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Virtual doctor will see you now

Sep 03 2014

New way to practice medicine may be a smartphone app away

Richmond Times-Dispatch

By Tammie Smith

The doctor may be just a smartphone app away, with telemedicine and mobile health services such as LiveHealth Online and MDLIVE.

Log on, pay a fee and a doctor is right there to answer your questions about sore throats, sprains, rashes, earaches, headaches and multiple other conflictions.

“You can have a doctor by your side 24/7,” boasts wording on the home page of the LiveHealth Online website.

Virtual doctor’s visits from your smartphone, tablet, laptop or desktop are becoming more than a trend, some experts said, driven by busy people, technology that makes connecting simpler, aging baby boomers who need to see the doctor more often, and the Affordable Care Act, which is providing more people access to health insurance.

“Most of the complaints tend to be seasonal,” said Dr. Mia Finkelston, a family physician in Leonardtown, Md., who works with LiveHealth Online.

Finkelston was speaking during an online demonstration of how the service works. She is also licensed to practice medicine in Virginia, so she can see patients in the state who log on to the service.

Anthem Blue Cross Blue Shield, Virginia’s largest health insurance provider based on enrolled members, is offering LiveHealth Online as a service to its members. Anthem members pay a standard co-pay or coinsurance, based on their health plan.

Without insurance, the cost for a doctor visit on LiveHealth Online is $49.

MDLIVE is $49 for a doctor visit and $79 for a one-hour therapy session. With another service, First Stop Health, individuals can talk to a doctor over the phone for $29.95, but the company also markets its services to employers who pay a monthly fee for each employee covered. Not all services are available in all states.

The companies providing the services say the 24/7 access may cut down on unnecessary use of emergency rooms and is an alternative to visiting an urgent care center, which may not be open around the clock.

“Doctors are not going to treat people unless they feel comfortable doing it over this platform, where they can get a lot of history, but they can’t really lay hands on the patient,” Finkelston said. “So it really does self-select patients.”

Depending on state medical and pharmacy practice rules, online doctors can write prescriptions, except for controlled substances.

“I think the direct-to-home piece and the whole mobile health piece (are) going to be a big wave,” said Kathy Hsu Wibberly, director of the Mid-Atlantic Telehealth Resource Center, housed at the University of Virginia Center for Telehealth.

“Mobile applications are a convenience but also very useful. For example, we are starting to see pilot projects, including one at U.Va. where stroke patients are accessing a physician while they are en route in the ambulance using mobile applications.”

New way to practice medicine may be a smartphone app away

BY Tammie Smith

Richmond Times-Dispatch

The doctor may be just a smartphone app away, with telemedicine and mobile health services such as LiveHealth Online and MDLIVE.

Log on, pay a fee and a doctor is right there to answer your questions about sore throats, sprains, rashes, earaches, headaches and multiple other conflictions.

That test project called iTREAT — Improving Treatment with Rapid Evaluation of Acute Stroke via mobile Telemedicine — is equipping ambulances with tablet devices and other technology that lets the emergency technicians videoconference with doctors while they are on the way to the hospital.

Traditional telemedicine for the most part has involved videoconferencing between two medical or clinical locations — from one doctor’s office to another, for instance. There has also been remote patient symptom monitoring, such as that offered by veterans hospitals.

Telemedicine has been particularly useful for bringing medicine to rural areas that do not have medical specialists.

“We see dozens of patients every week through telemedicine,” said Tamara Broadnax, director of telemedicine at VCU Medical Center.

Virginia has a parity law, she said, so that reimbursement for telemedicine is the same for face-to-face provided the standard of care is the same.

“The commercial endeavors are going to be a convenience for people and, if implemented correctly, could be very positive,” Wibberly said. “But I think there are a lot of concerns or issues that need to be addressed.”

“Is there going to be communication with the primary care provider if one exists, and how does that communication take place? Is there going to be some kind of continuity of care?” she said.

Another issue is how the providers are selected and vetted. And there’s concern about patient privacy.

“Also, someone needs to look at are they using appropriate standards of care,” Wibberly said.

The Virginia Board of Medicine is convening an ad hoc committee Oct. 1 to look at some of the recent trends. The national Federation of State Medical Boards in April adopted new telemedicine policy guidelines for what it described as a “fast-changing health care delivery environment.”

Such services as LiveHealth Online can be accessed through a Web browser, or a Web application can be downloaded and launched. The doctor visit is usually 10 to 15 minutes.

Finkelston, who has been practicing medicine for more than two decades, has been with LiveHealth Online for two years.

“It’s a new way to practice medicine,” she said.

“None of us want to or claim this can take the position of a primary care provider,” Finkelston said. “One of the first questions on the template is about a primary care provider.”

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