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Jan 24, 2018 OHIOHEALTH
Should I Stay or Should I Go? How Do Virtual Doctor Visits Work?

If you have a phone or a laptop, chances are you’ve made some video calls, and these days we’re using them for much more than letting grandma say hello to the kids. Live mobile video has become a great way to attend meetings when you’re out of the office, confirm you’re picking up the right ingredients at the grocery store, or troubleshoot a leaky faucet with a handy friend.

How great would it be if we could do doctor visits over the phone, too? OhioHealth is looking into that very thing, but there’s a lot more to it than firing up FaceTime or WhatsApp. We talked with David Applegate, MD, vice president of medical affairs at OhioHealth, to find out how virtual doctor visits work, what makes them work well, and what challenges still stand in the way.

What are the steps of a virtual doctor visit?

“Right now, we’re piloting virtual doctor visits with hand-selected patients, using the video conferencing application within our electronic health record,” says Applegate. “We schedule virtual doctor visits just like a regular office visit. When the patient ‘checks in,’ they are greeted by a medical assistant who asks them routine questions. With a virtual doctor visit, we don’t have the ability to take vital signs, but there are some health devices that can transmit data.”

After the assistant gets the information the physician needs, they log out and the doctor joins the visit. “Together, they can have a detailed conversation and discuss symptoms. Some physical examination can be done, too, like assessing functional movement or a rash on the skin. Then, the doctor can prescribe medication or treatment if necessary, and a follow-up visit can be scheduled,” says Applegate.

What types of patients are a good fit for virtual doctor visits?

“Of course, the ability to do a hands-on exam through a virtual doctor visit isn’t possible, so if you need that level of care you’ll still need an office visit,” says Applegate, “but for interactions where no physical exam is necessary, like regular follow-up visits with patients who have chronic conditions like high blood pressure or diabetes, it’s very easy.”

“We’ve also found it to be a great tool for patients being treated for mental and behavioral conditions, like depression or anxiety,” says Applegate. “We can check in with patients frequently to assess their mood. We can see how they’re coping and responding to their medications, so we can quickly make adjustments and get those prescriptions to their pharmacy, if necessary.”

What are the challenges of virtual doctor visits?

Applegate says technical issues present the greatest hurdle to virtual doctor visits, which can involve hardware, software and network problems. “Not everyone has high-speed internet access, or the latest phones, tablets or computers. This can affect the audiovisual quality and make conversation and diagnosis difficult.”

He says not only do patients need the right technology, they need to be familiar with using it. “We’ve done a lot of education as part of our pilot. We remind patients to make sure their device’s batteries are charged, that they find a quiet room with decent lighting so the doctor can see and hear them clearly, and that they choose a private setting that prevents interruptions.”

Applegate adds there has been a learning curve on all sides. “It’s as much a new experience for physicians as it is for the patients, and their comfort is equally important. It’s not an experience we’re pushing anyone into. Some physicians aren’t comfortable with it, just as some patients aren’t comfortable with it, and that’s okay. Ohio, in general, has been slow to adopt virtual doctor visits, and some insurers are reluctant to reimburse them the same as an in-office visit.”

The picture is getting clearer.

Applegate says what they’ve learned in the pilot has been promising and he is excited to see the program expand at OhioHealth. “We’re focusing on primary care visits for now, and you need to be an existing patient of a physician participating in the program, but we envision a day where patients can initiate virtual doctor visits at their convenience and wait in a queue to see a provider.”

He also wants to expand into specialty care for conditions such as multiple sclerosis. “In some cases, it’s a convenience; in others, it’s a need. For patients from rural areas who require follow-up care from a specialist, but do not need to be in the office, virtual doctor visits can save them hours in travel and time away from work. And they will also help patients with physical challenges who may need to check in with their doctors but may not be able to leave home. What we’ve accomplished so far is only part of the puzzle. We’re confident as we move forward that people will become more comfortable with virtual visits, and we’ll see greater acceptance of the idea.”

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