You know the drill. You schlep to the doctor's office and wait
for what
seems like hours - despite having an appointment. As the time ticks
away,
your frustration level rises, along with the number of other
commitments
you are missing.
That's today. But tomorrow holds promise for virtual improvement
-
literally.
In the not-too-distant future, a doctor's visit may be just a
click away.
Imagine having your appointment conducted as you sit comfortably in
front
of your home computer screen, describing symptoms or asking
questions of a
doctor via videoconference, and having your doctor respond in kind
from the
office. Need a blood pressure reading? A special cuff downloads it
directly
into your computer - and to your doctor in real time, just like in
a
face-to-face appointment.
It may sound farfetched, but virtual medicine is already
happening on a
trial basis in Boston, and more broadly elsewhere in the country,
with
Hawaii leading the way. Also in development: widespread use of Web
cameras,
instant messaging, and other e-technology to help ease healthcare
costs,
and relieve the burden that scheduling often represents.
There are clearly some limits to the new technology. It can't,
for example,
be used for a gynecological check up, or many other physical exams.
But
adaptations - such as the special blood pressure cuff - make it
possible to
do things that heretofore seemed possible only in person.
But is it good for patients? New studies - including a recent
one that is
Boston-based - suggest virtual medicine may win fans from both
sides of the
stethoscope.
Dr. Ronald Dixon, an internist at Massachusetts General Hospital
who uses
videoconferencing in his practice, is the senior author of a recent
Boston
survey comparing patient satisfaction with virtual visits versus
face-to-face doctor's visits. The study, published in the Journal
of
Telemedicine and Telecare, involved 175 patients, ages 18 to 85,
who were
randomly assigned to specially-arranged videoconferenced "office
visits"
or conventional ones.
Patients ranked the virtual mode nearly as high as being there
for most
measures, including time spent with the physician and ease of
interaction.
Overall, however, patients and physicians still preferred face
to face.
Dixon said the findings indicate that virtual visits may be
suitable for
common ailments, such as back pain and upper respiratory
infections, and
for routine follow-up of chronic diseases, including diabetes or
hypertension. It would not, he said, work well for more complex
health
problems.
For patient Paul Beninger, a 58-year-old biotech researcher who
participated in the study, virtual was as good as being there.
Beninger,
who also is a regular patient of Dixon's, was in the
videoconference
segment of the study and visited Dixon electronically.
"As long as one has a good working relationship with a
physician, being
able to do things remotely works very well," said Beninger, who is
comfortable in front of an Internet-connected video camera; he
regularly
uses the technology to chat with his globe-trotting daughter.
But he acknowledges it is not right for everyone.
"My mother, who is 88 and doesn't even have a computer, doesn't
even know
where the "on" switch is," Beninger said. "I don't imagine she
would be
comfortable with a computer visit."
In Hawaii, doctors and patients are well on their way to being
comfortable
with the technology.
Hawaii's Blue Cross Blue Shield in January launched its Online
Healthcare
Marketplace, which allows patients who've enrolled in the program
online to
log in, type in their medical request at any time of the day or
night, and
instantly see a menu of specialists who are available at that
moment for a
virtual visit. Patients have an option of a videoconferenced
session with a
specialist, a phone consultation, or instant e-mail communication
through a
secure website - for the price of $10 for a 10-minute visit.
The system provides patient and physician with simultaneous and
instant
access to a summarized version of the patient's medical records. So
far,
about 4,000 patients have signed on, and about 1,000 have used it,
said
Mike Stollar, a vice president at Hawaii Medical Service
Association, the
Blue Cross of Hawaii.
Access to quality and cost-effective healthcare are the twin
goals of the
program, Stollar said.
"We believe if people can get the right care as early as
possible there
will be savings," he said, "because if they wait until something
is
acute, we pay through the nose."
Among those logging on is Toby Morris, a 49-year-old Hawaiian
contractor
who was anxious one recent night whether stomach pain he'd had for
three
days was something that required immediate medical attention.
Morris signed
on, chose a phone consultation - "I'm not that much of a techie,"
he said
- and seconds later was reviewing the symptoms with a physician
he'd never
met before. They jointly concluded it was the flu.
"It was great for me because my schedule is sort of
unpredictable, and I
don't like to schedule much in advance," Morris said.
A few nights later, Morris's girlfriend logged on to find out
quickly
whether the prescribed shot she gave herself after being stung by a
Portuguese Man of War, a venom-filled marine organism, would be
sufficient
to control her life-threatening allergy, or whether she needed
emergency
care.
The virtual visit reassured her, Morris said, that she didn't
need to race
to the ER.
The software for Hawaii's pioneering program was created by
American Well,
a Boston-based company founded by two brothers who are physicians.
"The beauty of this system is that it can sort through the
specialists
available at that moment ... and pick a female pediatrician, for
instance,
who speaks Spanish," reflecting a patient's preference, said
American Well
CEO Dr. Roy Schoenberg.
In April, Blue Cross and Blue Shield of Minnesota announced it
will roll
out a similar program later this year for its 10,000 employees,
with a goal
of making it available to other consumers next year.
While declining to say whether a launch is in the works for
Massachusetts,
Schoenberg said such a prospect is a "very, very near future
thing."
But what about privacy concerns? Do patients find it
disconcerting to
discuss the intimate details of their health online?
Apparently not. As online banking, shopping, and social
networks, such as
Facebook, become commonplace, patients appear to be much less
worried,
compared to physicians, about their medical privacy, according to a
recent
study coauthored by Dr. Tom Delbanco, a Harvard Medical School
professor
and Beth Israel Deaconess Medical Center physician.
Delbanco's study - four focus groups involving 82 participants -
found that
patients are much more willing to do without face-to-face visits
than
doctors expected.
"Patients want doctors to be able to communicate and they want
it right
now," he said. "Privacy takes second place."
Recently, one of Delbanco's patients called him about a rash.
Delbanco
asked him to take a picture of the area and e-mail it to him.
"We were able to dispose of it without a visit. It was a minor
skin
infection," said Delbanco, who has been e-mailing with his
patients for
years. "Almost everyone has a digital camera and we e-mail JPEG
(computer-formatted) pictures of our kids. Why not send pictures of
our
skin?"
Dixon, the MGH doctor holding some appointments via
videoconference, hails
virtual medical technology as what he calls a valuable "enabler."
"It's not substituting, its augmenting," Dixon said. "I am
not talking
about introducing new widgets: I'm talking about the Internet,
camera, and
cellphones, using tools readily available to patients and ((making
them))
part of their healthcare."
Kay Lazar can be reached at klazar@globe.com.
c.2009 The Boston Globe