by Robert L. Smith, MD

[Ed. We are pleased to have  Robert L. Smith MD, MS a guest columnist, who will be discussing the merits of virtual care. Dr. Smith is CEO and Founder of Finger Lakes Family Care, an NCQA Level 3 Medical Home, and Co-Founder of the NowDox Virtual Care Community]

It is 4:30 on a busy afternoon in your primary care office. Your second to last patient of the day, who has a history of migraines, is now complaining of 5 days of an unrelenting headache that is slightly different from her normal pattern of migraine headaches. You are unable to send to her to a neurologist until tomorrow and need to rule out a potentially dangerous situation.

You reluctantly decide to send her to the emergency room where she receives a CT scan and is kept under observation for 6 hours until an intracranial aneurysm is ruled out. The total bill for her care comes to $1500.

Now imagine yourself as a primary care physician working in a highly functioning Patient Centered Medical Home. Instead of basing your assessment on what intracranial process is occurring by practicing defensive medicine, you decide to bring the specialist to the patient. You set up an instant video conference with a neurologist that is available for online consults and he is now live in the exam room on a flat screen monitor.

The neurologist is able to ask further questions as well as conduct a complete neurological examination through this virtual consult. The end result is that the neurologist is able to ascertain that the patient was not having an emergent headache, she is treated with pain meds and observed in our office, and after 20 minutes her pain scale drops from 10/10 to 2/10.  Her bill came to $150 for a moderate level outpatient visit. This is a true story that occurred a few months ago with an extremely grateful patient and is a great example of the power and potential of virtual care.

To discuss this intriguing concept further, check out the thread of this topic located on our forum.

This scenario can now be the norm rather than the exception with the use of online, and now mobile, video conferencing tools. Having the capability to expand care services to patients, even in acute settings like the one described above, is vital to delivering care in a patient-centric manner.  Once reserved to large practices and hospitals with stationary telemedicine stations, virtual care has now entered the world of mHealth.  Virtual care is based on rapid accessibility and online collaboration with fellow colleagues and patients. It is also platform agnostic and can be accomplished using any hardware or software platforms. And most importantly, it is now affordable to individual physicians and accessible for patients.

Skype, FaceTime, Vidyo, and GoToMeeting with HD Faces are all current examples of video conferencing software available on tablets and smartphones. The specific software will depend on the nature of the communication desired. If a simple video phone call is appropriate for a particular medical encounter, then simply using Skype between PCs or Macs or iPads or Zoom tablets will suffice. If screen sharing of a Head CT is needed between the Emergency Medicine physician and the Neurologist on call from home, a GoToMeeting session will be a more logical answer as both parties can share images and collaborate on treatment decisions. If a physician would rather have a dedicated, online meeting room that patients and colleagues can simply drop in for a virtual meeting, a Vidyo virtual room would be a great choice.

The point to be made about Virtual Care is that it is a form of communication between patients and physicians that needs to be efficient, specific to a particular workflow task, and remain completely generic depending on the device that either party is communicating from.  Physicians in a hospital ED may need to have access from a webcam on a desktop computer, while a hospitalist may need virtual access from a smartphone or tablet due to their mobility within their work environment.

A primary care physician may need to be mobile while performing hospital rounds in the morning, switch to a static desktop PC while finishing afternoon office hours, then return to a mobile device while on call in the evening. A visiting nurse will need to use a mobile device while performing a hospital discharge follow up in the patient’s home. Software now exists for both parties to choose which platform is appropriate and best for them at the time depending on their workflow needs at that moment.

Virtual Care is more than the specialist at an academic center providing outreach to a community clinic or by controlling a $50,000 robot that is wheeled between hospital rooms with a joystick. Virtual Care is a very efficient and pragmatic approach to patient care, independent of the physical location of the parties involved. It is a form of communication whose time has come and can be instrumental in “fixing” our current state of affairs within the healthcare system.

Regardless of the third party reimbursement structure we are currently beholden to and the lack of payment for collaboration around patient care when not directly examining a patient, Virtual Care is the new model for delivering a safer and more effective means of healthcare.  And the best part, we now have multiple apps across multiple platforms to achieve the next revolution in healthcare!