Telemedicine is an emerging technology in the field of medical care, a sort of virtual doctor’s office where patients can seek an online diagnosis for a number of ailments.

Also called telehealth, it has the support of some local physicians and industry organizations, who say it increases access to doctors for many who don’t have transportation, are immobile, uninsured or temporarily unable to make an office visit.

It also seems to have the support of many employers, who continue to look for cost-saving measures, according to an October 2017 Reuters story on the subject.

But even as more businesses adopt real-time cyber-based platforms for a variety of communication needs, telemedicine presents a particular set of challenges in the current technological era, said Dr. Seuli Brill, a bioethicist and family-medicine physician at the Ohio State University Wexner Medical Center.

Telemedicine is an emerging technology in which patients can communicate with physicians over the internet, according to@ThisWeekGary:

Would you agree to a telemedicine consultation in lieu of an in-person office visit with your physician?

— ThisWeekNEWS (@ThisWeekNews)October 5, 2018

Brill said such a mode of communication should exist only with patients who have an established relationship with their doctor.

“So much of medicine is context,” Brill said. “And the relationship in general brings accountability.”

In that respect, telemedicine can work in concert with regular office visits, she said.

For example, Brill said, she feels comfortable in assenting to an e-visit for a patient with diabetes, high blood pressure and anti-depression medicine. However, in other cases, such as swollen lymph nodes, she would require a face-to-face visit, she said.

Still, if such an issue were broached in an online discussion, it could help streamline the appointment-making process.

“I might not be able to do everything that’s needed, but I can at least start the communication, start the workup and work on some follow-ups,” Brill said.

Without question, emergency consultations are not recommended for a digital visit, she said.

Telemedicine has two essential types: synchronous, which is a live, streaming visit, and asynchronous, which involves still images, text files and video, Brill said.

Telemedicine in practice

Dr. Michelle Chambers, a dermatologist with Forefront Dermatology in northwest Columbus, said she uses a digital platform through which patients can upload pictures of skin issues and request a diagnosis or prescription refills.

Chambers said she has used it for six years, starting off doing pro bono work on the website and then merging it with her practice, seeing only a few patients a month online.

Patients must fill out a form, send pictures and enter a “waiting room.”

Chambers said she generally doesn’t do real-time diagnoses and won’t make a final call until she sees a patient.

“It depends on the condition,” she said. “I would never diagnose cancer with telemedicine.”

In some cases, she said, a nurse practitioner or physician’s assistant will help guide a doctor on a potentially serious condition, she said.

“For some things and some specialties, I don’t know how practical it would be,” Chambers said.

Though it’s unclear how it will affect her patient volume, Chambers said, the technology has the potential to increase in popularity for newer doctors and patients.

“I could see it with the younger generation because they’re so technology dependent,” she said. “I could see it definitely growing more in the future.”

Such an uptick has some physicians, such as Bryan Ghiloni, cautious.

Ghiloni, a family-medicine doctor at Mount Carmel Medical Group in New Albany, said he sees some good for patient care but also a “huge opportunity to misuse it.”

“For one thing, it’s here whether you like it or not so you can choose to ignore it and someone’s going to use it, appropriately or inappropriately, or you can embrace it and use it for good things,” he said.

Ghiloni tells a story about a mother whose child had an inner-ear infection and used telemedicine to communicate with her pediatrician. The doctor had a phone image of the child’s inner ear and prescribed an antibiotic, he said.

The child immediately recovered, raising doubts whether the prescription was even necessary, he said. Though that was a positive outcome, the potential for a tragic situation gives Ghiloni pause.

“Whether that was a misdiagnosis or misprescribed (medication), I think that is what physicians are worried about,” he said.

Second opinions

Not everyone is on board with telemedicine.

The Ohio Academy of Family Physicians in Clintonville is holding off its full support of telemedicine until some issues are resolved, said Ann Spicer, spokeswoman for the organization.

“Family medicine is very relationship-based, so caring for a patient remotely who the physician has no previous relationship with is concerning to many of our members,” Spicer said. “Also, the absence of a physical exam is concerning to some – less so if there is information available about the patient that can be accessed.”

The OAFP will hold a major policy discussion on the subject in January, a follow-up to a symposium held in 2014, when guests from the State Medical Board of Ohio and the Health Policy Institute of Ohio joined the summit, Spicer said.

“Does the care offered in a telemedicine encounter measure up to what is offered in an office, in-person encounter?” she said. “Do telemedicine visits result in more unnecessary antibiotic (prescriptions)? The data will drive physician attitudes, but in the absence of data, there is hesitation.”

Bill of telehealth

Meanwhile, a bill in the Ohio House of Representatives addresses the telehealth trend.

House Bill 546, sponsored by state Rep. Thomas F. Patton (R-Strongsville), would “prohibit health-benefit plans from treating telemedicine services differently from in-person health-care services solely because they are provided as telemedicine services.”

Patton said the bill is in the health committee and could be voted on by the committee this month.

He said 36 states have enacted some sort of telemedicine law and Ohio is “behind the curve on this innovative manner of treating Ohioans, especially considering the plethora of top-notch health-care providers located here in Ohio.”

Patton said the legislation is not a mandate; instead, it would bring employers, health-care providers and insurers to the table to negotiate rates.

“Our interpretation is that the bill does not require coverage of additional diagnostic or treatment services but instead merely applies the distance between the patient and the health-care provider (for example, in-person vs. virtual visit) to services already covered by the plan,” Patton said. “Thus, HB 546 is not imposing new coverage but simply is providing for the more efficient use of technology to reach constituents.

“Health-care providers and the insurance plans must still negotiate the actual cost of the services provided, which would most likely be less for telemedicine services than an in-person visit.”

Patton said he is optimistic that enough potential cost savings for providers and conveniences for patients would cause telemedicine to gain more traction in Ohio.

“Again, I think this is something the business community will embrace,” he said.

Reginald Fields, spokesman for the Ohio State Medical Association, said the group supports the bill and telemedicine in general.

“Telemedicine represents a tremendous opportunity to combine technology and medicine and make quality health care more accessible for patients no matter where they might be or regardless of how near their doctor’s office they may live,” Fields said. “It’s an important step in health care, which underscores the importance of this legislation.”