On-screen doctor visits are the new house call

  • Article by: ALLIE SHAH , Star Tribune
  • Updated: April 7, 2014 - 3:13 PM

Video doctor appointments are emerging as a more convenient way to diagnose and treat minor ailments, but skeptics caution there’s no substitute for the old-fashioned office visit.

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Laura Kaslow received a call from Dr. Sandy Wiita through a kiosk at the Blue Cross Blue Shield Minnesota headquarters in Eagan as part of the insurer’s Online Care Anywhere program.

Photo: Richard Sennott • Richard.Sennott@startribune.com,

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Three times a week, Dr. Joseph Olson dons his white coat, but he doesn’t leave his home in Storden, Minn. Instead, he fires up his tablet, peers into the camera and starts “seeing” patients via real-time video chat.

On the other end of the Internet connection are people who have logged on for the virtual visit through their smartphones or tablets. One by one, Olson examines them — diagnosing mostly minor ailments such as sinus infections, skin rashes and sprains.

Olson works for “Doctor on Demand,” a mobile app that started four months ago and is now in 40 states, with 1,000 doctors on staff. A 15-minute video session costs $40.

The app is part of an emerging health-care sector: doctors using technology to meet patients on their timetables. Blue Cross and Blue Shield of Minnesota has offered video chats for a couple of years and the Mayo Clinic has dabbled in the emerging technology with a pilot program for expectant mothers.

“We expect that it will be a routine process for someone to visit with a doctor for telemedicine through our online care as we grow into the future,” said Matt Marek, vice president of product and marketing for Blue Cross and Blue Shield of Minnesota.

The doc-in-the-box concept has raised questions about the quality of care. And even advocates for virtual exams say they work best for routine cases and that, when it comes to complicated diagnosis and treatment, there’s no substitute for a doctor’s skilled touch.

But the convenience video exams offer is compelling, especially since getting an appointment with a doctor — or even reaching one on the phone for a quick consult — can be difficult and time-consuming.

That’s why Rochester mom Kate Bomgaars has done Skype visits with her Mayo doctor.

“Especially in the wintertime, having children, to pack them up and take them in the car, park, get them all out of the car, drag everything upstairs and into the office, and wait around for an office visit — that’s a whole hour production just to get there,” said Bomgaars. “To have communication in the living room, it saves everybody a lot of time and energy.”

Emergency screen time

Blue Cross and Blue Shield offers its service, which costs about the same as Doctor on Demand, to patients through their personal computers and through kiosks at some of the employers it insures.

Paloma Lang, of Warroad, Minn., used the company’s Online Care Anywhere recently in a pinch.

Her granddaughter Mackenna, 2, had an earache. Lang’s daughter was facing a half-hour drive to the doctor’s office, and still more time waiting to see a doctor. Lang suggested that Mackenna come with her mother to Lang’s company, Marvin Windows, where a kiosk had just been installed to connect with a doctor via video chat.

Within minutes, a doctor appeared on the screen.

Mackenna’s mother used a thermometer and blood pressure cuff attached to the kiosk to take Mackenna’s vitals. There was even an autoscope tool with a camera attached to look into her ears.

The diagnosis: a slight viral infection that just needed time to run its course.

“I was pretty pleased with how quick it went, that we were able to speak with a live person,” Lang said, “and that we were able to actually look inside her ear and that the doctor could see what we saw. It’s just such a time saver.”

For Bomgaars, online video chats helped keep her connected with her doctor throughout her pregnancy with her first child.

As a participant in a pilot program through the Mayo Clinic’s Center for Innovation, Bomgaars skipped the routine office visits with her doctor and instead used her smartphone and other tools provided by the Mayo to self-monitor. The ability to video chat with her doctor gave her peace of mind throughout her pregnancy, she said, especially since she travels a lot. “Hands down, it allowed the flexibility in my lifestyle,” she said. “I was really comfortable with it.”

She now is the mother of two children under the age of 2, and said she would consider trying apps like Doctor on Demand for doctor visits for her kids.

Doctor on Demand co-founder Adam Jackson said the app, backed by TV personality Dr. Phil and his son, Jay McGraw, is not releasing numbers yet of how many people have used the service. But he did say the majority of cases are resolved during the video consultation.

Still, not everyone is rushing to embrace the video doctor exam.

For four years, HealthPartners has offered its online medical clinic called Virtuwell, which doesn’t have a video component. Instead, patients complete a questionnaire, then are connected with a nurse practitioner who can answer questions. Kevin Palattao, who developed HealthPartners’ 24-hour online tool, said that adding video doesn’t radically change the way patients and doctors interact. It’s just another “entry point into a similar experience.”

Video limitations

The looming question for virtual appointments is whether patients receive the same quality of care as when they see a doctor in person.

Video chatting doesn’t allow the doctor to touch the patient’s neck, for example, to feel if the lymph nodes are swollen when investigating complaints of a sore throat. They worry that doctors may not be getting all the information needed to render a proper diagnosis.

Linda Macdonald Glenn is a professor of medical ethics at Albany Medical Center in New York and at California State University. On the whole, she sees great potential in video visits, but she has concerns, too. She wondered: Can a patient’s privacy truly be ensured when discussing personal medical information by video?

Another issue is the potential for medical malpractice if the patient isn’t aware or doesn’t reveal something. “In a video interview of the patient, the patient may just present certain things,” she said. “In an office visit, the doctor may be able to pick up other clues — behavior, interactions, symptoms — that the patient may not themselves be picking up on.”

Olson agreed that there are limits to what he can do during his Doctor on Demand visits. Cases in which the patient reports abdominal pain, for example, are very difficult to assess remotely, he said.

“You have to actually press on a patient’s abdomen” to know how bad it is, he said. In those cases he immediately refers patients to an emergency room. Chest pain is another one. “I remember one patient called me and he had a hard time breathing and he was in his mid-50s. His wife was saying he has a history of heart problems. I said he needs to go to the nearest emergency department.”

Yet Olson, who also works as an ER doctor, mainly at Windom Area Hospital, thinks video visits work well for urgent-care situations and they help ease the burden on the busy health care system.

“Right now access to care is a big thing,” he said. “And this is allowing more immediate access to care.”

 

Allie Shah • 612-673-4488





 

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