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The doctor is in ....your mobile device

Associated Press

January 19, 2015 


CHICAGO — It was 11:45 a.m. and Dr. Christopher Bailey’s laptop was chirping, indicating a patient was on the line.

"Hi, this is Dr. Bailey. Can you hear me?" Yes, the female patient said, she could. She’d been violently coughing for days and was losing her voice, she explained. Her eye had turned red and she couldn’t sleep.

Bailey took a peek at the patient’s swollen throat as she said "ah" to her webcam and had her tap her forehead to determine how much her sinuses hurt before diagnosing her condition: an upper respiratory infection. Bailey prescribed cough medicine and an antibiotic, and he offered some practical advice — use a neti pot to flush her sinuses, keep talking to a minimum, take Tylenol for the aches and pains.

"That was great, very informative," the patient said after the 17-minute consultation. "Thank you so much."

Patients are bidding adieu to crowded, germy waiting rooms, opting to video chat with a doctor on their phone, tablet or computer within minutes of making the request.

About 400,000 patients had appointments with doctors via webcam in 2014 and experts expect that number to double this year. Large employers also have started offering the virtual doctor visits, via phone or web, as a benefit to their employees, according to Mercer data. The growth is driven by the fact that people feel more comfortable with technology than ever before, experts say, and insurers are starting to pick up the tab.

Consulting firm PricewaterhouseCoopers data estimate that nearly 39 percent of adults would be willing to have an appointment with a physician via smartphone, representing a potential $42.1 billion market. About half of the doctors surveyed by PwC’s Health Research Institute said more than 10 percent of patient office visits could be replaced by e-visits. About 37 percent said one-third of visits could be done virtually.

Several companies have popped up in recent years to facilitate e-visits between doctors and patients. Bailey, with a specialty in family medicine, works for Chicago-based Doctor on Demand, co-founded by a cancer radiologist and a technology entrepreneur in 2012 and backed by Google and TV personality Dr. Phil.

The Doctor on Demand app has been downloaded a few million times since it launched nationally about a year ago. Six or seven doctors in Chicago are online each day, part of a nationwide team of 1,400. Combined, the physicians handle as many as 1,000 patient calls a day nationally, which last an average of 10 minutes. If doctors work full time, usually from home in eight- or 12-hour shifts, they can make $150,000 to $200,000 a year. The cost to patients is $40, a figure that’s sometimes covered by insurance or employers, said Dr. Pat Basu, Doctor on Demand’s co-founder and chief medical officer.

Jamelia Hand recently used the Doctor on Demand app. Even though she’s a single mom in pharmaceutical sales who also runs her own side business, she’d always made time to go to the doctor’s office to refill her prescription.

But it was Christmas Eve when she realized she was on her last pill and the doctor’s office would be closed the next day. She’d seen a commercial for Doctor on Demand, but was skeptical.

"Being skeptical came from … knowing how impactful it is to sit before someone and have a meaningful interaction," Hand said, "but I was pleasantly surprised by the fact that (my doctor) wasn’t distracted. In a medical office, they’re doing 15 things. They’re not really able to listen to the patient. But with the video visit, I felt like I had all of her attention, it was all about me."

Doctor on Demand is one of several companies that have seen growth opportunity in e-doctor visits, including Teladoc, American Well and MDLive, which recently partnered with Walgreen to launch an e-visit app.

The price for a visit is $40 to $49, not significantly more than some people dole out for copays, and sometimes less than a patient with insurance would pay to visit the doctor in person. That’s increasingly the case as more employers offer high deductible health plans to employees, requiring them to meet deductibles of $1,000 or more for employee-only coverage and thousands of dollars for family coverage before insurance kicks in.

"People are becoming more cost conscious about out-of-pocket spending for medical services," Walgreen’s Chief Medical Officer Dr. Harry Leider said. "If you have a hard time getting in to a doctor and you’re paying out of pocket for three, four, five months of the year, paying $49 for a telehealth visit … looks pretty attractive."

The video chats are meant for people with short-term health problems, like bronchitis, upper respiratory tract infections or rashes, Leider said. It’s not meant to be used for medical emergencies, such as chest pain that could signal a heart attack, or chronic conditions like diabetes, he said.

The predictions of an e-doctor boom come as the health care system faces a shortage of primary care doctors and an influx of people with health insurance, now that the law requires people to have coverage or pay a penalty.

The growing virtual doctor trend could help unclog emergency rooms and doctors’ office waiting areas, Basu said. He sees a day when patients with easy-to-treat conditions get help via video and in-person visits are left for those who need more advanced help.

"For so long, we’ve seen backed-up waiting rooms," Basu said. "Doctors get this … ‘My patient just told me they drove 40 minutes in the snow, waited 30 minutes in the waiting room getting coughed on only to be told by me to take a couple of Tylenol.’"

The evolution of virtual doctor visits has been inevitable, experts say.

Smartphones and tablets that make doctor e-visits so convenient have become popular in the past few years. The iPhone, for one, launched in 2007, and the iPad in 2010. Today people feel not only comfortable with technology, experts say, but dependent on it.

If patients can take a picture of a goopy eye or shine a webcam down their throats to avoid a trek to the doctor’s office, they’re increasingly willing to do so.

Basu said his doctors diagnose and treat 95 percent of the patients who call. The other 5 percent are referred to specialists or in rare instances the emergency room.

Insurers are also more willing to cover part or all of the cost.

"I can tell you from our discussions with many of the nation’s insurers — if they’re not providing it, they’re setting up a mechanism to provide it," American Telemedicine Association CEO Jonathan Linkous said. "I don’t know any insurer who’s said no. They’re going to have to if all of their competitors are doing it."

Medicare covers some types of telemedicine services, usually for veterans or people who live in rural areas, but that is expected to expand, Linkous said.

Some obstacles facing the industry are rooted in regulations. For example, patients have to talk to doctors who are licensed in the state from which the patient calls. Doctors working for telehealth companies clamor to get dozens of licenses so they can treat patients from across the country, an expensive endeavor.

About 26 percent of doctors have licenses in more than one state, Linkous said.

Linkous said his organization has come up with an accreditation process for telehealth companies offering virtual doctor visits. So far 110 organizations have applied and he expects to hand out the first accreditations by the end of the month.

He said the goal is to push beyond simply providing assurances that doctors have valid licenses in the appropriate states. He wants these companies to conduct thorough background checks to make sure doctors haven’t had any form of discipline in the past, or had licenses revoked in one state only to gain a license in another.

"It’s a need," Linkous said of accreditation. "You need to have some code, some way of finding out that these people are not quacks."

Doctor on Demand’s Basu said his company conducts an "exhaustive background screen" on each applicant’s professional and personal histories.

Though medical malpractice is always a concern for doctors, Linkous said, it’s probably less of a concern with e-visits, because the medical conditions are less serious.

On the technology side, he said, companies still need to address the potential for dropped calls.

"There should be some sort of backup plan if there’s some sort of (connection) failure," Linkous said. "You’re probably not dealing with someone who’s bleeding, but you need a backup plan for an interruption in service."

Another obstacle: Some states — Arkansas, Idaho and Alaska — don’t allow doctors to prescribe medicines on a first-time video appointment.

And then there are privacy concerns. How do we know those videos are safe, never to be shared or leaked to YouTube?

Basu says friends at Google helped engineer Doctor on Demand’s security platform. The company doesn’t record video from the visits, uses encryption during the video calls and stores patient health information on secure servers that meet federal health insurance requirements.

Ceci Connolly, managing director at PwC’s Health Research Institute, said e-visits will become more useful as complementary devices get FDA approval. Regulators cleared 24 consumer digital health devices in the first 10 months of 2014, including a disposable biosensor system that enables remote monitoring of vital signs.

More do-it-yourself medical devices await approval this year.

"You’re also seeing that some of the newer entrants in health care and the big pharmacy chains and retailers are starting to include these virtual doctors," Connolly said. "That is the warning sign to the traditional doctor and hospital groups that if they don’t find a way to work this into their practices, those competitors are going to start stealing a lot of the market."