Healthcare without borders?

maneesh juneja, blog
Maneesh Juneja, Digital Health Futurist

Some of us have used tools like Skype or Facetime on our phones, tablets and computers to conduct video calls with family and friends, or we may use tools in the office such as Lync to have video-conferences on our laptops with colleagues around the world. In my own experience, even when conducting video calls over 4G on my phone or super fast broadband at home, I regularly have issues with either the quality of the video or the call unexpectedly dropping. When it works, it’s great, but the point is that it doesn’t always work as well as it should.

Virtual doctor visits

When I hear about the growing trend of ‘virtual doctor visits’, it makes me curious, as I’ve never personally only ever seen a doctor in person. I note that in Scotland, patients in rural areas are being urged to Skype their doctor over Christmas. Apollo Hospitals in India has just launched their “Ask Apollo” platform which provides remote healthcare to many of their patients who currently have to travel very far to see a doctor. When I was at the Body Computing Conference last month, Dr Leslie Saxon unveiled the world’s first Virtual Care Clinic, which is “a first-of-its-kind virtual hospital with health data being fed via wearable and injectable technology.” Last month, in the USA, Mercy opened the world’s first Virtual Care Center, described as a hospital without beds.

According to American Well’s survey of US consumers at the end of 2014, 64% are willing to have a doctor visit via video. Walgreens is currently rolling out a virtual doctor service in 25 states.

However, not everyone thinks replicating the 10 minute face-to-face doctor visit over video is what people actually want. Sherpaa, has a different angle on the future of healthcare interactions. A telemedicine article speaks about Sherpaa in terms of, “It explodes the notion of the appointment altogether, encouraging patients to engage with a small staff of doctors at any time, for any reason, via text message through a website and app.” It’s really fascinating to read on Sherpaa’s website about why they don’t use video, “First, and most importantly, not a single patient out of thousands and thousands of interactions over the last 3 years has ever asked for a video chat. That’s because people don’t, and won’t, actually choose video over email or phone to communicate with strangers or acquaintances.” That’s quite an interesting perspective, and I note that Dr Punam Bhende in India has tried a number of platforms (including Skype) but found that Whatsapp worked the best for follow up visits.

The impact on continuity of care?

Most services offering virtual doctor visits are focused on minor problems. Lower costs and greater convenience are often cited but some argue that making it easier to access primary care this way will actually increase demand, and that these services will end up increasing healthcare costs. What are the implications for continuity of care if you see a different doctor every time using these new services? Will the online doctor always have the ability to view your medical records?

Should the first visit always be in person, but subsequent visits be offered in person or online? A small study in the US has found that 75% of patients undergoing routine elective surgery would accept an online visit as their only follow-up with their surgeons. I wonder how much of today’s face-to-face interactions in healthcare can be shifted to the virtual realm? It’s not just the interactions with doctors, but nurses, pharmacists and a whole range of healthcare professionals.

We might feel that seeing a doctor online will negatively impact the relationship between doctors and patients. What if the ‘distance’ in the online interaction encourages patients to express problems that they might not discuss in person? Reading the reviews from patients who have used these online providers is fascinating.

One review by Kristin Lackey of the Amwell app, demonstrates how modern technology is reshaping healthcare, “So cool In less than 10 minutes, I was able to speak with a doctor, get a diagnosis, prescription sent to the pharmacy and stay in my pj's..If I hadn't come across this app, I would have had to wait another 2 weeks to see my primary or find another. Thanks!”

However, another review by Tim Lovell demonstrates that it’s not always smooth sailing, “Had video trouble at first, but then visit went great. The provider cancelled the charge on the visit that didn't work. Make sure you're in a well lit area if you need anything examined.”

And when technical problems occur, some creative thinking is required, as James Langerud mentions, “Great visit. A little technical glitch where the doctor could hear me but I could not hear him. Worked through by him writing on a notepad and I answered the questions.”

Innovate to improve healthcare efficiency

We can be confident in predicting that virtual visits will continue to grow in 2016 and beyond. Interestingly, research from IHS forecasts that in the US, virtual video consultations between primary care providers and patients will double over the next 5 years. The pressure to reduce the cost of healthcare, particularly in the US, is one of the biggest factors that is cultivating the desire to innovate in this arena. What’s exciting is that for those underserved communities, whether they are in rural America or rural China, the advances in technology when combined with changes to policy, processes and practice may make ‘seeing’ a doctor an everyday reality. How soon before we can all have healthcare without borders? Being able to virtually access the best doctors in the world is a dream that is now starting to take shape.

We have a generation of people growing up in a world where ‘on demand’ services are the default. As some of them become the patients of tomorrow, will they shift to the providers that can offer on demand, virtual doctor appointments? Do we expect a future where one day, seeing a primary care doctor in person will be a rare occurrence? Will the rise of virtual visits reduce the humanity in healthcare, given the absence of physical touch?