own home, be comfortable.”

Johnston at HealthLinkNow has implemented a virtual waiting room that replaces old magazines with health-relevant animations. While patients are waiting for their doctor to be ready for a virtual visit, they have access to that specially created online material, designed to both entertain and educate the patient about health risks.

3) Increased patient engagement thanks to screensharing

Video conferencing doesn’t just let doctors and patients see each others’ faces. VSee showed off a platform at ATA that enables doctors to bring up a patient’s chart or past radiology record and annotate it with a virtual pen during the conversation. This helps the doctor show patients very specific visuals. One partner, the University of California at San Francisco (UCSF) cancer risk program, uses the service to show patients their cancer pedigree and discuss it.

HealthSpot, a company that has developed health kiosks which include virtual doctor visit capabilities, takes advantage of Vidyo’s API for connecting devices. During a virtual visit, a doctor can listen to a patient’s heartbeat, take their blood pressure, and look in their ear with a connected otoscope, to name just a few devices.

This is yet an area where the virtual visit outshines the in-person one, because, for example, the e-otoscope’s readout shows up on the patient’s screen as well as the doctor’s, allowing the patient to see inside their own ear in near realtime. This makes it easier for doctor’s to explain procedures or conditions and for patients to be even more of a partner in their own care.

4) More convenient, automatic record-keeping

In addition, because doctors are already using camera’s in remote care it’s very easy for them to securely and privately take and save a relevant medical photo, via a connected otoscope or dermoscope. That means when the patient is in for a follow-up visit, the doctor is more likely to be able to compare anything unusual to how it looked in the last visit. On the doctor’s end, the patient’s EHR can be pulled up right alongside the real-time videofeed, making it more convenient for the doctor to update information. If information is being gathered through data input on the patient’s side, as with HealthSpot, that information can even (potentially) populate directly into the EHR.

5) Patients feel like doctors pay better attention to them during virtual visits

Anecdotally, patient response to virtual visits appears to be positive, and fears that patients will always miss the personal touch seem unfounded. In fact, something about the camera interaction actually makes some patients feel more connected.

“The content of the visits are quite similar. Once you’ve done this for a while, it can be a lot simpler,” said Dorsey. “Patients will say to me ‘I’ve never had someone listen to me like he did.'”

Johnston echoed that sentiment. “I’m still shocked by how patients tell us they feel the doctors are more focused on them,” she said.

Vidyo’s Senior Vice President of Vertical Markets, Amnon Gavish, said that the key to that kind of interaction is a high quality video feed with as little delay as possible.

“You get very low latency, which is lower than you would get with the phone line, and that actually contributes to a very natural flow of the call. It’s proved to be critical to creating the trust,” he said. “Patients and doctors say they forgot they were talking to the camera.”

  • Andy S

    How do you provide the frail/elderly with this type of service (video) without blowing up the ROI model? They are the ones to most benefit. Hardest for them to get to the doc and typically the ones with the chronic conditions yet the penetration of broadband required for video is miniscule (the stats for 65+ broadband is much different then the 75+). The provider is going to have to provide a device of some kind: $400+ fully baked amortized over a year is $35 a month…not including peripherals which will add another $20+ per month, 4G connectivity at $40 a month. That’s $75 a month (not including peripherals) for just connectivity. The service provider is going to want a piece of the action as well. $20-$50 a month probably. Lets take the low end. Thats $100 a month (minimum…probably more like $150-$200) for these folks. Doesn’t feel like the plans or CMS are going to jump to pay $100 per month to give elderly patients access to the doc. IMO video is going to be niche (rural environments, maybe some access to specialists, long term care) until connectivity within the home improves. Company’s can’t be built on rural Alaska. I see the vision for video but the economics aren’t working right now. If someone knows of a solution that is significantly cheaper for frail/elderly let me know as I have customers for you.
    Andy – VRI

  • Economical

    Andy, we have a very inexpensive solution for elderly with diabetes type 1 or 2. Interested? How about a one time fee for $20 for a self-monitoring app? However, one needs an iPhone or iPod-iTouch, haven’t transferred the personal management app to other smart phones/platforms yet but within the next 9 to 12 months we will have accomplished that goal. Who are you with and where do the numbers you have quoted come from?
    Signed: Economical, been in healthcare a long time.

  • Jack J Florio

    A 6th reason, which may one of the most compelling, is the cost effectiveness of these kind of visits. Patients can be triaged easily and if an office visit or a visit to a specialist is required, it can happen easily, This should help lower the cost of patients who normally visit the physician too often for minor reasons. It should also lower the barrier for a patient so seek help from a physician vs. waiting till the condition gets more serious and more costly.

    Last of all, this is a way to provide care to the masses in less developed countries or far reaching places in the US where physician coverage is limited.

  • Andy S

    Video?

  • Kel

    $100 a month for service doesn’t account for the significant amount of data that will be used exchanging video on wireless networks. The gesture interface is not intuitive (another hurdle) nor is trouble-shooting problems with a ‘phone itself or the service.

    Will the service carriers have exceptions / exemptions for “medical data” since the apps that use data for virtual visits will be categorized as “medical devices” by FDA. Will the carriers adopt new device return / exchange policies for these new “medical devices”?

  • Lee

    Economical, I would be very interested in your self-monitoring app. I have a family member that needs that kind of monitoring. Any help would be appreciated.

  • Sukhwant Khanuja

    A video with biometric solution can be put together for about $410+ $35 PMPM OR $70 PMPM on one year basis. Sample pricing is – WiFi Tablet (Asus) $150, WiFi BP $160 and WiFi Weight scale $100 (Blipcare) + internet/WiFi service (Comcast/TWC) $35 PMPM. For cellular 3G/LTE add a hotspot/MiFi for $100 (free on 2 year basis)

  • Larry Voorhees

    Let’s look at this in a slightly different light. Take the chronic diseases of CHF, COPD, Diabetes and Hypertension. In many in the Medicare population, those require monitoring. But we really don’t want to hand-hold those patients, we really want to teach them to be self-managing. And in addition, we want to be able to focus our attention on those “rising risk” patients with either those diseases, or tendencies toward them, so we can also teach them to be self-managing.
    So…why not simply issue these patients a low-end tablet (available today for $200 or slightly less), have our local IT department pre-load it with Lync 2010 or Lync 2013, lock it down so nothing else can be added. With Lync already within our system here, we can do either chat or video visits with those patients. We can have them contact our Remote Monitoring team on a daily/weekly basis, input their biometrics into the system, have it automatically populate to their EHR, have that EHR set up to send alerts to a nurse triage team if their biometrics are out of parameters. Have that nurse triage team conduct a face-to-face via Lync with the patient. If there appears to be a need for interaction with a provider right at that time, have an APRN available to be connected into the Lync conversation, have the nurse drop out of the conversation, and presto! the patient is connected with a provider in real-time via video.
    Granted, this requires that the patient have broadband capability. But even in our neck of the woods, a larger and larger part of our service area has broadband capability.
    So what is the organization out? The investment in 100 cheap tablets. ($20000), and what is the ROI? Reduced utilization of ED, of Admits, of Inpatient days by the Medicare population. Yeah, I think it’s worth it. We’re certainly going to try it here.