The Exchange

Seeing the Doctor Online

You notice a mysterious rash on your forearm. With no idea as to what might be causing it —  not bedbugs! — you take to the Web. Not to check WebMD for a quickie self-diagnosis but to Skype with your dermatologist and show him the affected patch of skin.

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Online doctor visits are becoming increasingly common as cheaper videoconference tools and more high-speed Internet connections make it a cheaper and more convenient alternative to in-person consultations. Some specialties in health care, including online therapy and teleradiology, have gone mainstream.

Over 10 million Americans use a form of telemedicine each year, according to the American Telemedicine Association, a group that promotes the use of remote medical technologies. ("Telemedicine" or "telehealth" includes the diagnosis, consultation and treatment of patients via videoconference, phone and other applications.) And 15 states have passed laws requiring private insurers to cover services provided via telemedicine. Basic email communication between doctor and patient has more than doubled in recent years: 29 million people sent or received email from their doctor in 2011, up from 13 million in 2010, according to Manhattan Associates, a pharmaceutical market research firm.

A Solution to Physician Shortage?

Virtual doctor visits are also being touted as a possible solution to the nation's physician shortage. According to 2010 projections by the Association of American Medical Colleges' Center for Workforce Studies, there will be a shortage of about 63,000 doctors by 2015, with greater shortages on the horizon — 91,500 and 130,600 for 2020 and 2025, respectively.

Some studies have even shown the health benefits of online communication between doctors and patients. A 2010 Kaiser Permanente study, for example, observed more than 35,000 patients in Southern California who had diabetes, hypertension or both, and found patient-physician email within a two-month period was associated with a statistically significant improvement in effectiveness of care. Results included 2% to 6.5% improvements in glycemic, cholesterol and blood pressure screening and control. (Kaiser Permanente offers many telemedicine services, the latest being a health-management app for the iPhone which lets members email their providers, check lab test results, order prescription refills and manage appointments on their phones.)

Insurers are getting on board, too. Many big names, including Aetna, Cigna, UnitedHealth, WellPoint and Kaiser Permanente, offer coverage for a variety of online medical consultations. In 2010 two BlueCross BlueShield organizations in upstate New York started offering their members and employers virtual physician visits. And last year drug-store chain Rite Aid, along with OptimumHealth, began offering online consultations with doctors and nurses through NowClinic at its pharmacies in some regions. With the service, Rite Aid customers can see and speak directly to doctors who can discuss symptoms, provide guidance, diagnose and prescribe certain medications. (Patients pay $45 for a 10-minute visit with a NowClinic doctor; visits can be extended an additional 3 or 5 minutes for an extra charge.)

Getting Digital Care

A handful of services have landed in the marketplace offering patients a more digital-based way of getting care. One example is Telcare, an FDA-approved wireless glucose meter ($150) for diabetes patients that launched earlier this year. The device automatically uploads results online that can be read by preselected caregivers who can also provide feedback. MDLiveCare, founded in 2006, is a network of board-certified physicians and licensed therapists who can diagnose, recommend treatment and prescribe medication through phone or online video consultations.

The appeal is obvious. "You don't have to take off school, take off work, find parking, or sit in a waiting room," says Dr. G. Daniel Martich, chief medical information officer at the University of Pittsburgh Medical Center.

UPMC, for instance, offers e-visits for issues that don't need urgent attention. Patients log on to the hospital's patient portal from anywhere and fill out a form explaining their symptoms. "We put it through algorithmic approach…. Depending on how you answer one question, it leads to the next question," says Dr. Martich. Altogether, the form takes five to 10 minutes to complete and is kept with the patient's electronic records; a doctor usually responds within two hours. "We promise a 24-hour turnaround," Martich says.

So does this mean, with a fast Internet connection and a Webcam, that your days of waiting endlessly at the doctor's office are over? Not exactly. This method of care isn't right for everyone or every medical issue. Indeed, there are skeptics who think telemedicine has significant limitations, particularly when it comes to the more delicate aspects of the doctor-patient relationship. Using the Web to make appointments and get answers to simple questions is one thing. "But there are some elements of taking care of people that don't lend themselves to 21st century technology," says Dr. Sam Bierstock, whose company, Champions in Healthcare, helps hospitals implement electronic health records. "Patient care that comes with a certain amt of empathy and guidance depending on the situation — I don't think you can do all that in cyber world."

Most important, online doctor visits shouldn't be used in emergency situations. "They tend to work best when there's already an established patient-physician relationship," says Dr. Anthony Shih, executive vice president at the Commonwealth Fund, a health research foundation.

This mode of care, he adds, has been successfully used for routine requests, like prescription refill requests and checking in with your doctor for monitoring chronic illnesses in between in-person visits (for example, emailing your blood pressure readings for patients with hypertension). If you want to see your doctor about a new and potentially complex health problem,  he says, online communication is not your best bet.

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