Digital Doctors: The Pros & Cons of “E-Visits.”

With the growing shortage of primary and rural health care providers, patients are going online, turning to “digital” doctors and nurse practitioners for help with common ailments like a runny nose, a rash, and the flu. Patients log on to a website and describe their symptoms to a doctor or nurse practitioner. Telemedicine—a telecommunications capability that allows patients to consult with their doctors via two-way video, text, or e-mail—is becoming increasingly popular. Health care providers interact virtually instead of face-to-face.

Most major insurance companies now pay for electronic visits (e-visits), and a market report by Massachusetts-based BCC Research predicts that the global telehealth market will grow into a $27.3 billion industry by 2016. Seeing a “digital doctor/nurse” can be convenient and cost-effective, but the phenomenon has as many critics as advocates.

The American Academy of Family Physicians (AAFP) cites a study done from medical institutions affiliated with the University of Pittsburgh School of Medicine.The care patients received for two different medical conditions, sinusitis and urinary tract infection (UTI), was studied.

The study cites 5,165 visits for sinusitis, 9% of which were e-visits. Of the 2,954 UTI visits, 3% were e-visits. For each condition, there was no difference in how many patients had follow-up visits either for that condition or for another reason. However, there was an alarming outcome: An increase in the amount of antibiotics prescribed as a result of e-visits.

"When physicians cannot directly examine the patient, physicians may use a 'conservative' approach and order antibiotics," wrote the authors of “A Comparison of Care at E-Visits and Physician Office Visits for Sinusitis and Urinary Tract Infection" in the January 14, 2013 issue of JAMA Internal Medicine, formerly Archives of Internal Medicine.

One of the authors of the study, Ateev Mehrotra, MD, assistant professor at the University of Pittsburgh School of Medicine and policy analyst for the RAND Corp., explained that patients have sought care from places such as retail clinics and emergency departments because they were able to access them immediately. Patients got care, without the wait they would have faced at a primary care physician’s office.

E-visits work best for current patients when they cannot make a traditional in-office visit. As the trend grows, “digital doctors” need to adhere to the following guidelines for e-visits set by the AAFP:

• E-visits are available only to established patients who have previously received care from the physician’s practice;
• The patient initiates the process, and agrees to e-visit service terms, privacy policy, and charges for receiving asynchronous care from a physician or other qualified health professional;
• Electronic communication occurs over a HIPAA-compliant online connection: Confined space training for medical response to collapsed structures
• An e-visit includes the total interchange of online inquiries and other communications associated with this single patient encounter;
• The physician appropriately documents the e-visits, including all pertinent communication related to the encounter, in the patient’s medical/health record;
• The physician or other qualified health professional has a defined period of time within which responses to an e-visit request are completed; and
• E-visits should be a payable physician service.

(Top photo) Photo: Digital Photos

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