| | December 20188UTLOOKHealthcare Tech Sometimes it seems that the terms Virtual Visits and Telehealth are a bit like fusion energy. It is the technology of the future, and always will be. In other senses, these care platforms have been in place for many years now, often hyped, and yet not quite breaking into the mainstream. The popular sentiment is that consumers are demanding care to be delivered via their mobile devices, but does the evidence support this? Where is the physician voice in these conversations?Certain elements of telehealth are well-embraced by the community to the point where they have become the standard of care. Rural hospitals are quite dependent on telespecialists from tertiary care centers to provide expertise for management of conditions as diverse as burns, stroke, retinal disease, and cancer. On the opposite side of the spectrum exists firms that offer stand-alone telehealth firms that have established their own physician groups and are successfully marketing their products directly to consumers.Where are traditional physician practices in all of this? One point of confusion for the average physician is the value proposition of offering video-enhanced phone calls with a complete stranger, as opposed to voice-only calls within the context of an established physician-patient relationship. The vast majority of physicians have always been available via phone for their patients, whether it to review recent lab results and make medication adjustments, or handle a weekend emergency.Formal studies of "telemedicine" have rarely done a heads-on comparison of these disparate scenarios. A Cochrane Collaborative meta-analysis published in 2010 attempted to compare telemedicine against face to face visits, and found little benefit. A later literature review published by the Agency for Healthcare Research and Quality (AHRQ) in 2016 suggested some mild benefits for chronic diseases such as diabetes and heart disease. Most of these telehealth studies assumed a longitudinal care team relationship with the patient, rather than episodic. The authors also noted the "apples to oranges" problem of comparing very different definitions of telemedicine, and the bias in the literature towards positive results. Much of the positive press about telemedicine that appears in the lay and industry press is driven by its boosters.The technology continues to advance in the meantime, so it is difficult to draw firm conclusions. We know that when a physician manages a familiar patient over the phone, it often prevents a visit, either to the office or to the emergency room. This is not always the case, as some more skittish physicians will consider it too much of a liability to tell a patient to "wait until Monday morning" rather than run into the emergency room. Sometimes the call will result in the physician urging the patient to appropriately seek expert emergency care, often appropriately so. In the era of increased co-pays, such coaxing may save lives.On the other hand, direct-to-consumer telemedicine with a dedicated physician team that is unconnected to the patient's regular care team has shown to increase consumption of health dollars overall. It has been shown to increase the prescribing of antibiotics for questionable indications. There is typically also a poor hand-off to the patient's regular healthcare providers, and little to no integration with the patient's usual health record.By Sarah Kramer, Chief Medical Information Officer, Yuma Regional Medical CenterCan We have Connected Health without Connected Physicians?Sarah KramerIN MY OPINION
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