Medical Informatics: Virtual visits save time, money and improve care quality

BOSTON--If it was up to Ronald Dixon, MD, director of the Virtual Practice Project at Massachusetts General Hospital (MGH), three out of five physician appointments would take place virtually.

During a time when many patients encounter difficulty accessing care due to the shortage of primary care physicians, virtual visits are an opportunity to lower costs, especially with low-risk patients, Dixon said at the Medical Informatics World Conference on April 8.  

“A relationship with a clinician is leveraged using technology,” Dixon said of the approach. With the proliferation of technologies like smartphones, tablets and telehealth devices, physicians can successfully treat patients virtually, improving continuity of care.

A utilization-based patient segmentation methodology helps determine which patients are the most appropriate for virtual visits. Those with high risk of readmission due to frequent  visits may be best for face-to-face encounters, while low-risk patients and those with predictable treatment regimens for chronic conditions may benefit from virtual visits.  

“70 percent of follow-up visits could be done virtually,” he added.

Dixon described a typical asynchronous virtual visit: A patient answers a set of condition-specific questions over a secure website. Within 24 answers, a physician reviews the answers and provides a formalized response and determination. “You are still personalizing information, but it’s mostly the technology making the decision with the patient being involved,” he said.

Other types of visits include synchronous visits, real-time encounters over videoconferencing or remote physiologic monitoring, which uses devices to monitor a patient’s clinical and physiologic measures such as blood sugar, blood pressure and caloric expenditure.

Among Dixon’s 11,000 patients at MGH, patient satisfaction is high due to the convenience while physicians save time. “The average physician virtual visit drop to 3.62 minutes,” he said.

Some resistance among both physicians and patients remains a challenge, although Dixon said his research has shown that physicians make the diagnosis whether over the internet or face-to-face.” He described one instance when he diagnosed a skin condition, shingles, by looking at a photo over a smartphone. The patient, however, still felt compelled to visit the doctor in person to be sure.

Looking forward, Dixon said the trend away from fee-for-service must continue, and it must be ensured that fee-for-service is not a disincentive to a virtual visit.