Some experts believe that in a few years health care will look a lot like Amazon, with a list of health services on demand and quick access to health resources via virtual care.
Gone will be the need to make appointments for some basic health problems or sitting endlessly in a waiting room at an emergency room with a child screaming with an ear infection.
“It has to be as convenient as Amazon,” said Dr. Edward O’Bryan, chief medical officer for Medical University of South Carolina Business Health when describing the launch of their new virtual urgent care system. “It’s improving access to health care for the residents of South Carolina.”
While telehealth and telemedicine are terms that are constantly thrown around, broadly they mean different things. Telemedicine is about the actual remote interaction between a patient and a provider, while telehealth is the entire spectrum of services that might make telemedicine possible.
Both are practices that have been around for a while.
“We’ve been doing telehealth since the telephone was invented,” O’Bryan said.
Now more telehealth is coming to computers and smartphones. MUSC recently launched a locally run virtual urgent care system that allows doctors to connect directly to you.
Patients have the option of handling health concerns, such as pink-eye, flu, minor burns, head lice, sinus infections and other minor health problems through the online system.
After answering a series of questions on the website, patients are given the option of video conferencing with a doctor or talking with an on-call provider to answer additional questions and/or provide a more detailed diagnosis.
From there, patients can immediately get a prescription from a MUSC provider remotely if necessary. O’Bryan compared it to a “choose your own adventure” but with health care.
This development is far from being the only telehealth program introduced in South Carolina or at MUSC.
“I would guess a vast majority of hospitals are using telehealth in some form,” said Thornton Kirby, CEO of the S.C. Hospital Association.
Roper St. Francis Healthcare currently offers remote patient monitoring with their care team and plans to launch their own virtual urgent care this summer. But primary care physicians, such as Dr. Kay Durst with Durst Family Medicine, have already been using telehealth with their patients.
At Durst, patients can call the practice and schedule a virtual visit with their physicians between 9 a.m. and 4 p.m. Through a virtual appointment with them on a laptop, tablet or smartphone patients receive a diagnosis, care plan and prescriptions.
“We’re kind of building it all,” Durst said.
In another effort a few years ago, the Hospital Association partnered with the state mental health department to launch a statewide telepsychiatry program that all hospitals with an emergency department can access.
In the past couple of weeks, national virtual provider Nurx has announced their services being available in South Carolina. Through Nurx patients can get products like birth control and pre-exposure prophylaxis or PrEP prescribed and mailed to them.
To legally offer telehealth or telemedicine to South Carolina residents, consulting physicians must be licensed in South Carolina according to the National Telehealth Policy Resource Center. Also, when prescribing medication via telehealth, they can only do it when an in-person diagnosis isn’t necessary.
At this stage providers want to make sure patients understand what can be offered via telehealth in combination with in-person services.
“We view telehealth as just another avenue to provide excellent care,” said Carter Crawford, a project manager with Roper St. Francis.
What it means for SC
The terms telehealth and telemedicine center on two things: convenience and access. With convenience, it’s providing services that make navigating health care easier and more efficient. With access, it’s about reaching areas in South Carolina where urgent care may not be readily or closely available.
“We believe (telehealth) should be furthering our access,” Crawford said.
Telehealth programs like MUSC’s virtual urgent care want to possibly address both of those things.
In providing access, the service is currently open to the public and anyone, regardless of whether they are a current patient, can use it by paying the $25 flat rate for a virtual care visit.
The virtual service is a 24-hour/7-day a week system. A physician, physician’s assistant or nurse is always on call. If patients feel uncomfortable with handling something remotely, the provider will offer in-person suggestions.
“I always give the option to go to your primary care,” said Sheila Roxanne Riser, a physician assistant who works on the virtual urgent care team.
Another example of access priority is with the statewide telepsychiatry program. One of the key goals with its creation was to provide a mental health resource to areas and facilities that may not have immediate access to one.
“Not all hospitals have a neurologist on site,” Kirby said.
Patients can get medications prescribed and refilled through the online system and the service will locate the closest pharmacy for efficient pick-up. Online medications that cannot be prescribed via virtual care are controlled substances like opioids and lifestyle medications like Viagra.
The average turnaround time for a visit through the online system is nine minutes.
“I couldn’t even fill out the (traditional urgent care) paperwork in under nine minutes,” O’Bryan said.
While getting internet access out to residents of rural communities has been an ongoing challenge, things such as physician compensation are also an area that’s evolving.
Kirby compared the compensation conversation to what newspapers are discussing with building digital models on online platforms. There is essentially a whole new medium that can be used to provide a service and people are currently trying to figure out how to sustain themselves financially.
With telehealth it’s the same thing he said.
“We have the infrastructure in place,” he said. The brick-and-mortar facilities are not going away.
But Kirby also predicts that because the demand is there and most providers are aware it’s something that needs to be figured out, it’s a concern that will likely fix itself with time.
Another challenge is finding the fine line with what can be diagnosed virtually.
For example, something like an ear infection might be relatively simple to examine, diagnose and treat via telehealth. Something like a broken arm might be a little more challenging. As a result, providers place a lot of emphasis on patients not using these telehealth platforms for emergency events.
Other challenges experts have highlighted include gaining the public’s trust with the new technologies and getting folks access to necessary devices for use. Right now if patients wanted to use these telehealth services, they would need a device that has access to the internet.
“It’s not a question of if we’re gonna figure this out, it’s when,” Kirby said.