Online doctors make house calls again

ROB VARNON
http://www.connpost.com

The digital doctor will see you anytime you want.

And that’s one reason Devon Herrick, an analyst with the Dallas-based National Center for Policy Analysis, says more doctors need to embrace technology and go online to give patients more access to health care.

The study, released Thursday, found not only are some doctors answering questions via e-mail, but they are also treating patients over the Internet. But Internet doctoring faces a mountain of questions about quality, liability, regulatory control and security before it becomes more accepted, according to a Connecticut-based patient advocate and the executive director of the Fairfield County Medical Association.

Herrick, however, expressed confidence in telemedicine’s future and said it could improve access to doctors — a big issue that’s still haunting the country.

In a 2001 Center for Studying Health System Change report, one-third of patients said they had problems seeing their primary care physician, according to Herrick. Studies in subsequent years have shown this as a continuing problem only exacerbated by higher costs and more people going without insurance. The U.S. Census Bureau will release an annual report on the insurance rate in the nation on Tuesday. Herrick said one reason people have access trouble is because doctors’ hours conflict with most people’s work schedules.

But services like Texas-based TelaDoc can help supplement medical coverage, according to Herrick.

Herrick said his organization offers employees access to TelaDoc as one of its benefits. According to TelaDoc, the company hires licensed doctors to provide medical diagnosis after reviewing a patient’s medical history and a telephone consult. It costs the patient $35 per consult.

Herrick said a client of TelaDoc has to enter his or her medical record into a database. This service isn’t meant to replace a primary care physician, he said, but it could help someone who is traveling get access to affordable care without going to an emergency room.

For example, he said a person who lost his or her prescription drugs could get a TelaDoc doctor to prescribe enough doses to get the person through the vacation.

Attorney Jennifer Jaff, executive director of Farmington-based Advocacy for Patients with Chronic Illness Inc., said digital medicine should be used as a tool to supplement traditional health care, not replace it.

She couldn’t imagine what pressing medical problems a person would have that could be dealt with over the phone or Internet through a service like this. A person with strep throat or some other ailment would have to go in for a throat culture and be examined, she said.

But Jaff agrees that telemedicine can help cut costs and improve care.

For example, Jaff said she had an operation and the incision became infected and needed daily care.

But instead of going to the hospital every day or having a nurse visit her house, Jaff and her doctor used technology to treat the wound.

“I took a digital picture of the wound and he looked at it and I dressed it myself,” she said. Her doctor would get the daily e-mail and if he had a concern he would tell her how to clean the wound or whether it was fine. She said the doctor did it for free, because law requires them to consult on the operation for 90 days after its conclusion.

She also sees value in telemedicine for managing chronic conditions. She said patients know their doctors and often a phone call can take the place of an office visit.

Jaff, who has a chronic condition, sees a specialist in New York, but she cuts down on visits by relying on phone calls.

Like Herrick, Jaff said she also sees value in using digital imaging to help review MRIs and X-rays. It could also be used to bring specialists into a doctor’s office via video conferencing, she said.

Herrick said doctors have been slow to adopt new technology despite the efficiency they create. Key issues preventing wider acceptance include how to determine what to charge for a phone call and insurance companies’ unwillingness to cover the service, he said.

But some insurers are beginning to cover it, Herrick said, including Connecticut-based Cigna.

The other major issue is jurisdiction, he said. Each state licenses doctors, which means a digital doc in Nevada couldn’t dispense medical treatment in Connecticut. TelaDoc hires doctors in every state.

It’s cost prohibitive and limiting the use of the Internet, according to Herrick.

Mark Thompson, executive director of the Fairfield County Medical Association, said technological advances aren’t going to free up doctor time.

“They are more busy today because they have to see more patients in a day then a decade ago to keep the doors open,” Thompson said. It’s a cost issue, he said, because liability costs have increased and so has overhead as doctors hire more people to try to deal with collecting payments from insurance companies.

Thompson said there are so many different types of insurance plans that it’s nearly impossible to keep up with what each plan covers and doesn’t. Doctors have to review tables of medicine to see if what they prescribe is covered and to see if something else will work if it’s not covered.

He also questioned the idea of dispensing medical advice over the Internet, because he expects the cost of malpractice insurance would kill those doctors.

But Thompson said there is some benefit to telemedicine, especially for rural areas where the nearest doctor is 100 miles away.

“But that’s not the case in Fairfield County,” he said.

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