Com­ing to a screen near you

John Hearne speaks with Mary O’Brien, founder of VideoDoc, an Ir­ish com­pany that of­fers com­pa­nies ac­cess to an on­line doc­tor con­sul­ta­tion ser­vice via mo­bile phone, plus tech­nol­ogy for GPs to do like­wise

Irish Examiner - - News -

VideoDoc, of­fers com­pa­nies ac­cess to an on­line doc­tor con­sul­ta­tion ser­vice via mo­bile phone, plus tech­nol­ogy for GPs to do like­wise.

With doc­tors’ wait­ing rooms over­flow with sea­sonal flu vic­tims, the dilemma for many pa­tients cen­tres on try­ing to get to see the GP with­out risk­ing con­tract­ing some­thing worse. One solution is to see the doc­tor with­out ac­tu­ally leav­ing the house.

It’s called tele­health, and it’s all about har­ness­ing telecom­mu­ni­ca­tions to help im­prove health out­comes.

VideoDoc is an Ir­ish firm that of­fers an on­line doc­tor con­sul­ta­tion ser­vice via web and mo­bile, and also of­fers the tech­nol­ogy di­rectly to GPs to offer these fa­cil­i­ties to their own pa­tients.

Co-founder and CEO Mary O’Brien ac­knowl­edges that one of the key chal­lenges the com­pany faces lies in teach­ing peo­ple what on­line con­sul­ta­tion can offer.

“The NHS in the UK has a statis­tic that says 60% of ev­ery­thing that’s treated in gen­eral practice can be treated over the tele­phone, and that’s be­fore you add the ben­e­fit of a video,” she says, list­ing a very wide range of sit­u­a­tions when GP care may not re­quire a con­ven­tional con­sul­ta­tion.

“When you’re wor­ried about a per­sonal health or med­i­cal is­sue, if you want to get a health as­sess­ment, a med­i­cal or a test, if you need a re­fer­ral or sec­ond opin­ion, when you need a sick note, if you are con­sid­er­ing A&E for a non-emer­gency sit­u­a­tion ... when you’re not com­fort­able talk­ing to your own GP about a prob­lem or if you’re trav­el­ling and need med­i­cal care.”

She es­ti­mates that since the ser­vice was es­tab­lished three years ago, VideoDoc has treated up­wards of 160 com­plaints.

Men­tal health is­sues, in­clud­ing anx­i­ety, de­pres­sion and stress fea­ture fre­quently in the stats, as do uri­nary tract in­fec­tions, eye in­fec­tions and skin con­di­tions.

“The pa­tient,” she ex­plains, “takes a high def­i­ni­tion photo of their skin and the doc­tor can then pre­scribe a top­i­cal cream, or what­ever it is that’s re­quired. As these ser­vices be­come more com­mon­place, pa­tients be­come more aware of them and the ben­e­fits of con­ve­nience, as well as price.”

She adds that 30% of pa­tients are now on their third vir­tual visit.

There will al­ways be sit­u­a­tions, how­ever, where re­mote di­ag­no­sis and treat­ment won’t work. O’Brien says that 25% of cases they see are re­ferred back to gen­eral practice.

“Pa­tients might need to go for urine screen, a blood test, they might need a phys­i­cal check-up, they need the doc­tor to lay their hands on them to be di­ag­nosed and ef­fec­tively treated.”

But does it re­ally make sense to dis­pense with a phys­i­cal ex­am­i­na­tion at all? Do the risks of mis­di­ag­no­sis and un­safe pre­scrib­ing in­crease with the dis­tance be­tween doc­tor and pa­tient?

Two years ago, the Ir­ish Med­i­cal Or­gan­i­sa­tion called on gov­ern­ment to pre­vent health in­sur­ers from of­fer­ing cus­tomers video ac­cess to GPs on the grounds that these ser­vices posed a risk to pa­tients.

Mary O’Brien says that the doc­tors that work with VideoDoc are all trained in ‘telemedicine pro­to­cols’ and in de­liv­er­ing re­mote health ser­vices.

“Doc­tors by pro­fes­sion tend to err on side of cau­tion; that’s why 25% of pa­tients are re­ferred back to their own doc­tor, to A&E or to an out-of-hours doc­tor ser­vice. So in terms of mis­di­ag­no­sis, or un­safe pre­scrib­ing, com­ing to us is not any different to go­ing to see a doc­tor in gen­eral practice. Those kinds of is­sues can hap­pen, but it’s about the safety net­ting and the train­ing we give doc­tors to en­sure that they do not.”

Con­trary to what you might think, on­line con­sul­ta­tions tend to take longer than con­ven­tional ones, pri­mar­ily be­cause the re­mote doc­tor must put in the time tak­ing notes and ex­plor­ing the pa­tient’s his­tory.

It is, of course, pos­si­ble to share med­i­cal files with the re­mote ser­vice along the same lines as you would do to au­tho­rise shar­ing med­i­cal files in the case of con­ven­tional practice.

The pa­tient can also au­tho­rise shar­ing med­i­cal in­for­ma­tion from the re­mote con­sul­ta­tion to their own GP. All VideoDoc treat­ment providers are Ir­ish Med­i­cal Coun­cil reg­is­tered GPs, based in Ire­land.

Once you have an on­line ac­count, you can log in at any time and view your con­sult his­tory. In ad­di­tion, all pa­tients get a per­son­alised dis­charge doc­u­ment at the end of each con­sul­ta­tion, de­tail­ing all that was dis­cussed to­gether with treat­ment de­tails; so in­stead of hav­ing to re­mem­ber ev­ery­thing, you can re­fer back to this doc­u­ment. It also in­cludes de­tailed gen­eral in­for­ma­tion on the na­ture of the ill­ness or con­di­tion.

As a busi­ness, VideoDoc is fo­cused on the cor­po­rate sub­scrip­tion mar­ket. The com­pany com­mis­sioned a sur­vey late last year which found that dig­i­tal health ser­vices could play a role in at­tract­ing em­ploy­ees in a buoy­ant labour mar­ket.

Some 45% of the 1,000 em­ploy­ees ques­tioned said that they did not re­ceive any health­care ben­e­fits from their em­ployer. Of those that did, 43% said that it was in­suf­fi­cient to cover the cost of pri­vate health in­surance.

The sur­vey sug­gested that if pro­vided with dig­i­tal health ser­vices, this perk would in­flu­ence 65% of em­ploy­ees in their de­ci­sion to work for one com­pany over an­other.

“We charge a com­pany €15 per em­ployee, which buys a sub­scrip­tion for 12 months of un­lim­ited doc­tor ap­point­ments for an em­ployee. Ob­vi­ously, that doesn’t re­place health in­surance but it is a health ben­e­fit, and it’s not cost pro­hib­i­tive.”

When ques­tioned about time cur­rently be­ing spent away from work to visit a GP for ev­ery­day ill­ness, al­most two-thirds of those asked said that they had taken time off in the past year to visit a GP. Of these two thirds, 27% ad­mit­ted it was only for pre­scrip­tion re­newal ser­vices. With re­gards to cost, 16% of Ir­ish em­ploy­ees said they spend any­where be­tween €200 to €600 a year on stan­dard GP ap­point­ments.

“On­line doc­tors ser­vices are a cost-ef­fec­tive and timely way of re­ceiv­ing GP care for treat­ment and di­ag­no­sis of ev­ery­day ill­ness,” says Mary O’Brien. “In fact, many VideoDoc cor­po­rate sub­scrip­tions across the UK and Ire­land have re­ported ben­e­fits to their over­all com­pany as a re­sult. As well as im­prov­ing em­ployee en­gage­ment and re­ten­tion rates, they are see­ing a real re­duc­tion in ab­sen­teeism, as staff don’t have to take time off work dur­ing busi­ness hours to visit a GP.”

Dig­i­tal health re­mains a rel­a­tively new con­cept in Ire­land. Only 13% of em­ploy­ees said they’d used on­line con­sul­ta­tion in the past and al­most one quar­ter ad­mit­ted they didn’t know the ser­vice ex­isted. Pro­vid­ing dig­i­tal health ben­e­fits to staff is not, how­ever, all that new. A 2016 Mercer National Sur­vey for em­ploy­ees in the US showed that al­most 60% of large em­ploy­ers pro­vide med­i­cal cov­er­age for a dig­i­tal health ser­vice.

Mean­while, health in­surance providers are also em­brac­ing this phe­nom­e­non. VHI’s on­line doc­tor ser­vice gives ev­ery­one — not just VHI mem­bers — on­line GP ac­cess be­tween 8am and 10pm ev­ery day for €24 per con­sul­ta­tion. Laya Health­care also of­fers a dis­counted on­line GP ser­vice, as does Ir­ish Life Health.

The pa­tient can take a high def­i­ni­tion photo of their skin and the doc­tor can then pre­scribe a top­i­cal cream, or what­ever they need. As these ser­vices be­come more com­mon­place, pa­tients be­come more aware the ben­e­fits of con­ve­nience, as well as price — Mary O’Brien, founder and CEO of VideoDoc

With a video med­i­cal ser­vice, all pa­tients will get a per­son­alised dis­charge doc­u­ment at the end of each con­sul­ta­tion, de­tail­ing all that was dis­cussed to­gether with treat­ment de­tails; so in­stead of hav­ing to re­mem­ber ev­ery­thing, you can re­fer back to...

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