Telemedicine Applied too Broadly, Time Needed to Identify Ideal Applications

Extending typical physician office visits by utilizing similar technologies we use to communicate on a day-to-day basis is one way for providers to venture into a new tech-centered healthcare environment.

Patients are viewing telemedicine as a simple extension of the brick and mortar care model made famous by companies like Minute Clinic, which offers convenient access to a care provider for a small number of common conditions.

These virtual visits occur via video or a voice connection. Patients are seeking treatment for acute problems such as sore throats, ear aches, urinary tract infections, etc. In addition patients are using telemedicine technologies for follow-up care for conditions such as diabetes, hypertensions, and beyond.

Employers seeking comprehensive and affordable health plans for their employees are interested in this mode of delivery. Virtual visits have transitioned from a curiosity to a ‘table stakes’ offering in the world of employee health. Several companies now offer telehealth services, offering a range from a complete service (i.e., software platform for access and a network of physicians who are waiting by the (video)phone for your call) or pieces of the service (for instance, just the software platform).

But the question still remains, is the quality of a virtual visit comparable to an in-office visit?

In an article published in JAMA Internal Medicine, employed individuals were trained to act as patients with acute illnesses such as: ankle pain, strep throat, common cold, low back pain, and a urinary tract infection. These trained “fake” patients performed 599 virtual visits across a number of different telemedicine vendor scenarios with varied results.

The correct diagnosis was arrived at in 458/599 visits. Rates of guideline-adherent care ranged from 206 visits to 396 across eight different vendors. The big challenge with this — and something we have trouble talking about — is lack of comparison to the face-to-face office visit. For example, in traditional office-based circumstances, doctors misdiagnose and sometimes do not follow established guidelines.

For another visual, a second article published in the Journal of Telemedicine and eHealth, authors specifically target virtual visits utilizing Teladoc in comparison with office visits. Teladoc, a recent publicly traded company, is able to offer clients a complete service (i.e., software platform for access and a network of physicians who are waiting by the (video)phone for your call) or pieces of the service (for instance, just the software platform).

Using a different approach of retrospective insurance claims analysis, the authors discovered Teladoc doctors performed worse on a number of indicators when compared to office-based practitioners. Specifically, Teladoc physicians did not order strep tests as much as office providers and ordered antibiotics for bronchitis more often.

These results make sense as we can assume a patient would wonder why they would have bothered with a telemedicine visit if they would just be required to visit an office for a strep test, according to Dr. Joseph Kvedar, a contributor to In the case of antibiotics, the virtual provider may be more cautious without the person in the same room and err on the side of treating with antibiotics.

Together, these articles highlight the existing holes preventing widespread adoption of virtual visits. These results highlight the need to make sure we as telemedicine professionals get it right. We can take comfort in the low utilization, and work on educating providers on the pitfalls of the virtual environment. We can also educate our patients up front that even though their entry into the healthcare system will be virtual, they may need to travel to get additional diagnostic services, etc.

For the full article on telemedicine expansion click here. 

For the JAMA Internal Medicine article click here. 

For the Journal of Telemedicine and eHealth article click here. 


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