virtual care

RECENT POSTS

Virtual Check-Ups: The Doctor Will See Your Online Responses Now

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

Veronica Thomas
CommonHealth Intern

Like many patients with chronic conditions, Lesley Watts used to come in to the doctor’s office for a check-up on her digestive disorder every 12 months. This not only meant time spent in traffic and scouring for a parking spot, but also the brain fog and stress of answering her doctor’s questions on the spot.

But a year ago, when it was time for her visit, she instead  received an email reminder to pull up an online form that asked her everything her doctor needed to know about her symptoms. From the comfort of her recliner, Watts carefully answered the questions, among them: “Overall, how have your reflux symptoms been since your last office visit?” “How much have your symptoms affected your work, social, and/or home life?”

When she was satisfied with her responses, she clicked “submit.” The next day, she received instructions from her doctor about how to manage her symptoms better. Visit complete. And patient satisfied.

“It asked me questions that I had never been asked before, and as a consequence, I learned about symptoms I had not recognized,” she remembers. “I believe I received better care because I was able to take my time and provide more accurate answers.”

“We believe that it can actually increase your engagement with the system because you’re thinking about your condition outside of the physician’s office.”
– Dr. Ronald Dixon

Virtual care and tele-medicine are hot health topics, replete with weighty promises of revolutionizing healthcare. But they often refer to realtime video-chatting or texting with a clinician—whether it’s your personal provider or a random doctor overseas.

The Massachusetts General Hospital service that Lesley Watts participated in aims to conduct virtual visits without the realtime interaction.

Instead, patients complete an online questionnaire for their specific conditions, and send it to their personal doctor—whom they already know and trust—for review and response. For the past two years, primary care clinicians at an MGH Beacon Hill practice have been using over 30 different forms to follow up with some of their adult patients.

According to Dr. Amy Fogelman, a physician at the Beacon Hill practice, the clinical questionnaires are especially useful for chronic conditions that need management over time, like obesity and hypertension. In fact, the obesity questionnaire has proven more effective at helping patients lose weight than any other method she’s tried, she says. Continue reading

Coming Soon: $10M ‘Tricorder’ X Prize For Self-Diagnosis

Jim, I' m a doctor, not a device developer!

Remember how in Star Trek, Dr. McCoy could point his tricorder at things and magically — oops, I mean, “scientifically” — determine all kinds of chemical components and medical diagnoses?

The X Prize Foundation — best known for offering prizes for space flight and cheap genome decoding — is about to put up $10 million for the invention of a medical device in the spirit of that tricorder: It must be able to diagnose 15 common medical conditions within three days, with no intervention from a health care professional.

Eileen Bartholomew, the foundation’s senior director of life sciences prize development, spoke today at the Center for Connected Health symposium in Boston, and said the tricorder prize is expected to be officially launched in 2012.

She offers some rough guidelines in the video below, including examples of the conditions it should be able to diagnose, from hypertension to sleep apnea. The prize, underwritten by Qualcomm, was first previewed in May — here’s the announcement — but the details have taken more shape since then. The contest could last about three years, Eileen said.

An interesting twist: Did you ever think about the tricorder as a tool for patient empowerment? That seems to be part of the X-Prize idea: The real-life tricorder isn’t meant for latter-day Dr. McCoys, it’s meant for patients, for us. If it can be developed, each of us could unleash our inner Bones…

Will Health Reform Finally Push Doctors To Email And Skype?

Dr. Lester Hartman as seen via Skype

No one could blame 3-year-old Anish for getting hysterical when he saw a doctor. He’d been through open-heart surgery and a skull operation. He knew that white coats often meant pain.

The first time his mother brought him to see Dr. Lester Hartman of Westwood-Mansfield Pediatric Associates, he had such a meltdown in the office that the visit had to take place in the parking lot, with the engine running, Anish in his carseat, and the pediatrician leaning his laptop on the driver’s side window as he took notes.

Clearly, this was not going to work. So these days, unless Anish needs to be physically seen, his parents schedule their appointments for evening hours. They sit at their home computer and they consult with Dr. Hartman, face to face, but not in person — by Skype.

Those Skype visits put Dr. Hartman way far out on the cutting edge of using technology to communicate with patients, even though Skype is now very old news in the general population. But he has high hopes that if health reform plays out as expected in Massachusetts, he’ll be able to ramp up Skype and use other electronic tools more creatively in his practice. (See his guest post below.)

‘Why hasn’t it gone further faster?’

Health care lags dramatically — perhaps “pathetically” is the correct adverb — behind other sectors in the use of the technological tools that now tend to dominate our personal lives — email, Skype, Facebook, smartphones. As Dr. Ronald Dixon of Massachusetts General Hospital put it: “Our patients are all Skyping with their grandchildren, so why can’t they Skype with us?”

But multiplying signals suggest that early adopters like Dr. Hartman may soon get a major boost from a political source: The looming state health reform. It aims to save money by shifting care away from “fee-for-service” payments for each procedure and toward giving doctors a “global” budget for a patient’s annual care.

Health insurers do not generally reimburse doctors for time spent emailing or Skyping or texting. When a doctor is paid for each bit of in-person care, but not for such “virtual” care, that’s a major disincentive to go virtual. On the other hand, if a doctor is paid an overarching annual sum for your care and will get bonuses for keeping you healthier and within your budget, checking in with you by email or Skype may suddenly become much more attractive.

Dr. Joseph Kvedar, director of the Center for Connected Health at Partners Healthcare and a practicing dermatologist, says that under the current health-care payment system, he emails constantly with his patients for free just because he sees it as part of caring for them. But “If the cash register never rang, I wouldn’t have a job. Right now, if you stop coming in to the office, I have a real problem. That won’t be the case anymore two years from now. The time is upon us that it will be as quaint as bank tellers.” Continue reading