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Let the Doctor Come to You in a “Virtual Visit”

Private: Adam M. Licurse, MD, MHS
Contributor Adam M. Licurse, MD, MHS

You may have heard the words “telehealth” and “virtual healthcare” a lot lately. These terms embrace the many ways that patients and healthcare professionals can connect through technology.

A great time-saver for patients is the “virtual visit.” This appointment with a doctor takes place from the comfort of your home or office, via secure video, sparing you the inconvenience and travel time of going to the doctor’s office or clinic.

“It is easier for our patients – you don’t lose time from work, you don’t have to sit in traffic or in a waiting room. We come to you,” says Adam Licurse, MD, MPH, a primary care physician and telehealth medical director at Brigham and Women’s Hospital. For certain needs, he notes, virtual visits may even be better for the patient because keeping up with regular visits can affect care quality.

The number of virtual visits with Brigham physicians has been increasing, as they are nationwide. Over the past year, Brigham physicians have conducted nearly 2,600 visits and currently log more than 220 per month.

One patient was skeptical when his doctor first suggested an online visit after he missed an in-person appointment. “I’m usually not a big fan of online communication,” says Allen. “But it was convenient for me because I didn’t have to go in.”

For a virtual visit, a patient needs only a phone or tablet or a computer with a camera that connects to the Internet. Through an app, the patient connects to a secure video platform. At the appointment time, the patient logs in and may spend a few moments in a virtual waiting room. The visit itself is about the same length as an in-person office visit, and often shorter.

A survey conducted after 600 initial virtual visits with Brigham physicians found that 97 percent of patients were satisfied with the experience and would recommend the program and 74 percent felt that the interaction actually improved their relationship with their provider.

Who is an appropriate candidate for a virtual visit?

Video visits are most appropriate for patients who need to check in with their doctor about test results or ongoing symptoms, and for previously-diagnosed chronic conditions.

“If the patient needs a physical exam, then that visit is not done virtually,” says Licurse. He also strongly recommends that virtual visits be used only after a doctor-patient relationship is established through prior in-person visits.

At the Brigham, the most frequent conditions addressed during virtual visits include follow-up care for voice and speech problems, sleep disorders, hypertension, anxiety and depression, and prostate disease.

Virtual visits are especially useful for patients who otherwise might miss a follow-up. That was the case for Allan. He describes his needs as “low-maintenance” and found the virtual visit an easy way to check in with his doctor about his diabetes regimen and other ongoing needs.

“And afterward I could get right back to what I was doing,” Allan says. “It was just like a phone conversation. But I could see the doctor.”

Using virtual visits to increase the number of “touchpoints” between the patient and the care team may help to monitor symptoms and keep treatment on course. “For many situations, virtual visits are better than a phone conversation alone,” says Dr. Licurse. “Through a video visit, I can see how a patient’s skin looks, their mood, whether they’re fatigued and even aspects of their living environment such as how they store their medications.”

Private insurance increasingly is covering telehealth services, and in 31 states insurers are now required to cover telehealth equally with in-person services. While Massachusetts does not have that requirement, Brigham charges patients no more than a typical small co-payment for a virtual visit.

Use technology to connect care, not fracture it

Telehealth options and virtual visits also are offered by companies that use their own separate health care providers and technology. But there are advantages to working with your usual doctors and care teams.

When various healthcare professionals involved in your care are not within the same organization, care can be fragmented if they do not share one common EMR (electronic medical record) and easy ways to communicate with each other.

Brigham has its own telehealth capacity, with a secure video platform that complies with patient privacy rules.

Dr. Licurse pre-empts most people’s questions about whether a virtual visit can pick up on all the nuances of an in-person visit. “There’s always the possibility that a provider will miss something virtually that they would see in person,” he says. But from experience at the Brigham and elsewhere, he describes that risk as “vanishingly small.”

Virtual visits are a first step toward harnessing the full capabilities of new technologies to measure and transmit a patient’s ongoing biometrics so that caregivers can monitor them remotely.

“Now we can talk with you, and see each other,” says Dr. Licurse. “Eventually, we’ll be able to listen to your heart and your lungs, too.”

Private: Adam M. Licurse, MD, MHS
Adam M. Licurse, MD, MHS

Adam M. Licurse, MD, MHS, is a primary care physician and Telehealth Medical Director at Brigham and Women's Hospital.

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