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The Advent of the Virtual Doctor: Will this Help Seniors?

If you Google the words virtual doctor, it is amazing how many websites there are where you can visit online via webcam with a US trained, board certified, licensed and credentialed doctor in order to obtain a diagnosis and treatment for a variety of minor ailments. Who would have thought a few years ago that you would hear the expression “The doctor will Skype you now!”  Even drugstores are starting to add on-line clinics to their premises. Are these on-line clinics the way of the future?

Telemedicine started more than 40 years ago as a way to deliver healthcare to geographically isolated patients, but its growth was slow. Things have changed dramatically in the last few years however, primarily as a result of the development of high-speed communication networks. Just recently Vidyo, a company that makes HIPAA compliant video conferencing software, announced a deal to provide video conferencing services to the Alaska Native Tribal Health Consortium that will connect 2,500 providers at 200 sites to patients (HIPAA is the Health Insurance Portability and Accountability Act created to protect the privacy of personal health records).

Web based technologies have already revolutionized industries such as banking, books and publishing, and the delivery of music and movies. The healthcare industry is undergoing its own transformation as new innovations aim to streamline, simplify and improve the delivery of care. The era of Electronic Medical Records (EMRs) has arrived and hospitals and physicians are coming to appreciate the value of collecting, analyzing and sharing data about patients. According to 2012 data from an annual survey by the federal Centers for Disease Control and Prevention, 72% of office based physicians used electronic medical record or electronic health record systems compared to 48% in 2009.

When you arrive at your doctor’s office you may sign in on an iPad instead of a clipboard. Your doctor can review your test results on his or her laptop or handheld device in the examining room, accessing laboratory results from a facility half way across the country.  To fill a prescription, the doctor taps his computer and it is sent digitally to your pharmacy, and yet you are still experiencing a face-to-face consultation with your physician. How would an e-visit compare?

In certain states, medical boards only allow doctors to practice telemedicine if there is a prior doctor-patient relationship, sometimes involving a prior medical exam. Other state boards insist that doctors treat patients only in their own state so that if patients are injured, they have a state agency to go for help. Accountability is of paramount importance so that patients are protected. With many of the on-line clinics the doctor who handles your case will be seeing you for the first time. Virtual services are intended for patients with relatively minor problems that do not require hands on treatment.  In 2012 alone, there were over 900 million doctor visits in the US. Supporters of virtual medicine say that about 50 per cent of these visits could have been handled remotely.

We have all experienced waking up with a sore throat, a sinus infection or dreaded pink eye and our instincts tell us that a visit to the doctor is in order. Urinary tract infections for example are very common in seniors and can be extremely painful and uncomfortable and almost always require treatment by a physician.  Minor though these ailments are, they can make one feel very miserable and can escalate if not treated promptly. However it is not always possible to get an appointment with one’s primary care physician right away. Until recently, the alternative has been a trip to an urgent care center or busy emergency room. For many seniors, physically getting to the doctor can present a problem. If seniors no longer drive, they may have to arrange for a family member or friend or caregiver to take them to an appointment. This may make them put off going to the doctor, believing the problem will just go away. An online doctor visit could provide a positive interim solution. Virtual visits may also prove advantageous in the ongoing treatment and monitoring of chronic conditions such as diabetes, obesity, high blood pressure and high cholesterol.

The main stumbling block for seniors with online care accessed from home as opposed to at a pharmacy is that you require a computer, internet access, a webcam and knowledge of how to use them. Although many seniors have embraced technology or have been forced to learn the basics by younger family members, for many others the e-world is still an alien place. A caregiver or family member may need to be there to help the senior access these clinics.  A visit to your senior loved one in their home may still be more convenient that organizing a physical visit to the doctor and the “waiting room” would be more pleasant and comfortable and free of other sick people and their germs.  The average cost of an online visit is $45, which more health insurance plans are starting to cover.

Some physicians and consumer groups are worried about the trend – concerned that patients could be in danger by not being seen face-to-face, and that physicians could be at more risk for malpractice suits. Glen Stream, president of the American Academy of Family Physicians, feels that “getting medical advice over a computer is only appropriate when patients already know their doctors.”  In September 2013, Tacoma based Franciscan Health System became one of the first hospital networks to offer virtual urgent care. In addition to talking to the patient, one of their doctors may also perform the equivalent of a medical exam by demonstrating what he wants his patient to do. For example, for a suspected sinus infection he may ask the patient to push firmly on her cheeks to see if this causes any pain or discomfort. “This is not intended to replace the intimacy of the doctor-patient relationship,” said Chris Stidman, SVP of OptumHealth, “but to provide a convenient way of dealing with minor ailments.” NowClinic says it leaves it up to the experience and discretion of the doctor to determine whether it is safe to treat the patient in this manner; if there is any doubt, other alternatives will be suggested.

Data is presently sparse on the quality of virtual care. The federal Department of Health and Human Services’ Office of Health Information Technology, which is overseeing the digital transformation of healthcare, says the medical applications of telemedicine do help patients – especially those who prefer to stay in their homes as they battle chronic conditions. A study that came out in January 2013 in JAMA (Journal of the American Medical Association) supported the idea that telemedicine can help reduce health care costs but identified areas of concern. Co-author Dr. Ateev Mehrotra, an associate professor at Harvard said the study team found evidence that diagnosis and treatment were equally successful in e-visits and office visits for patients with sinus and urinary tract infections.  However doctors seemed to prescribe more antibiotics in e-visits, which could represent an unfortunate trend in the light of the growing rate of resistant superbugs and the decrease in the effectiveness of our drugs. The patients in the study were also interacting with their own doctors not through public sites.

A five year study by a team from the Universidad Politecnica de Madrid in Spain, led by Professor Enrique J. Gomez and Cesar Caceres, came to the conclusion that patients can be treated through video conferencing by physicians as effectively as if the patients made physical visits to the doctor’s office. Instant messaging was also shown to be effective. The virtual hospital in Spain was not only dealing with patients who suffered from minor ailments, but was managing the cases of 200 stable HIV sufferers. Frequent visits to the hospital are a major investment of time and money for the patients. The virtual system reduced the number of physical visits to the doctor from six or eight to only three or four.

The telemedicine industry is expected to continue growing and e-visits are likely to become routine as the public grows to accept them and as further technological advancements are made. Many seniors may see technology as an intrusion in their doctor-patient relationship, but virtual visits for minor ailments may have an important role to play if they are viewed as a complement to existing care rather than a substitute for regular doctor visits. For individuals who suffer from multiple illnesses and are taking several medications, extra precautions would seem advisory. The new Baby Boomer generation of seniors is much more computer savvy and more likely to take future innovations in their stride. E-visits may help provide an answer to the worsening doctor shortage and offer a viable alternative for those who put a high value on accessibility, convenience and price.  In the end it will come down to finding the right balance. The human touch cannot be underestimated and there will always be times when a little old-fashioned one-on-one will be just what the doctor ordered.

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This article was written by Jane Noble.

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