Tuesday, August 16, 2011

Implications of a Technology-Based Medical Encounter

Author: Sheetal Chowdhary

The typical medical encounter consists of scheduling an appointment, commuting, waiting, finally seeing the doctor, and visiting the pharmacy. Some have proposed restructuring the above with a technological approach:

1. Video call triage: The patient makes a video call to the doctor’s office. The doctor’s office computer accesses the medical record and a triage nurse directs the patient to the ER, a specialist, or the current office.

2. A follow up without new complaints, such as blood pressure management, can be done by video call. The video call becomes part of the electronic medical health record and no transcription is necessary. The doctor can issue a conditional prescription and the patient can have the blood pressure checked at the pharmacy.

3. Regular non-video call visits can continue for more complex cases or per patient preference.

The above approach saves time for both the patient and doctor. The patient does not have to visit the office in certain cases. The doctor can spend more time with complex cases since simple follow ups are managed by video call. One can argue that the technological approach is more efficient than the typical medical encounter for all patients. A doctor would be able to see more patients.

However, the technological approach raises several concerns:

How much can you technologically streamline a patient encounter without adversely affecting the quality of care? A traditional medical encounter undeniably has more benefits than a video encounter. A physical exam is often invaluable. Even a patient following up for hypertension may merit a cardiovascular exam and an annual eye exam at the minimum. However, one could argue that patients with stable blood pressure on medication can be seen by a video encounter. Personally, if I see a patient for hypertension, then I would want to check the blood pressure myself and not leave that up to the pharmacy.

Will video calls promote “video doctors”? The concept of practicing medicine by video call may be more convenient and save time. However, excess video calls may promote “video doctors” or professionals that see patients only by video. Outsourcing concerns for doctors could arise from video calls as a video can be accessible to any doctor anywhere in the world.

Will video calls increase liability for the doctor? The standard of care for video calls may need to be addressed to guide physicians since a physical exam is not thorough. It is intuitive that video calls are a bit more risky since the full benefits of an office encounter cannot be addressed.

Which patients would be comfortable with a video call? Most likely the demographic comfortable with using technology is probably adults and young adults. Therefore, it can be argued that technologically streamlining the younger population could leave more time to take care of the increasing elderly population in the office. Also, video calls may be more economically feasible for patients without insurance.

The technological approach has the benefits of being more cost-effective and time-efficient, but at a potential trade-off for quality of care and increased legal risk.

About the author:

Sheetal Chowdhary is a candidate for Doctor of Osteopathic Medicine in 2012 from Touro University Nevada College of Osteopathic Medicine. In 2008, she was nominated for Student D.O. of the Year. She attended New York Institute of Technology on the T.K. Steele undergraduate scholarship and majored in Life Sciences. Her interests include research, writing, the outdoors, and philosophy.

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