Advantages & challenges of providing virtual primary care on HealthTap

Advantages

Challenges/trade-offs

VPC doctors build strong relationships with their patients by focusing intently during the time dedicated to the video visit. Doctors and patients can connect by private message between visits.

There's no physical contact between doctors and their patients. VPC doctors cannot shake their patients’ hands, comfort them with a pat on the back, or hold their hands in moments of need.

VPC doctors provide high-quality, compassionate care by video visit. Research shows virtual care compares favorably or equal to in-person care in HEDIS scores in 13 out of 16 areas. 

The scope of practice in virtual care is limited to actions that do not require physical contact. 

VPC doctors provide personalized, private, patient-centered healthcare with no interruptions, while looking at and conversing directly with their patients via high-resolutionvideo. 

VPC doctors take primary responsibility to evaluate and manage their patients without the benefit of clinical support staff during virtual visits. 

VPC doctors examine their patients through careful observation of their patient's appearance and attire, mannerism, affect, mood, voice, verbal tone and intonation, facial and eye movements, skin color and complexion, posture, and motor movements. 

VPC doctors cannot percuss, palpate or auscultate, or give injections, suture wounds, change dressings, etc.

Vital signs and other biometrics can be captured during video visits with the advent of inexpensive, home-based devices, such as scales, BP cuffs, thermometers, pulse oximeters, glucose meters, spirometers, and more. 

Patients may not have at-home health devices. Some will prefer to visit a pharmacy or clinic for in-person evaluation. 

VPC doctors use the best of their clinical knowledge, skills, and experience when assessing their patients by video. VPC doctors collect patient history and are directly able to ask important questions.

VPC doctors cannot themselves collect samples for laboratory testing during video visits. Doctors order labs and their patients travel to a specimen-collection office. 

VPC doctors gain insight into the economic, social, cultural, and environmental features of their patient’s home life. 

Just as for new patients in a physical office, prior medical records may be hard to obtain. 

HealthTap VPC lab orders are sent automatically to Quest Diagnostics. Lab results from Quest Diagnostics are uploaded automatically to the patient’s chart.

Lab orders cannot be sent directly to other laboratory services such as LabCorp or regional laboratories. 

Prescriptions are sent electronically to the patient's preferred pharmacy. Before doing that, HealthTap guides the patient with information about alternative pharmacies where their prescription may be less expensive. 

VPC doctors are not yet able to transmit electronic orders for medical devices and supplies. VPC doctors create orders for medical devices and supplies via a PDF document that can be faxed to a medical supply company that their patients print at home.

Patients can see their doctor's virtual office hours calendar availability, and can book visits at times that work well for them.

VPC doctors cannot book visits on behalf of their patients during their virtual consultations (patients must manage their future appointment bookings). 

Easy schedule management with no double-booking or appointments outside of scheduled office hours.

VPC doctors manage their own schedules and must plan ahead to avoid the need to cancel video visits booked on their schedules.

Video visits cannot run over the allotted time.

Patients may need to schedule an additional video visit if more time is needed.

Patients can send their doctor a private message anytime. Patient messages are intended for coordination of care and triage to the right level of care.

VPC doctors are expected to acknowledge or respond to private messages within one business day (M–F).

HealthTap’s VPC clinic is affordable, convenient and effective for patients who can be cared for via remote consultation. Doctors are given a very large fraction of visit transaction fees.

Patient awareness may lag. Not everyone has yet discovered the convenience and effectiveness of virtual care. Some patients do not expect their virtual PCP to provide compassionate personalized ongoing care.

VPC doctors deliver video visits in a private, quiet, professional space with just a computer, tablet, or smartphone and an internet connection.

Doctors must be comfortable using web or mobile applications on a computer, smartphone, or tablet.

No brick-and-mortar space, equipment, and staff to manage.

No dedicated front-desk or other clinical staff to assist with managing patients during consultations. 

Practice from home in a quiet, professional space.

VPC doctors may occasionally miss in-person interactions with colleagues, patients, and clinic staff.

No commute to an office needed.

Specify dedicated office hours that prevent double booking and ad hoc booking or end-of-day add-on appointments.

Flexibly adjust office hours from week to week to accommodate other life events. 

VPC doctors are not exposed to contagious diseases from patients via video.

Telehealth offers new ways to assist patients: 1) as primary PCP or 2) as a supplemental, readily available option to augment existing care or provide care when in-office option is delayed or otherwise unavailable (i.e.: an online PCP for patients who already have an in-person PCP).

VPC doctors must use the appropriate technology during consultations, and may encounter patients who have difficulty managing their devices or who have poor internet connectivity.

Mainstream opposition to telehealth has receded in recent years; now the AMA embraces telehealth.

Most telehealth companies are looking for doctors who hold active licenses in multiple states, so there is some overhead required to acquire and maintain proper licensure. 

Patients want and need telehealth (particularly in healthcare deserts), and offer comparable and often better patient satisfaction scores.