Much can be accomplished during a virtual visit to the gynecologist, including discussing birth control and getting a prescription for birth control pills; getting advice on urinary tract infections (UTIs), including whether to use an over-the-counter UTI test kit; having your hormone replacement therapy regimen adjusted; having rashes or bumps in the vulvar area examined; and discussing any other health concerns you might have.
However, there are symptoms for which you will likely need to seek urgent or emergency in-person care. Those include, but aren't limited to, any symptoms of a possible ectopic pregnancy, severe vaginal bleeding, complications following a gynecological surgery or other procedure, more severe vaginal or uterine pain, and symptoms of a vaginal infection with a fever.
Many skin problems are diagnosed primarily by appearance, in combination with a person’s medical history, and that makes dermatology a good candidate for telemedicine. So-called teledermatology is also effective for follow-up visits, when a person has been seen in person in the past, or for medication refills for an ongoing problem.
There are instances where an in-person visit is better, such as for an annual skin check, in which a tool called a dermatoscope allows the doctor to see a magnified view of any skin lesions. And of course, any procedures involving the skin, such as taking a biopsy, need to happen in person.
Good asthma management often requires regular check-ins with a doctor, and virtual visits can be a good alternative to in-person visits for routine appointments.
Telemedicine typically works well for discussing your current treatment plan, refilling prescriptions, and asking your doctor any questions you might have about your health or your treatment plan. Telemedicine has the added benefit of minimizing your in-person exposure to others, and it saves you the time you’d spend traveling to and from appointments.
For some people, opting for a telemedicine appointment also gives them access to allergy-immunology specialists that may be located hours away from where they live.
However, when you connect with your doctor over the phone or by videoconference, your doctor can’t directly measure your vital signs, take your blood pressure, check your peak flow or other respiratory measures, or do any other type of physical examination that might be warranted. If your physician feels you need to have certain lung function tests such as spirometry or plethysmography, you’ll likely need to visit a medical facility to have them done.
A lot of the treatment for addiction and recovery is done through dialogue with a therapist or in a group, and that means that a lot can be accomplished through a virtual visit. For some people, particularly those who live far from an addiction treatment center, virtual visits with a mental health professional can even be more convenient than in-person visits. The drawback is the loss of social support that some people get from in-person meetings with a therapist or other professional.
Addiction and recovery support groups are also widely available online, now that the coronavirus pandemic has made in-person meetings unsafe. Again, while some people appreciate some aspects of virtual recovery meetings, such as the anonymity they can have online, others miss the support they get from in-person meetings.
In some respects, telemedicine is ideal for managing Crohn’s disease, particularly if it allows for more frequent check-ins with your doctor. This form of inflammatory bowel disease benefits from frequent monitoring by a physician and prompt attention if symptoms worsen between scheduled visits.
Because telemedicine eliminates travel time and time spent in a doctor’s waiting room, both routine appointments and urgent appointments to discuss symptom flares can take place more efficiently. That means less time and often less expense for you, and it also means your doctor may have more appointments available when you need them.
There are some instances in which an in-person appointment for Crohn’s disease is necessary, including the initial diagnosis, which generally involves an examination of the inside of your colon and possibly imaging scans. Certain complications of the disease also require a physical exam to determine the best course of treatment. And of course, any surgical procedures must be done in person.
Remote cardiac device monitoring — that is, remote monitoring of an implanted cardiac device, such as a pacemaker, implantable cardioverter defibrillator (ICD), or implanted cardiac monitor–loop recorder — isn’t new. In fact, it’s been around since the early 1970s, although the technology’s improved considerably in the past couple of decades. But the COVID-19 pandemic has illuminated its benefits, including keeping people with heart problems away from hospitals or doctors’ offices, where they could be exposed to contagious illnesses.
Remote monitoring allows your healthcare team to monitor your heart health and the function of your cardiac device without you having to be physically present. Even better, it can communicate this information in real time using wireless technology and a Bluetooth-enabled device.
This means your doctor knows when your device has corrected a heart rhythm abnormality soon after it happens — provided you’re within in close-enough range of your home monitor — rather than several months later, when you make an office visit and have your device data collected with a special wand. It can also alert your provider to a problem with the device, such as a low battery.
While remote cardiac device monitoring isn’t without its technological challenges — including getting knocked offline by weak cellular service — it has been credited with improving patient health through earlier detection and treatment of heart rhythm problems.
According to position statement (PDF) released by the American College of Rheumatology (ACR) in 2020, the ACR supports the role of telemedicine as a tool that can potentially increase access and improve care for patients with rheumatic diseases, but it should not replace critical face-to-face assessments conducted at medically appropriate intervals.
Virtual visits can be a great choice for migraine care, particularly when you’re seeing a physician or other healthcare provider with whom you already have a relationship. This is true both because you’ll likely feel more comfortable talking to a professional you already know, and because an in-person physical examination can be an important part of determining the cause — or causes — of your symptoms and the best way to treat them.
Virtual Urgent CareTelemedicine allows post-stroke patients and their doctors to continue meeting for post-stroke rehabilitative and preventive treatment visits.
But even before the pandemic, one type of remote stroke care for doctors was already well-established: In-hospital telemedicine for stroke care, called telestroke, has been around since the late 1990s. Telestroke describes an arrangement by which remote stroke experts help local emergency physicians assess patients with suspected stroke and decide how to manage their care. The practice helps ensure that people experiencing stroke will receive appropriate care, even if they don’t go to a hospital with its own on-call stroke team.
As long as you have a good internet connection, adequate lighting, and space to lie down, walk, stretch, and turn around while on-camera, you can likely benefit from a virtual physical therapy visit.
Much of what a physical therapist does is analyze how people move and prescribe stretches or exercises that can make moving more efficient and more comfortable. And it turns out, that can be done pretty well remotely, using telemedicine instead of in-person office visits.
Are telemedicine virtual visits worthwhile? According to experts and recent research, the upsides include the following:
They save time. “A lot of people don’t have time to drive to an appointment and then sit in a waiting room for 10, 20 minutes or longer,” says Bishop. “We have patients who use Houston Methodist Virtual Urgent Care at work, going into a private office and shutting the door for their appointment, or using it from home.”
They save money. While the cost of a virtual visit varies widely depending on your health insurance coverage, choice of provider and type of service (read on for details), it’s likely to cost less than a visit to an in-person urgent care center or hospital emergency room for the same problem.
They save money. While the cost of a virtual visit varies widely depending on your health insurance coverage, choice of provider and type of service (read on for details), it’s likely to cost less than a visit to an in-person urgent care center or hospital emergency room for the same problem.
For example, you could spend as little as $0 to $82 for a virtual urgent care visit. That’s a wide range, but it’s less than the average $176 price tag for a visit to an in-person urgent care center or the $350 to $600-plus you could spend for treatment of an earache, bronchitis, or strep throat at a hospital emergency room, according to Dignity Health, one of the nation’s largest healthcare providers.
Then there’s the cost of transportation. You won’t have to shell out money for gas and parking or for a taxi, train, or bus. “For someone who’s driving an hour and a half and paying $25 for parking for a routine checkup after a successful knee replacement, a virtual visit can be a big savings,” Carr notes.
Bishop adds childcare costs to the savings, too. “You won’t have to pay a babysitter while you go to the doctor,” she notes. “Just find a quiet spot in your home, tap on the app, and get started.”
You avoid exposure to infectious germs. Virtual visits keep you out of settings where you could be exposed to the flu or other infectious viruses, bacteria, or other germs, Bishop notes. “That can be important if you have low immunity, if something is going around in your community, or at times like this when coronavirus is spreading,” she says. “It can help you stay healthy if you’re not sick, but just need to see the doctor for something minor or for your annual well visit or for a routine visit to manage a chronic health condition such as high blood pressure.”
Covid-19 has sped the adoption of virtual care, or the provision of health services remotely in a synchronous or asynchronous fashion. No longer just a convenient enhancement to in-person clinical care, virtual care is needed by patients, clinicians, care teams, and health systems alike. But the gap between the promise and the reality of virtual care is substantial: The stakeholders often don’t get what they need while trying their best to navigate a new paradigm.
We aim to close this gap by helping health systems refine and reimagine their virtual care journey while prioritizing the needs of the people who get and give the care. Our guiding principle is a needs-based approach that retains the best practices of in-person visits while sensibly adapting to the unique characteristics of a virtual setting.
The recommendations presented here are the result of a collaborative effort by University of Texas MD Anderson Cancer Center (MDACC) and Texas A&M University’s Mays Business School. We integrate insights drawn from our experience implementing a broad suite of virtual care services at MDACC with operating procedures and virtual care guidelines identified at other institutions, such as the University of Pittsburgh Medical Center and Jefferson Health. We also leverage our collective expertise in health care innovation, health services research, digital transformation, and clinical care — and did informal interviews with telehealth experts.
The result is a framework we call DIBS for “Documentation, Integration, Best Practices, and Support.” All four of our DIBS categories have potential benefits, to varying degrees, for all stakeholders in virtual care. Everyone gets “dibs” on optimal design, and no one gets overlooked.
Health systems should identify and document in detail the activities and interdependencies of everyone directly or indirectly involved in providing, receiving, and designing virtual care. Toward that end, we recommend that health systems create a service blueprint that reflects all the unique activities of health care personnel for a typical virtual care encounter (see the exhibit “A Blueprint of an Outpatient Clinic Visit at MD Anderson Cancer Center”). Health systems should tailor blueprints to reflect their specific strategies for implementing virtual care.