Virtual Healthcare for Urgent and Non-Urgent Care

Caring for Ailments Without a Physical Space

virtual healthcare physician
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The internet is changing everything. One can buy underwear or a new car with an app. Even a home purchase is possible, including qualifying for a mortgage on a smartphone. Even if you did a traditional walk-through of your potential new house, odds are you handled most of the transaction via email and signed all of the documentation along the way electronically, except for that last part that had to be notarized.

Similarly, 911 centers are evolving to allow callers to use text messaging to report emergencies. In some parts of the country, the initial response to a cardiac arrest might be crowd-sourced through an app that alerts nearby volunteers. How long before ambulances and fire engines drive themselves to the emergency?

With all this change and virtualization, it's no wonder that healthcare delivery is trans as well. Not just self-driving ambulances—a concept that many patients are not really crazy about—but even the way that one sees a doctor is changing.

Virtual Healthcare: Forming Long-Distance Relationships

Virtual healthcare (also known as telehealth or telemedicine) is a term that relates to using telephone or video chat to get evaluated and treated by a physician. Virtual healthcare is a good option for urgent care because it allows a patient to see her doctor (or any doctor) whenever she wants, usually without waiting and with a quick visit.

It's also good when a patient's doctor is far away. My wife's physician moved over 100 miles away from us, but her relationship with her doctor is still strong. She can use telehealth options to help her stay in touch and do quick assessments by phone or video chat. She doesn't have to start over with a new doctor.

In some cases, the platform for this communication is based on a smartphone app. Other platforms can be web-based or use staffed call-centers. In many versions, physicians can be contacted in between seeing patients the old-fashioned way: in the office.

Types of Virtual Care Systems

Virtual healthcare didn't just pop up out of nowhere. It's been an evolution of tech and health.

Nurse advice lines came first. Those were intended to cut costs for insurers by using a nurse to provide guidance on whether to go to the ER or make an appointment. Nurse advice lines usually are protocol driven (nurses have a script and an algorithm they are supposed to follow), but they've grown to provide much more than simple guidance on which type of physical care options to seek.

Nurses now provide all sorts of medical help and many advice lines employ nurse practitioners to potentially assess patients and help them obtain the care they need. These are still protocol-driven processes, but they need autonomous caregivers to be able to make strong clinical decisions.

The next iteration was called telemedicine. In this version, there is a doctor available on the other end. That's what led to virtual care apps and platforms.

Telemedicine programs have a wide range of different structures. For most smartphone apps, there is nobody between the patient and the physician. It's just the patient, the doc, and the phone.

Virtual Visits, Real Jobs

In most versions of the virtual model currently on the market, physicians are the gold standard of health care provider. A nurse or medical assistant might answer the call initially and process the patient's particulars—name, date of birth, insurance, address, primary physician, etc.—but the money is in the physician's interaction, which is usually very brief.

This is a pretty good deal for a doctor.

Patient interactions are abbreviated because nobody wants to spend longer than necessary on the phone. You get just what you need, but it's not as personable as being face to face. Once you've sunk your time into the process of checking in and doing your penance in a typical waiting room, you could feel a little short-changed with a five-minute visit at the clinic. On the phone, however, shorter visits are usually preferred. It's better for the patient because the entire experience is over quickly and it's more lucrative for the physician because of the high patient turnover.

In other, more sophisticated cases, the physician acts as a virtual guide to on-site medical teams made up of nurses or paramedics. Physicians use the bedside medical care providers to be their hands, eyes, and ears. A nurse or paramedic can get up close and personal with the patients. They can feel temperature and moisture of the skin. They can listen to lung sounds and take vital signs. They can also provide significant medical interventions with orders from the physician.

Many telemedicine programs are used to help hospitals reduce readmissions of patients who were recently discharged. Medicare created this particular incentive by penalizing hospitals if recently discharged patients have to be admitted back to the hospital for the same condition.

Other telemedicine programs use this model to diagnose and guide care for potentially complicated emergency medical procedures. Using telemedicine, a physician can be added to almost any emergency interaction almost anywhere in the world. Docs in San Francisco can guide surgeries in Antarctica or a neurosurgeon can work with paramedics to identify stroke patients.

In some cases, the paramedics or nurses at bedside wear technology like video goggles or body cameras to help the physician see the patient up close.

Answering the Call

How about those other jobs, though? Where is that nurse who answered the phone? Those could be either call center employees answering phones in their cubicles and handling a dozen interactions an hour, or they could be folks in their own homes answering calls that are routed to them through a software platform.

Nursing school doesn't have a section on telephone assessment and care, so most of these positions need some sort of training to prepare the nurse for telemedicine. Assessments are much different when you're limited to the screen of a smartphone or, worse yet, just using your patient's words to visualize their medical presentation.

911 dispatchers are experts when it comes to visualizing what's going on at the other end of a telephone call. Dispatchers who are trained to handle medical calls, including providing medical instructions to non-medically-trained callers, know how to take command of a conversation and get the caller to comply. 911 dispatchers have very little actual medical training. The algorithm makes all the decisions for them. It's designed to guide them through the medical interaction based only on the caller's answers to questions posed by the algorithm.

In most cases, patients calling into a virtual urgent care app are not experiencing life-threatening emergencies, but it is a possibility with each call. Nurses can't just ignore those types of calls. Putting nurses through training similar to that of a 911 dispatcher helps to create a hybrid that can use algorithms in a more sophisticated way.

Improvements for the Future

Regardless who answers the phone or who is providing the medical care, IT specialists and computer coders are needed to make the whole thing work on the front end. Many of these platforms don't yet exist. It's the computer coders who are at the forefront of creation. Network engineers and communications specialists help make the system work only after the designer creates the foundation.

Medical billers keep the revenue flowing on the back end. Most of these platforms are new and don't yet fit into traditional medical insurance billing models. The future of virtual healthcare depends on finding a model that generates revenue and is sustainable.

Sources:

Gordon, A. S., Adamson, W. C., & DeVries, A. R. (2017). Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization. Journal of Medical Internet Research19(2), e35. http://doi.org/10.2196/jmir.6783

Schoenfeld AJ, Davies JM, Marafino BJ, Dean M, DeJong C, Bardach NS, Kazi DS, Boscardin WJ, Lin GA, Duseja R, Mei YJ, Mehrotra A, Dudley RA. Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits. JAMA Intern Med. 2016 May 1;176(5):635-42. doi: 10.1001/jamainternmed.2015.8248.

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