“I’m expecting that in four years, most of my practice will be virtual,” reports Holly Thacker, MD, Professor and Director of Cleveland Clinic’s Center for Specialized Women’s Health. “As a women’s health menopause specialist, most of what I do clinically is intellectual—talking with patients, ordering tests, reviewing lab results and prescribing medications—rather than hands on, so telemedicine works really well and allows me to see patients who might not be able to make it into the office for follow-up appointments.” In addition, she notes that demand for virtual healthcare is expected to increase given that younger generations are already doing everything from their shopping and banking to dating online.

Dr. Thacker began embracing telemedicine two years ago. She maintains a physical practice in Cleveland but is also licensed to practice in the state of Florida, where she has observed many menopausal women are without care.

Practical matters

Dr. Thacker now blocks off part of her daily schedule to conduct virtual visits, although she is also amenable to conducting unscheduled telemedicine visits in-between her office visits. Training to perform the visits was minimal, involving a quick run-through of the technology and how to retrieve patients from an electronic waiting room. Equipment for both the physician and patient consists of a cellphone, tablet or computer that has been loaded with Skype or another two-way video program. Most visits last about 10 minutes, involving routine follow-ups to review laboratory results or requests for medication refills. “I find virtual visits allow me to serve more patients, while reserving my office time for new patients,” she says.

Pros and cons of virtual visits

Although not every patient encounter can be performed virtually and physicians whose practices are largely unscheduled are unlikely to adopt their use, the benefits of these visits for follow-up care are manifold, Dr. Thacker says:

• Physicians report high levels of satisfaction with use of virtual visits. “They’re convenient, and they eliminate the need for a nurse, patient service specialist and a physical examination room,” she notes. “They can be performed quickly and efficiently.”
• Patients also report high satisfaction with these visits, which can be done in the privacy of the patient’s home or place of employment. “It’s interesting to see patients in their own environment, where they are more likely to feel at ease and to be open about their healthcare needs,” Dr. Thacker reports. “Most patients don’t react well to seeing a white coat or to the prospect of being poked and prodded.”
• Visits tend to be less expensive for patients than in-person visits, without the need to take time off from work, arrange transportation and pay for parking. “Most insurance companies now cover virtual visits, and physicians receive standard rates for them,” she says. “Even if patients have to pay for the visits out of pocket, they are usually less costly than in-person visits.”

As with any technology, there are some pitfalls associated with virtual visits, including the chance that the technology may fail to work on either the physician or patient side. In addition, it is essential that patient confidentiality is safeguarded, and visits are performed in a private, quiet environment where neither party will be disturbed.

To enhance the patient experience, Dr. Thacker refers all patients she sees in her office or virtually to Speaking of Women’s Health, a nonprofit online program of the Cleveland Clinic Center for Specialized Women’s Health that seeks to educate women to make informed decisions about health, well-being and personal safety for themselves and their families.

eConsults

Dr. Thacker is also a proponent of eConsults, which permit physicians to consult with colleagues and obtain a specialist’s opinion on a case. This allows the requesting physician to give patients a fully informed evaluation of diagnostic conundrums and treatment options without the need for the patient to make additional appointments. “Traditionally, physicians have done casual check-ins with experts where they stop other doctors in the hallway to pick their brains about challenging cases,” she explains. “The eConsult is a more official, more comprehensive way of doing these hallway consults, which are invaluable to the practice of medicine. The consulting physician can review labs, tests and a patient’s chart and give an opinion via text or email rather than on the fly.”