This story appears in ParentMap's January 2018 print edition. Subscribe today!
It’s 3 a.m. and you hear your child coughing over the baby monitor. After you creep quietly into their room to take their temperature without waking them up, you discover they have a fever. Do you rush them to the hospital or wait until morning? If you’re like most parents, you probably turn to a familiar source for help: the internet.
If you’ve been known to spend hours on WebMD or Googling the symptoms of croup, you’re not alone. A 2013 Pew study found that 72 percent of Americans search for medical information online. We spend so much time Googling our way to a diagnosis that, as reported by Google in June 2016, about 1 percent of the site’s searches related to medical symptoms. And plenty of those Google searches lead us straight into a doctor’s office or emergency room.
Better access to medical care seems like a win-win situation. In today’s increasingly digital world, it makes sense to leverage the tools at our fingertips. But is all of this access to technology making us healthier? Are there downsides to asking Amazon’s Alexa if our kids have a cold?
The answer depends on whom you ask.
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Dr. Chris Cable is the senior medical director of clinical excellence and integration for Kaiser Permanente of Washington. Kaiser Permanente has long offered a variety of virtual health care services, including scheduled phone visits with a patient’s regular doctor, 24-hour phone visits with consulting nurses, online visits for common conditions and teledermatology, which offers same-day review of skin photos taken by a primary care physician. This year, it also launched video doctor visits.
Kaiser Permanente’s virtual health care services are staffed by many of the same doctors and nurses you’d see in the office. They accept insurance, and in many cases, there are no copays or cost sharing associated with virtual visits — so seeing a virtual doctor can save you time and money. If the doctor or nurse you consult virtually isn’t able to help you, they’ll refer you to a provider who can.
Cable points to this continuity of care as the reason why virtual health care provides the same level of care as standard providers. And it’s certainly easy to see the benefits. We’re increasingly a population of digital natives, who have come to expect that we can access medical care based on our “convenience and preference,” Cable says. That’s why more than a million virtual visits occur each year at Kaiser Permanente’s Washington facilities alone, he says.
Kaiser Permanente isn’t the only local hospital that’s experimenting with virtual health care. CHI Franciscan in Tacoma offers virtual urgent care (which can be accessed from a website or by phone) and virtual specialist visits, which use encrypted video to connect providers and patients. In the past three years, CHI Franciscan has conducted nearly 12,000 virtual visits. On average, these virtual visits have increased 15 percent with each year, says Lana Adzhigirey, program manager of Care Transformation for Virtual Health Services at CHI Franciscan. Like Kaiser Permanente, CHI Franciscan accepts standard insurance for its virtual health services (although Adzhigirey notes that Medicare doesn’t cover telemedicine services).
Adzhigirey says this increase in virtual health care services is a benefit to patients. “From headache to mental health to chronic heart disease, studies show telemedicine to be just as effective as in-person care,” she says. “The providers delivering virtual care are held to high standards, and there are virtual practice protocols guiding their work.”
A variety of internet start-ups also provide virtual health care apps, websites and even integration with Amazon Echo. HealthTap made news last year when it launched Doctor A.I., the first virtual health care provider that you can see simply by asking Alexa about your baby’s fever or that mysterious rash.
Like an actual doctor, Doctor A.I. asks you a variety of questions and uses data pulled from a database that contains information from more than 105,000 doctors across 141 specialties. Based on your answers, Doctor A.I. suggests a variety of solutions, such as reading doctor-suggested content or connecting you with a physician for a live consultation. It can even help you schedule an appointment with a local specialist or suggest you go to an urgent care facility.
"Years of diligent, collaborative work of some of the brightest doctors, engineers and data scientists combined with groundbreaking work of some of the best user-experience and visual designers on the planet have brought to life a first-of-its-kind, smart and compassionate Dr. A.I.," wrote Ron Gutman, HealthTap founder and CEO, in a statement on the company's website after the service’s launch last year.
A local start-up, 98point6, launched a similar service in February. Using its app, patients in Washington can connect with primary care physicians, who can answer questions, diagnose and treat non-emergency illnesses, order lab tests and send prescriptions directly to your pharmacy. For now, this service is only available for adults 18 years and older, but the company plans to expand to pediatric care next year.
“We know moms and dads can’t always find the time to visit the doctor, and it can take months to get an appointment these days,” says Samantha Bergin, vice president of marketing for 98point6. “98point6 makes it easy to get expert treatment in as much time as they have on hand and in every context — standing in line at the grocery store, at their child’s soccer game or even while they’re at the office — allowing them to multitask their way back to health.”
Unlike other virtual health care options, 98point6 is free to use — for now. Patients can use the app for free, and are only responsible for the cost of in-person referrals, lab tests or prescriptions they might need. But Bergin says the company plans to begin charging for the service in early 2018. However, she notes that the cost of a year of 98point6 access will still be less than most copays.
Bypassing the standard health care insurance system isn’t accidental. 98point6 CEO and co-founder Robbie Cape points to this as one of the primary benefits of the service. “It is well documented that skyrocketing costs and lack of access to quality medical care are two of the biggest challenges facing our health care system today. An unconscionable number of people don’t receive the care they need, physicians are burning out, and employers are hamstrung by health care costs,” says Cape. “98point6 is creating a new approach to primary care where everyone wins: consumers, physicians, businesses, payers and provider groups.”
Not everyone agrees. Many of these services provide on-demand health care, with little or no continuity of provider. As convenient as these visits may be, they come with a warning. “One might argue that a rash is a rash is a rash, and it doesn’t matter who sees it,” Dr. Allan Goroll, a general internist and professor of medicine at Harvard Medical School, told medical publication ACP Internist. “But knowing the patient is critical to a successful virtual visit. Not knowing the patient makes a virtual visit susceptible to misdiagnosis and to the need for excessive testing.”
Goroll’s warning makes sense. Most of us have experienced the difference in care we receive from a stranger versus a primary care physician we’ve seen for years — and this is particularly true for people with complex chronic medical conditions who rely on a team of providers who are intimately acquainted with their history and treatment.
Still, consulting with a virtual doctor — any virtual doctor — has to be better than trying to Google our way to a diagnosis. So, go ahead and ask Alexa at 3 a.m. if your baby has a cold. Just be smart about when you use virtual health care services and when you access health care the old-fashioned way.