Telehealth News

Is Telemedicine As Reliable As The In-Person Visit?

A recent study finds that one in four virtual visits conducted through one of the eight most popular telehealth platforms is inaccurate or incomplete.

By Eric Wicklund

- A targeted test of eight popular direct-to-consumer telehealth platforms has found that roughly one in four visits produces an incorrect or incomplete diagnosis – and doctors performing these virtual visits followed standard protocols little more than half the time.

The study, conducted from July 2013 to September 2014 and recently published in JAMA Internal Medicine, doesn’t compare the results to in-person visits, but it does raise questions as to how virtual visits are monitored for quality – and how doctors employed by telehealth companies are vetted or trained.

And while telemedicine is gaining momentum across the country, those questions of quality – and comparisons to in-person visits – have compelled medical boards in states like Texas to mandate stricter standards for virtual visits. In addition, the American Medical Association has used those concerns to delay action on standards around telemedicine.

The researchers in this study concluded that the convenience of a virtual visit can’t make up for quality concerns, and shouldn’t be the sole source of healthcare for the consumer.

“Although virtual urgent care and in-person urgent care have not been compared head-to-head, virtual urgent care has its downsides – indirect physical exam, difficult access to testing and unclear follow-up,” Dr. Jeffrey Linder, a researcher at Brigham and Women’s Hospital and Harvard Medical School who co-authored an editorial accompanying the study, told Reuters. “While the quality of care is not perfect anywhere, a patient’s primary care doctor should be a person’s first point of contact.”

For the study, researchers trained 67 volunteers to present one of six common acute illnesses - ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain and recurrent female urinary tract infection – to one of eight telehealth providers selected for their volume of web traffic. Some 600 visits were recorded to American Well’s Amwell, MDLIVE, Consult a Doctor, Doctor on Demand, Ameridoc, MeMD, MDAligne and Now Clinic.

According to the study, those visits resulted in a correct diagnosis between 65 percent and 94 percent of the time, while standard care protocols were followed between 34 percent and 66 percent of the time. The study also found that doctors on these platforms used complete medical histories and did thorough exams between 52 percent and 82 percent of the time.

While the study didn’t examine phone-based visits (Teladoc, one of the largest phone-based telehealth platforms, wasn’t included), it did note that the selected channel for the visit, whether it be web-based or via video, didn’t seem to affect the outcome.

“One of the more surprising findings of the study was the universally low rate of testing when it was needed,” Dr. Adam Schoenfeld of the University of California, San Francisco, told Reuters. “We don’t know why, but it may reflect the challenges of ordering or following up on tests performed near where the patient lives but far from where the doctor is, or concern about the costs to the patient of additional testing.”

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