It’s late on a Sunday night when you first notice a strange, surprisingly painful rash on your face. At first, you figure it’s some kind of simple contact dermatitis caused by an allergy or an irritant. But then you Google and find a picture and decide you just might have shingles, a decidedly unpleasant viral infection related to chickenpox that spreads rapidly and causes unsightly and painful sores. It’s too late for an office visit. Even the local Urgent Care Center is closed. What to do?
You can spend hours in the emergency room, you can suffer until morning or you can grab your smartphone or computer and download a free video-conferencing application (app) that will promptly connect you in real time with a licensed physician or board-certified dermatologist in your area who can identify the rash via your webcam or smartphone and if needed, send a prescription for an anti-viral or other medication to your pharmacy. The cost of this virtual office visit is around $50. The relief you feel is priceless.
The reach and impact of telehealth seemed to have made a difference during Hurricanes Harvey and Irma when MD Live and Doctor on Demand offered free, remote physician consultations via phone or video to families trapped in homes and shelters for several days following the storms and free insulin was distributed to people with diabetes via social media outreach (courtesy of Lily and DirectRelief).
Welcome to the world of telemedicine.
Also known as telehealth, telemedicine encompasses an array of health care services that are delivered or accessed remotely via electronic or digital communication. Telemedicine includes phone, email, video-conferencing, electronic or digital transmission of medical reports and images (x-rays, scans, and photos, for example) e-monitoring devices such as heart or blood pressure monitors and wearable external monitoring devices like Fitbit.
More than 15 million Americans received some kind of remote medical care in 2015 according to the American Telemedicine Association (ATA). And there were one million virtual doctor visits via direct to consumer companies such as Teladoc, Doctor on Demand, MDLive, NowClinic and American Well.
Given our acceptance of, and insatiable appetite for the convenience that technology offers, the growth in the number of virtual doctor’s visits—the ATA estimates 1.2 million visits in 2016, a 20% increase from last year—isn’t surprising. After all, we now bank, shop, file taxes, correspond and connect via our digital devices.
Virtual doctoring is limited to non-emergent problems and ailments. For example, on its website, Teladoc, one of the first telemedicine startups, says its physicians can handle rashes, cold & flu symptoms, sore throat, bronchitis, acne, ear infections, conjunctivitis, allergies, sinusitis, tonsillitis, moles and warts, laryngitis and more. Doctor on Demand, a San-Francisco-based startup launched in 2013, treats the same conditions plus diarrhea and vomiting, travel illness and sports injuries. It also has a network of 300 psychologists vetted and qualified to treat mild depression, stress and relationship problems. Therapy sessions cost $50 for a 25-minute session and $90 for the full 45 minutes. The doctors can also prescribe medications and electronically send the prescription to your local pharmacy.
And while many hospitals and physician groups have established their own telemedicine platforms or partnered with existing players, not everyone is on board. Some physicians remain skeptical and suspicious of this impersonal doctoring. They worry that virtual health care will undermine the doctor-patient relationship and are concerned about diagnosing a patient without medical tests to support their diagnosis. Say, a child has a sore throat. Without a swab test and a throat culture, can the doctor definitively determine if the child has bacterial or viral strep? Should the doctor prescribe an antibiotic if he or she is not sure of the diagnosis?
Management of certain chronic diseases such as diabetes, seems well-suited to telemedicine. “For diabetics the daily tasks of counting carb and monitoring blood glucose levels can be eased using a smartphone app,” explains Thomas W. Miller PhD, ABPP, Professor Emeritus & Senior Research Scientist, Institute for Health, Intervention & Policy at the University of Connecticut. “A nurse can observe a diabetic taking his medication and administering injections remotely through the use of a video telephone. The oversight is reassuring and motivating and when you have compliance you have a better chance of improving the management of the condition.”
Additionally, says Dr. Miller, if a patient knows that every time he tests his blood glucose levels they will be read by a healthcare practitioner, he may be more motivated to comply. “Diabetes never goes on vacation. If you have it you have to manage the disease 24/7. Having someone to answer to increases rates of compliance.”
San Franscisco-based Virta Health has designed a telehealth program aimed at helping people control their need for insulin or get off medication completely. The program works through patient video chats with a remote Virta doctor, who consults with the primary care physician, reviews blood screens and medical history and makes diet and medication recommendations.
In addition, participants can use the company’s app to upload their blood sugar levels, blood pressure, body weight and other measurements. A registered dietitian monitors the data and checks in by phone, text or email to encourage the patient and discuss any concerns. To facilitate weight loss, the program educates diabetics about food swaps—lower carb foods like grilled chicken for pasta; almonds instead of sugary snacks.
More research is needed to measure long-term effects of virtual programs like Virta but one study examined the program’s impact on 241 people with type 2 diabetes. The results were published in the journal JMIR Diabetes in March (2017). The study found that 56% had lowered their blood sugar to non-diabetes levels after 10 weeks and about 90% had reduced or stopped their use of insulin. (Virta is available to people with type 2 diabetes and prediabetes as a covered benefit through some employers/health plans. For those without insurance, the cost is approximately $400/month.)
That depends on the patient and the situation. For people who live in rural areas and have limited access to doctors, telemedicine is an appealing substitute for a late night dash to the ER or a long drive to doctor’s office, a long wait in the waiting room and about 15 minutes with the doctor.
Having 24/7 access to healthcare providers via telehealth is a reassuring option for caregivers and patients alike. Another plus is the convenience in this time when many consumers report it’s becoming increasingly difficult for find a doctor on their health plan and even harder to get an appointment in a timely fashion. According to a 2014 survey of Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates, consumers are facing ever longer waits. Among the key findings of the survey conducted in 15 markets by Merritt Hawkins, a physician recruitment firm:
And for those suffering from a chronic illness like diabetes or a chronic condition such as back or neck pain, a virtual checkup with a qualified physician is less stressful and probably as effective as an office visit for a check-up.
Good to Know
“Telemedicine has pros and cons,” admits Dr. Miller. “The biggest difference between a virtual and a traditional office visit is the lack of hands-on contact between the patient and the physician or another healthcare provider,” he explains. “This is especially true in mental health. The patient has to understand that you’re not in the room with him or her and that the non-verbal communication that plays such an important role in the way we relate to one another might not be as distinguishable in a telehealth option.”
Dr. Miller, who uses telemedicine in his practice, says there are a few important things that every consumer should understand about telemedicine:
He’s also a big fan of wearable technology. “I’m actually a participant in Fitbit study sponsored by Verizon,” he says gleefully. His Fitbit tracks and uploads information to his health provider about his activity level, food consumption, water intake, sleep cycle, calorie intake, and output. (In addition to the Fitbit, he was given a monitoring smart scale that collects “loads of information” for the study.) “I think these wearable devices can be very helpful in motivating patients because it gives them targets to meet in terms of physical and mental activity.”
“When I meet with them in three months, I’ll know where I am in terms of sleep habits, physical activity, diet and other measures,” says Dr. Miller. “I was delighted to get into the study because I want to be able to see this from a patient’s perspective. Wearing the device has motivated him, he says. “I have to hit my target. I push because it gives me a reading of how far along I am,” he says.
Dr. Miller is excited about the future of wearable technology and telemedicine in general. “I think the day will come when we’ll have all kinds of at home tests that technology will be able to read and analyze. “And when that happens, I think both clinicians and patients will find telemedicine much more acceptable for care.”