Get Connected with Online Physician Consultations

By Nany Tice, MD
Published: Wednesday, Jan 21, 2009
How does today’s connected, “always on” world translate to your medical practice? Should you be e-mailing your patients? Performing online consults? Telephone consults? What about telemedicine? The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one place to another via electronic communications to improve patients’ health status. This includes providing direct patient outreach and services and use of the Internet and other technologies for tele-consultations, patient medical education, remote patient monitoring, online medical records, specialist referrals and much more.”

Why is telemedicine important?

The AMA has reported that as many as 70% of all doctor visits are for information only or for matters that can be easily handled over the phone. Data shows that more than 36 million Americans have been treated successfully through telemedicine, telephone, or e-mail consultations. In addition, there is also a growing population of patients who can’t travel to the doctor easily, compromising their health and increasing their incidence of medical complications. Therefore, physicians and patients are gradually turning to electronic communication as a supplement to traditional visits. This technological step forward raises concerns about time, cost, liability, privacy, and security, remembering that communications need to be HIPAA compliant. But what if you could set up a system in which patients could receive e-mail and telephone consultations, including diagnosis and treatment for the more minor issues that don’t require office visits? What if for chronic patients you could set up a telemedicine system with secure video visits, with the ability to take vitals, obtain pertinent history, and measure important variables? What would systems that address all these concerns look like? What, if any, are the technical, liability, and ethical issues? “There is a whole move toward consumer-oriented healthcare: Your time, your place, your way,” says Jonathan Weiner, professor of health policy, Johns Hopkins Bloomberg School of Public Health.

Since a variety of modalities and technologies now make it possible for physicians to exchange information, from brief messages to complete patient records, with each other and with patients—including tools as simple as e-mail and as sophisticated as two-way secure video with biometric patient monitoring— many physicians are integrating them into their practice. A host of services are becoming available at various levels of service, both to physicians and directly to patients.

Physician adoption of electronic communication, particularly with their patients, has grown slowly in recent years; an estimated 38% of physicians reported using online communication with their patients in 2008, up from 31% in 2007, and 25% in 2006, according to Manhattan Research surveys. While the telephone appears to remain the channel of choice for urgent contact, many physicians are discovering that e-mail is a more efficient means for eliminating phone tag and documenting transactions.

So what services are available? Some physicians have begun to offer patient access via e-mail. Although convenient, e-mail correspondence does raise the concern that a physician won’t be able to respond in a timely fashion to a barrage of messages. Many physician users say this has not been the case and that the bulk of patient correspondence tends to be regarding setting appointments, refilling prescriptions, and transmitting lab results, which would probably have been more time-consuming through traditional methods.

According to Christopher Guadagnino, PhD, the number of physicians who offer online patient consultations might increase in the wake of several developments in 2008:

  • CPT code 99444, a Level I reimbursement code for online evaluation and management services provided by a physician (formerly Category III CPT Code 0074T.
  • Aetna and Cigna will reimburse US physicians for online consultations.
  • Large medical malpractice insurers will offer premium discounts to physicians who e-mail with patients.
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