Dispelling the Most Common Myths About Virtual Care

August 24, 2020 - Virtual care has become a staple of healthcare during the coronavirus pandemic, and the positive experiences of patients with remote access signal that its utility will extend well into the future.

While virtual care has grown in popularity and enabled care access despite the limitations imposed by COVID-19, assumptions about its effectiveness as a form of care delivery remain. Even among proponents of the modality, differences in opinion have given rise to myths about what constitutes high-quality virtual care and how likely patients from various demographics are to seek out care in this manner.

Recently, Scott Johnson and Donna Baldwin, D.O. of text-first virtual care platform CirrusMD sat down to dispel a few common myths and advocate for a virtual care experience that prioritizes individual patient preference over a provider-centric approach.

Myth 1: Virtual care must include video to be effective

With the pandemic proving a boon to videoconferencing technology, many providers have become accustomed to appointments with doctors taking place on any number of unique video platforms. But video may actually reproduce challenges similar to in-person care.

“First-generation technologies recreated the brick and mortar experience remotely based around one-to-one interactions,” says Johnson, who serves as president and COO at the company. “Certainly, they introduced efficiency and made some positive steps forward, but along the way they came across many of the challenges that facing brick-and-mortar approaches.”

Even virtual patients encounter wait times and their interactions with providers in real time are limited to a set amount of time.

“There are other ways to be effective with virtual care. Our experience tells us that you absolutely can accomplish virtual care via other modalities,” he adds. “A text-first approach is not the only other way to do this, but data suggests much higher utilization and reuse among patients as a result of convenience and usability. It's across all age groups; it's across all demographics.”

As a family physician serving as chief quality officer and specialty medical director CirrusMD, Baldwin knows firsthand that effective care begins first and foremost with being accessible to patients.

“Whether it's a diabetic patient who's struggling with taking her medications, I have to be very agile      at being able to figure out why and figure out how to reach that patient, one explanation or one approach for every patient doesn't work,” she explains. “Having the ability to touch patients is ideal and it would be great if I could meet them 24/7 wherever they are, but that's unrealistic.”

What’s more, a number of patients are neither comfortable with nor capable of making a video visit happen, owing to a lack of safety for the former or a lack of reliable connectivity for the latter. As it turns out, texting can unearth important details and lead to deeper levels of engagement.

“We know that physicians can't be in their offices ready to see patients at all times, so the ability to be there for patients when they need it and start treatment pretty quickly can reduce that disease burden quite a bit,” Baldwin adds.

Myth 2: Virtual care must take place in real time

Traditional approaches to patient scheduling and its impact on reimbursement mean that the average physician's day is packed tight and measures a patient's face time within 15-minute increments. Extending that reality into the virtual world makes time an impediment to effective patient care.

By giving patients limited windows of opportunity to interact with providers in real time, they may be unwilling or unable to address all their concerns and retain the care plan and information they receive.

“On top of a national physician shortage, synchronous workflows mean providers can only see three to four patients an hour,” Johnson observes. “When you move to a more asynchronous type of workflow, physicians can see anywhere from eight to 15 patients in an hour and reduce the average wait time for video of 44 minutes to typically less than 60 seconds via text.”

Removing time as a limiting factor also provides benefits from a diagnostic perspective and even supports a longitudinal approach to care.

“Disease processes evolve. Things either evolve and improve, or things evolve and get worse. Sometimes they present and it's clear what it is, but so often that evolution has to happen. Being able to avoid those limitations to make a decision can reduce the cost of care, unnecessary medication, and unnecessary testing,” Baldwin maintains.

“As physicians, we need time to assess,” she continues. “We need time to kind of see how things are going to play out. It's in our nature to allow things to progress, so to be able to stand by a patient to do that in a longitudinal type environment is great.”

From the patient perspective, more opportunity to engage providers and ask questions reduces pressure on patients to cover as much as possible during a real-time encounter. That translates into greater comfort sharing information, which in turn builds trust with providers.

Myth 3: Virtual care only appeals to specific patient populations and kinds of care

If there is a silver lining to the current public health crisis, it has shown that patients and providers alike are capable of functioning in a digital-only environment. And while not ideal, it puts to bed the notion that care is only effective via face-to-face interactions.

Assumptions about tech literacy across generations have fueled beliefs that older populations are unwilling or unable to use virtual care technologies, but recent experience says otherwise.

“That only those in their 30s to 40s would use virtual care is just not true,” Johnson stresses. “We've seen fairly consistent utilization across all demographics and a small spike in that 30 to 40 range, to be fair. Everyone uses chat and so much of that utilization comes down to the comfort of having a conversation that isn’t in person or on camera.”

Clinically, the anonymity of texting can lead to more open conversations with patients. “We've all had experiences where we may text something that we would not otherwise say to someone's face or tell them over the phone, and that's true in medicine as well,” says Baldwin.

For those dealing with behavioral health issues, texting reduces the effort necessary for scheduling an appointment, showing up on time, or coping with waiting on providers. For those living in areas with limited bandwidth or connectivity, technical limitations do not add to the frustration and introduce yet another barrier to care.

Without a doubt, in-person care services are vital to treating certain patients and conditions, especially those that are episodic in nature. But virtual care has wide applicability for preventive care, especially for chronic disease and medication management where frequency of communication matters. And while many patients present for virtual care as a result of physical symptoms, a text     -based approach continues to enable practitioners such as Baldwin to often identify root causes that are mental, behavioral, or a combination of both in origin.

"I treated a 36-year-old mother of two who needed a prescription to sleep at night, but throughout our chat we were able to discuss the stresses of her day-to-day life and conduct a screening to find out she met criteria for severe anxiety," Baldwin recounts. “We were able to start her on anti-anxiety medication and follow up with her over the next two weeks—all because of this single interaction over text.”

The effectiveness of virtual care hinges on the ability of providers and patients to engage each other in meaningful ways. What becomes clear as virtual care continues to evolve is the need to suit the modality to the individual patient and condition. There are no panaceas in healthcare, but virtual care has the potential to fill in the gaps in traditional healthcare and, in some cases, provide better pathways to positive outcomes.