Virtual care – or remote practitioner-patient interactions – is on the rise. According to a recent article in the Wall Street Journal, virtual care services saw a 20% increase from 2015 to 2016, and experts from the WCH Institute for Health Systems Solutions and Virtual Care (WIHV) agree that by 2025 majority of patient interactions with providers and healthcare systems will occur virtually.[1]

But there are still people who lack access to even basic health care, particularly those living in very remote areas. While geography often dictates the quality of medicine a person has access to, so does one’s financial situation. In the U.S., healthcare is notoriously expensive, and not every citizen or non-citizen can afford it, even basic services like a yearly check-up.

One possible solution to both of these problems could be virtual care.

Virtual Care: A Short Definition

According to the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), virtual care describes[2]:

any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care.

In essence, the term refers to the interaction between a patient and a healthcare provider that is done remotely, with the use of virtual or digital technologies, such as video conferencing software or even mental health apps on smartphones.

Virtual Care vs. Telemedicine vs. Telehealth

Virtual care can sometimes be used interchangeably with other terms such as “telemedicine” or “telehealth,” though it’s important to note there is a key distinction between the two.

Telemedicine or telehealth refers to all aspects of the treatment of various medical conditions that are done without having to see the patient in person and often includes virtual care.[3]

Succinctly, virtual care by definition is reserved specifically for patient-practitioner interactions enabled by telecommunication tools, while telehealth, in contrast, extends to electronic health records or electronic medical records (EMRs) and remote patient monitoring.

The fact that these terms are so often confused only underlines the importance of virtual care to practitioners worldwide, and both play a valuable role in the blended care practitioner’s toolkit.

What Are the Benefits of Virtual Care?

Healthcare and technology have always gone hand in hand, and there is no doubt that digital technologies will change the way healthcare looks and feels.  Healthcare providers also see great potential in modern technology.

Virtual care significantly improves day-to-day operations for health care providers and their organizations.

Telecommunications allow them to talk to their patients remotely making collaboration more effective. Even if it is for smaller issues like making a virtual check-in with the patient after surgery, the convenience of doing it virtually creates win-win scenarios for everyone involved.

The true benefits of virtual care, however, go far beyond just giving patients easier access to healthcare services. Virtual care significantly improves day-to-day operations for health care providers and their organizations.

Patient Virtual Care

In most published literature concerning virtual care, an overwhelming number of cited benefits have to do with the patient. A few examples include:

  • Enhanced Convenience. Instead of having to travel to a medical check-up, people in remote areas can easily access these services remotely.[4]
  • Improved Accessibility. Having healthcare services so accessible offers the potential promise of encouraging people to attend to their health needs in a more timely manner and more frequently. By addressing health concerns when they first appear and checking in frequently on progress, patients can actively participate in improving treatment outcomes.
  • Lower Financial Costs. sometimes even as much as half the cost of a traditional in-person appointment.[5] This again can encourage people to address their health issues, particularly when the person cannot afford health insurance or to cover the cost of a traditional health service.

Benefits for the Provider

Let’s consider provider benefits of virtual care – does it offer practitioners similar or comparable advantages?

  1. Reducing healthcare investments. The potential of virtual care services can have a visible impact on healthcare providers, from nurses, doctors, and clinicians to administrators and other medical office staff. On-site visits, for instance, are an important part of patient care, but they consume a lot of time and resources, especially due to missed appointments. Telepsychiatry interventions, as one example, have been shown to reduce some of these costs while delivering comparable results to practice-based treatments.[6]Some of the visits can be easily done with the use of video software, where the nurse or doctor can check in with the patient remotely, answer all their questions, and deliver needed care on the spot.
  2. Potentially limits practitioner burnout. The most significant long-term benefit of virtual care through the time-saving that it offers is the potential prevention of clinician burnout. As Dr. Adam Licruse writes in the Harvard Business Review: “…as we focus our energy on provider burnout, we hope that virtual care will allow for more-flexible provider schedules over time, permitting clinicians to provide some care from outside their practices if they wish“.[7] By making at least some processes more efficient, the levels of stress that providers may face can also be lowered, which in turn may lead to preventing exhaustion.

Benefits for Healthcare Organizations

Although some are concern that virtual care can decrease the number of patients that make appointments and therefore affect the success of a health organization, many experts argue the opposite. Rather, findings suggest:

  • Virtual care services may help institutions be more efficient. Dr. Licruse describes how his organization saw a 50% reduction in the need for referrals to specialists, meaning less spending on the organization’s part for sometimes unnecessary consultations.[7] It is not unreasonable to predict that the advent and popularity of e-clinics may play a role.
  • They may improve – or at least not negatively impact – patient retention. There is no evidence to suggest any health organization will lose real-life patients if they also adopt a more virtual-friendly service. Rather, increasing evidence suggests that internet-based treatments can have valuable patient health engagement benefits, while organizational research is continually focused on how further practitioner adoption can be encouraged.[8][9][10]

Virtual Care vs. In-Person Treatment Quality

Quality assurance is a huge practitioner concern when it comes to any type of healthcare. So while it’s cheaper, and offers easier access to services, virtual care also needs to be safe in order to positively impact the lives of patients and practitioners.

Challenges to Virtual Care Practice

In today’s telemedicine and virtual care fields, quality assurance has posed some practical challenges, and there is not a lot of data pinpointing exactly how safe the market is as a whole.

We do know that virtual care regulations vary from state to state, but a lot of pressure remains on patients and users to practice diligence to ensure they are getting[11][12]:

  • Science-based mobile therapy or mHealth apps
  • Therapeutic treatments from accredited mental health practitioners who are licensed to practice in their particular state[13]. Different regulations may apply when it comes to mental health coaching, which as a field of practice is comparatively less regulated.
  • Private, secure healthcare services with regard to data collection and storage practices[14]

Virtual care and telehealth enthusiasts claim that today’s technology offers the same level of experience and quality of services as the traditional face-to face-meetings with your doctor. Many of these tools and their usage are subject to federal and state laws, and specifically HIPPA regulations.[15]

The American Medical Association, for instance, has developed a set of policies for physicians to ensure quality when using virtual care.[16] These guidelines, however, are more concerned with doctors adopting safe practices than companies who rely only on virtual care services as a business model. This leaves virtual care in larger organizations with many gray areas.

Choosing a Virtual Care Provider

So, what does this mean for the patient? It may mean you have to tread lightly. When we look at the accuracy and quality of virtual care services as a whole there are significant variations.

Most of the research into virtual care has been focused on blended care and the added value it can bring when combined with traditional medical services, such as a doctor video-calling their patients a few days after surgery to see how they are doing.[17] But when looked at solely from the perspective of exclusively digital health services, the quality of said services can vary greatly.

Designing Guidelines

One study of commercial virtual care companies showed differences in how often the practitioners’ recommendations were adherent to medical guidelines and even if the diagnosis itself was correct, to begin with.[18] What was surprising to see was that the mode of communication did not seem to make a difference.

The need for stricter regulations regarding virtual health care services has lead to a conversation about what needs to be done to make sure these services are safe. Teladoc, a virtual care company based in the US established the healthcare industry’s first organization that focuses solely on virtual care.

Elsewhere, The Institute for Patient Safety and Quality of Virtual Care has been officially recognized by the Department of Health and Human Services as a Patient Safety Organization (PSO) that focuses on conducting quality and safety activities to improve the safety of virtual care providers.[19]

The Future of Virtual Care

Ongoing innovation in the world of telehealth and virtual care has brought many new and improved technologies to make way for better health care services and can now direct these services to a wider audience.

There is a high chance of more people using it as soon as next year. The Centers for Medicare and Medicaid have already finished policies to bring telehealth benefits to Medicare Advantage plans, which will only lead to an increase in the number of people using virtual care services. With the new benefits, Medicare Advantage enrollees will be able to access virtual services as they would when utilizing a regular healthcare provider.

Some important things to consider when arguing for the bright future of virtual care is better quality care where the care is most desperately needed.

  1. New Technologies, Better Care

The conversation about the safety of virtual care services is far from over. Many believe that rapidly emerging technologies like mobile care, artificial intelligence, virtual reality, and machine learning, could play an important part in shaping the future of telemedicine.[20]

Some signs of this progress are already visible. Mobile devices with internet connectivity have the ability to connect a patient with a doctor from any location, so the patient doesn’t have to be in their own homes for a consultation. This can be incredibly beneficial in the mental health sector, where a patient can get in touch with their therapist at any moment, as needed.

  1. Chronic Care Management

While at the moment most of the virtual care is rather focused on more minor medical needs, we are starting to see these services stepping into chronic care management for people with more complex conditions and illnesses.[21]

Examples include treatments delivered remotely – either entirely or in part – for:

  • Diabetes treatments – such as endocrinology treatments, dietary and symptom tracking behaviors [22][23]
  • Neurogenerative disorder treatments – as seen in treatments for patients with Parkinson’s disease[24]
  • Major Depressive Disorder – through iCBT, video therapy, or behavioral treatments to target symptom severity[25]. With the rapidly expanding field of telehealth, increasingly more specialized treatments, e.g. Applied Behavioral Analysis (ABA), and Acceptance and Commitment Therapy (ACT) are now being made available digitally.

There is a lot of potential here, but not without virtual care needing to make some modifications. For one thing, a virtual care model for chronic illness management will require continuity, which many of these services currently do not offer.

Patients log on to a platform and are then matched with a doctor best suited to help them. But outside of this initial introduction, it is possible that they never interact again. When it comes to patients with chronic conditions, this is not a viable option. Many virtual care providers are working on changing their models in order to overcome these new challenges.

Final Thoughts

Industry providers estimate that around 72% of consumers would prefer a virtual visit with their doctor, rather than a traditional one.[26] There is definitely a great interest in these types of services, from the point of view of the patients, healthcare providers, and institutions.

The future of healthcare most likely will contain a bigger prevalence of virtual care services, and the new technologies that may become more widespread will have a strong say in what it will look like.

For the patient, this means more available options. And if the virtual one gets chosen, this will mean a cheaper option as well.

References

  1. ^ Beck, M. (2016). How Telemedicine Is Transforming Health Care. Retrieved from https://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402
  2. ^ Jamieson, T., Wallace, R., Armstrong, K., Agarwal, P., Griffin, B., Wong, I., & Bhatia, S. (2015). Virtual Care: A Framework for a Patient-Centric System. Retrieved from: https://www.womenscollegehospital.ca/assets/pdf/wihv/WIHV_VirtualHealthSymposium.pdf
  3. ^ HRSA (2017). Telemedicine and Telehealth. Retrieved from : https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth
  4. ^ McGrail, K. M., Ahuja, M. A., & Leaver, C. A. (2017). Virtual visits and patient-centered care: results of a patient survey and observational study. Journal of Medical Internet Research, 19(5), e177.
  5. ^ Godman, H. (2016). Need an appointment right away? Consider a virtual doctor visit. Retrieved from: https://www.health.harvard.edu/blog/need-an-appointment-pronto-consider-a-virtual-doctors-visit-2016091610206
  6. ^ Serhal, E., Lazor, T., Kurdyak, P., Crawford, A., de Oliveira, C., Hancock-Howard, R., & Coyte, P. C. (2019). A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities. Journal of Telemedicine and Telecare, 1357633X19853139.
  7. ^ Licruse, A. (2016). One Hospital's Experiment in Virtual Health Care. Retrieved from: https://hbr.org/2016/12/one-hospitals-experiments-in-virtual-health-care
  8. ^ Barello, S., Triberti, S., Graffigna, G., Libreri, C., Serino, S., Hibbard, J., & Riva, G. (2016). eHealth for patient engagement: a systematic review. Frontiers in Psychology, 6, 2013.
  9. ^ Wasson, J. H., Forsberg, H. H., Lindblad, S., Mazowita, G., McQuillen, K., & Nelson, E. C. (2012). The medium is the (health) measure: patient engagement using personal technologies. The Journal of Ambulatory Care Management, 35(2), 109.
  10. ^ Deloitte. (2018). Virtual health: Extending the human touch in care delivery - Strategies to engage physicians and encourage adoption. Retrieved from https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-virtual-health-care-physcian-adoption.pdf
  11. ^ APA. (2013a). Guidelines for the Practice of Telepsychology. Retrieved from https://www.apa.org/pubs/journals/features/amp-a0035001.pdf
  12. ^ Gamble, N., Boyle, C., & Morris, Z. A. (2015). Ethical practice in telepsychology. Australian Psychologist, 50(4), 292.
  13. ^ APA. (2013b). Telepsychology 50-state Review. Retrieved from https://www.apaservices.org/practice/update/2013/10-24/telepsychology-review
  14. ^ Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2013). Security and privacy in electronic health records: A systematic literature review. Journal of Biomedical Informatics, 46(3), 541.
  15. ^ United States. (2004). The Health Insurance Portability and Accountability Act (HIPAA). Washington, D.C.: U.S. Dept. of Labor, Employee Benefits Security Administration.
  16. ^ American Medical Association. (2017). AMA Telemedicine Policy. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/telemed-policy.pdf
  17. ^ DeJong, C., Santa, J., & Dudley, R. A. (2014). Websites that offer care over the Internet: is there an access quality tradeoff?. Jama, 311(13), 1287.
  18. ^ Schoenfeld, A. J., Davies, J. M., Marafino, B. J., Dean, M., DeJong, C., Bardach, N. S., & Mei, Y. J. (2016). Variation in quality of urgent health care provided during commercial virtual visits. JAMA Internal Medicine, 176(5), 635.
  19. ^ McLeod, C. (2019). Teladoc Health Establishes First and Only Patient Safety Organization (PSO) for Virtual Care. Globe Newswire. Retrieved from: https://apnews.com/Globe%20Newswire/2f47f3ca720349bd1631a747febff104
  20. ^ Riva, G., & Gamberini, L. (2000). Virtual reality in telemedicine. Telemedicine Journal and e-Health, 6(3), 327.
  21. ^ Rajda, J., & Paz, H. L. (2019). The Future of Virtual Care Services: A Payor's Perspective. Telemedicine and e-Health. Retrieved from https://www.liebertpub.com/doi/full/10.1089/tmj.2019.0020
  22. ^ Mummah, S. A., Mathur, M., King, A. C., Gardner, C. D., & Sutton, S. (2016). Mobile technology for vegetable consumption: a randomized controlled pilot study in overweight adults. JMIR mHealth and uHealth, 4(2), e51.
  23. ^ Malasanos, T., & Ramnitz, M. S. (2013). Diabetes clinic at a distance: Telemedicine bridges the gap. Diabetes Spectrum, 26(4), 226.
  24. ^ Dorsey, E. R., Venkataraman, V., Grana, M. J., Bull, M. T., George, B. P., Boyd, C. M., & Biglan, K. M. (2013). Randomized controlled clinical trial of “virtual house calls” for Parkinson disease. JAMA Neurology, 70(5), 565.
  25. ^ Fortney, J. C., Pyne, J. M., Mouden, S. B., Mittal, D., Hudson, T. J., Schroeder, G. W. & Rost, K. M. (2013). Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. American Journal of Psychiatry, 170(4), 414.
  26. ^ VivifyHealth. (2019). Telehealth Virtual Healthcare: Study Finds Most People Want It. Retrieved from https://www.vivifyhealth.com/83-of-consumers-are-not-using-telehealth-but-most-wish-they-were/

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