Medical knowledge has grown rapidly over the last century, but our ability to carry out preventive health and disease treatment recommendations falls far short of what we would like.
Preventive health-screening compliance is in the range of just 50%-70% for interventions such as mammography and colonoscopy. For treatment of diseases such as hypertension and diabetes, only 50%-75% of patients are treated to the recommended goal. Among patients who are prescribed medications for chronic diseases, compliance varies enormously, with patients missing anywhere from 20% to 75% of the prescribed doses. Although investing in research to find new preventive and treatment strategies is important, it is likely that closing gaps in care in areas of already demonstrated efficacy can deliver greater value.
Dr. Neil Skolnik
Gaps in care exist at all levels. There are gaps in how well new treatments are communicated to physicians; gaps in how well clinicians implement both new and existing recommendations; and gaps in how patients carry out the recommendations of their physicians. Some of these deficiencies are due to poor compliance with evidence-based recommendations at the individual patient level, and some are system-wide issues. Even when a doctor is aware of guidelines and intends to implement these proven strategies, there are barriers to seeing the right patients at the right times to assess and coordinate needed care. At the system level, the costs of delivering care in an environment with significant reimbursement pressure limits the extent to which preventive and proactive strategies can be implemented.
However, dynamics are changing rapidly with the fast-moving field of virtual care. When patients decide that they need medical care, either for an acute or a chronic problem, they can go to a website and submit a question. They may get answers to their questions from physician-curated answers to similar questions or from a new answer authored by a physician. They may connect via text, phone, or video chat for virtual appointments with physicians they know or physicians new to them who have the appropriate subspecialty training. During these virtual visits, the patients can provide their histories and even upload pictures or other documents as needed; the physicians can evaluate the patients, create encounter notes, develop management plans and even prescribe labs and medications via any pharmacy in the United States and refer patients to other doctors for virtual or in-person visits and/or follow-up virtually or in person, as needed. This can all happen very quickly, anywhere, anytime at the convenience of both the physician and the patient.
The emergence of these end-to-end solutions for virtual care, enabled by the rapid advance of digital health technologies and the pervasive use of mobile platforms, may overcome many barriers for both physicians and patients. In a virtual care environment, patients can be connected with physicians anytime, anywhere, and in a highly convenient and efficient way for both parties – thus lowering the hurdles to needed care and increasing the speed at which care can be delivered. Patients get easy access to information guiding them to proved preventive care. These platforms also deliver follow-up care plans and reminders electronically via the communications channels that patients use in their daily lives including text, e-mail, and phone messaging.
A well-organized virtual environment can increase patient awareness and engagement. In addition, today’s virtual care platforms use algorithms to ensure the right doctor is matched to the right specific patient in need, and they even possess decision-support capabilities to doctors that help them deliver guideline-supported care. Because of this, the hope is that more care can be delivered by existing doctors to larger numbers of patients in a more cost-effective manner.
One potential issue, of course, has to do with how this will change the relationship between physician and patient. After all, we live in a world where the individualization of information and services is increasingly taken for granted, and the field of health care is no different. For some people, at some times, having the personal touch of and relationship with a physician will be important. For other people, at other times, convenience, easy access, and delivery of evidence-based, dependable care will be most important. The fact is, both are possible when the new virtual care platforms are merged with traditional models of care.
To be successful in capturing value in this new and rapidly emerging field, many obstacles need to be overcome (N. Engl. J. Med. 2015 372:1684-5). Current legal and regulatory frameworks do not fully support virtual care, for starters. One such challenge is state licensing for physicians, which is not currently flexible enough to support virtual care. Another even more significant challenge is to develop the evidence base showing that virtual approaches are safe, efficacious, and truly cost-effective for specific clinical applications. The truest advantage of virtual health care is the potential to bring the right information to the right patient at the right time.