- Describe your topic.
- Use of telehealth/virtual health by patients. For which medical conditions [acute, chronic, or intermittent] is the use of telehealth/virtual health a proper replacement for in person clinical evaluation which lead to improved outcomes and overall decreased use of health care resources?
- Describe why this topic is important.
- There is a strong push and discussion of the benefits of the use of virtual health platforms by patients. These discussions are often led by supplies of such solutions such as clinical providers or health care systems, and even by consulting groups such as Deloitte (https://www2.deloitte.com/insights/us/en/industry/health-care/virtual-health-care-health-consumer-and-physician-surveys.html). Much of the discussion is based on convenience and decreased loss of time by employees by using such services from the convenience of their home. However, there has been little or no discussion of which medical conditions are best evaluated and treated in this manner. Are we instead replacing one site of care for another for conditions which are self limiting and not actually required medical evaluation (such as typical upper respiratory infection in healthy individual, limited low back pain, even influenza in the healthy individual)? If so, then health care resources and dollars are still being used with no benefit for the patient, payers, or society at large - just a change in the site of care. In addition, if patients are being shunted to receive virtual health instead of in person evaluation and treatment, it is vital that we set standards of care as to the types of conditions where virtual care is appropriate, the type of evaluation which a patient should expect, and clear limitations of the virtual care and where it should not be employed. Due to lack of physical interaction with a patient, providers of virtual care may actually order more tests and subspecialty referrals to evaluate for causes which could be determined without such testing if the visit was in person. Therefore the result may be overtreatment and overtesting. We have all seen the news stories where a mother has her child with asthma return for a follow-up by a video call and it appears as though the evaluation is limited to a few nonspecific questions as to how the child is doing and a quick look at the child. This is wholly inadequate. Instead, there should be a review of the child's peak flow measurements, a review of use of rescue medications, and specific questions about the child's activity and precipitation of asthma symptoms.
- Tell us why you are suggesting this topic.
- Virtual care has become the panacea for limited access to clinical care and we have no safeguards for its use nor evidence as to when and where it is appropriate. Patients may be receiving less than optimal care while they and payers, including public payers such as CMS, will use limited health care resources without improvement in outcomes nor decrease in costs.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- Expectation that standards are set and patients protected from wasting money or receiving inadequate or inappropriate care.
- How will you or your group use the information from a new evidence report?
- This is a request which does not affect my work or group specifically but all patients and providers, as well as payers.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- This information should be disseminated to patients, health care groups, payers, providers, and society in general.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- This information should be disseminated to patients, health care groups, payers, providers, and society in general.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- patient, caregiver, trained physician
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Please tell us how you heard about the Effective Health Care Program.
- email from AHRQ
