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Telehealth: Technology meets health care

See how technology can improve your health care.

How many times have you heard it said that the internet has changed modern life? Indeed, it's likely changed how you stay in touch with family and friends and buy goods and services. And it's probably even changed how you search for information about health problems.

Several telehealth tools are offered to help you manage your health care and receive the services you need. During the coronavirus disease 2019 (COVID-19) pandemic, many people used telehealth. People often still use it. Find out more about telehealth.

What is telehealth?

Telehealth is the use of digital information and communication technologies to access health care services remotely and manage your health care. Technologies can include computers and mobile devices, such as tablets and smartphones. This may be technology you use from home. Or a nurse or other health care professional may provide telehealth from a medical office or mobile van, such as in rural areas. Telehealth can also be technology that your health care provider uses to improve or support health care services.

The goals of telehealth, sometimes called e-health or m-health (mobile health), include the following:

• Make health care easier to get for people who live in communities that are remote or in the country.
• Keep you and others safe if you have an infectious disease such as COVID-19.
• Offer primary care for many conditions.
• Make services more easily offered or handy for people who have limited ability to move, time or transportation.
• Offer access to medical specialists.
• Improve communication and coordination of care among health care team members and a person getting care.
• Offer advice for self-management of health care.

Many people found telehealth helpful during the COVID-19 pandemic and still use it. Telehealth is being used more often.

Here are many examples of telehealth services that may be helpful for your health care.

Virtual visits

Some clinics may use telemedicine to offer remote care. For example, clinics may offer virtual visits. These can allow you to see a health care provider, mental health counselor or a nurse via online video or phone chats.

Virtual visits can offer care in many conditions such as migraines, skin conditions, diabetes, depression, anxiety, colds, coughs and COVID-19. These visits allow you to get care from a provider when you don't need or can't get an in-person visit.

Before your visit, your health care team may send you information or forms to fill out online and return to them. They may also make sure you have the technology you need. They'll check to see if you need to update or install any software or apps too. And they can tell you how to sign on and join the video chat for your visit. Also, the health care team can explain how to use the microphone, camera and text chat. If needed, ask a family member to help you set up the technology you need.

You only need a smartphone, tablet or computer with internet access to join the virtual visit. You can find a comfortable, quiet, private spot to sit during your visit. Your provider also meets from a private place.

Other options

Some people may use web or phone-based services for medical care or advice. When you log into a web-based service or call a service that offers primary or urgent care, you're guided through many questions. The provider or nurse practitioner can prescribe drugs. Or they may suggest home care tips or more medical care.

While these services are handy, they have drawbacks:

• Treatment may not be coordinated with your regular provider.
• Important details from your medical history may not be considered.
• The computer-driven model used to make decisions may not be right for you if you have a complex medical history.
• The service doesn't easily allow for you to make decisions with your provider about treatments.

Remote monitoring

Many technologies allow your provider or health care team to check your health remotely. These technologies include:

• Web-based or mobile apps for uploading data to your provider or health care team. For example, if you have diabetes, you may upload food logs, blood sugar levels and drugs that a nurse checks.
• Devices that measure and wirelessly send data, such as blood pressure, blood sugar and oxygen levels.
• Wearable devices that automatically record and send data. For example, the devices may record data such as heart rate, blood sugar, how you walk, your posture, tremors, physical activity or your sleep.
• Home monitoring devices for older people or people with dementia that can find changes in daily activities such as falls.
• Devices that send notifications to remind you to do exercises or take drugs.

Providers talking to providers

Providers can also use technology to give people better care. For example, in a virtual consultation, primary care providers can get input from specialists in other locations when they have questions about your diagnosis or treatment.

The primary care provider sends exam notes, history, test results, X-rays or other images to the specialist to review. The specialist may answer by email. Or they may do a virtual visit with you at your provider's office. They may also ask for a face-to-face meeting.

In some cases, a nurse or other health care professional may use technology to provide care from a medical office, clinic or mobile van in a rural area. They may call a specialist or provider at a medical clinic to do a remote consult.

These virtual consultations may prevent unnecessary in-person referrals to a specialist. They may also cut wait times for you to see a specialist. And they may remove the need for you to travel to a specialist.

Patient portal

Your primary care clinic may have an online patient portal. These portals offer a safer way of contacting your provider instead of email. A portal provides a safe online tool to do the following:

• Message your provider or a nurse.
• Ask for prescription refills.
• Review test results and summaries of earlier visits.
• Schedule visits or ask for appointment reminders for preventive care.

If your provider is in a large health care system, the portal may also provide one point of contact for any specialists you may see.

Personal health apps

Many apps have been made to help people better organize their medical information in one secure place. These digital tools may help you:

• Store personal health information.
• Record vital signs.
• Calculate and track your calories.
• Schedule reminders for taking drugs.
• Record physical activity such as your daily step count.
• Personal health records

An electronic personal health record system (PHR system) is a collection of information about your health that you control and maintain. A PHR app is easy for you to see anytime via a web-enabled device, such as your computer, laptop, tablet or smartphone. A PHR also allows you to review your lab results, X-rays and notes from your provider. Your provider may give this to other providers with permission.

In an emergency, a personal health record can quickly give emergency staff vital information. For example, it can show your current conditions, drugs, drug allergies and your provider's contact details.

The potential of telehealth

Technology has the potential to improve the quality of health care. And technology can make it easier for more people to get health care.

Telehealth may offer ways to make health care more efficient, better coordinated and closer to home. You can go to a virtual visit anywhere — such as at home or in your car. And you don't need to travel to go to a virtual visit.

Telehealth can be useful so you can stay home if you're sick or if it's hard for you to travel. And you can use telehealth if you live far from a medical center. And many people have been able to keep distance from others at home and still receive care during the COVID-19 pandemic. And providers can diagnose and treat COVID-19 remotely.

Virtual visits can also provide you with the choice to meet with specialists who don't live where you do.

The limitations of telehealth

Telehealth has potential for better coordinated care. But it also runs the risk of gaps in care, overuse of medical care, inappropriate drug use or unnecessary care. Providers can't do a physical exam in-person, which can affect a diagnosis.

The potential benefits of telehealth services may be limited by other factors, such as costs. Insurance reimbursement for telehealth can vary by state and type of insurance in the U.S. But insurance keeps expanding for telehealth services in the U.S. And during the COVID-19 pandemic, insurance restrictions changed for a period of time. Check with your insurance company to see which providers have virtual visits covered by insurance.

Also, some people who need improved access to care may be limited because of not having internet access or a mobile device. People without internet access may be able to access telehealth services by using wireless internet offered at public places. For example, libraries or community centers may offer wireless internet for virtual visits that can take place in private rooms.

Sometimes technology doesn't work well. It's important to have a plan with your provider to call them by phone if there is an issue with the virtual visit.

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• Telehealth. National Institute of Biomedical Imaging and Bioengineering. https://www.nibib.nih.gov/science-education/science-topics/telehealth. Accessed May 6, 2022.
• What is telehealth? Telehealth.HHS.gov. https://telehealth.hhs.gov/patients/understanding-telehealth/. Accessed May 6, 2022.
• Ong MK, et al. Telemedicine for adults. https://www.uptodate.com/contents/search. Accessed May 5, 2022.
• Doraiswamy S, et al. Use of telehealth during the COVID-19 pandemic: Scoping review. Journal of Medical Internet Research. 2020; doi:10.2196/24087.
• Brotman JJ, et al. Providing outpatient telehealth services in the United States: Before and during coronavirus disease 2019. Chest Reviews. 2021; doi:10.1016/j.chest.2020.11.020.
• Telehealth: Defining 21st century care. The American Telemedicine Association. https://www.americantelemed.org/resource/why-telemedicine/. Accessed May 6, 2022.
• Mahtta D, et al. Promises and perils of telehealth in the current era. Current Cardiology Reports. 2021; doi:10.1007/s11886-021-01544-w.
• AskMayoExpert. COVID-19: Outpatient management. Mayo Clinic; 2021.
• Tapuria A, et al. Impact of patient access to their electronic health record: Systematic review. 2021; doi:10.1080/17538157.2021.1879810.
• Takahashi PY (expert opinion). Mayo Clinic. May 9, 2022.

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What should I know before my telehealth visit?

Learn tips to help your telehealth visit run smoothly.

On this page:

How do i prepare for my virtual appointment, what should i do before a video visit, how do i ensure my telehealth visit is successful, how can i feel confident with telehealth.

Before the start of your telehealth visits, you should:

• Know the costs. Before the visit, ask how much it will cost. If you can’t afford the visit or do not have health insurance, your health care provider may have local resources.
• Ask for help if needed. Let your provider know if you need support like a screen reader, closed captioning, a translator, or other help.
• Check your visit details. Your health care provider will remind you about your visit. They may send you a text, email, call, or message in the patient portal (video). Sometimes there are forms to fill out or directions on how to start your telehealth visit.
• Find a good spot. Choose a quiet place with good access to the internet. Make sure you are comfortable and can talk openly.
• Test your technology.  Make sure your internet and the device you are using for the visit works well. Sometimes, a member of your health care provider’s team will help you test. If you have technology problems, look at these technology trouble shooting tips .

Learn what you need and how to start your video visit.

There are many tools or apps for telehealth video visits. They might look a little different from each other, but they all work in similar ways. After you log in, here is what to look for:

This button controls your camera. When you see a slash through it, that means your health care provider cannot see you.

This button controls your microphone. When you see a slash through it, that means your health care provider cannot hear you.

When you click this button, a chat box will open up. The chat box lets you type and send messages to your health care provider.

This button is usually red. Clicking on it will end your telehealth video meeting.

Once you are logged in to your appointment, you should:

• Adjust lighting. Make sure your health care provider can clearly see you.
• Steady camera. Keep your device stable. Put your computer on a desk or table or use something to hold up your phone or tablet.
• Be centered. Sit so your face is in the middle of the screen and the camera is at the same height as your eyes. Remember, how you look on the screen is how your health care provider will see you.
• Check sound. Make sure you can hear well. Test your speakers or earphones and adjust the volume if needed.
• Close extra stuff. Shut down other things on your computer or device. This can make your internet faster and you won't get distracted.

Learn about features you may use during your telehealth visit.

Feeling prepared and knowing what to expect will help you have a successful visit. Some tips for success include:

• Sign on early. If something goes wrong or you can't get the video to start, you can message your provider or call their office.
• The medicines you are taking and how much
• Any problems, worries, or questions you want to discuss
• Your temperature, weight, blood pressure, or blood sugar level
• Allergies to food or medicine.
• Stay on track. It is best not to eat or drink during a telehealth visit. And always be safe — do not have a telehealth visit while you are driving or running errands.
• Be patient. Sometimes health care providers are running late, just like in a regular provider office. Be patient if you have to wait.

Confident means that you have the information and ability to speak for yourself during your health care visits. In order to feel confident in your telehealth visit, you should:

• Learn how telehealth works.  It is okay to ask your provider how the telehealth visit will work and what to expect.
• Share your name and pronouns.  Tell the provider the name you like to be called and your pronouns. They should respect your preferences.
• Take your time.  This is your visit. You shouldn’t feel rushed or like you can’t speak up.
• Pick a good provider.  Find a health care provider who really listens to you and what you are feeling.
• Ask questions.  If something isn’t clear, ask your provider to explain it. Make sure you understand their answers.
• Get a summary. After the visit, ask the provider to send you a summary or notes. This can include answers to the questions you asked.
• Only share what makes you comfortable.  You decide what you want to tell your health care provider. If you don’t want to answer something, it is okay to say so.
• Know your rights.  Understand what information your provider can share and what they can’t. Learn how your personal health information is   kept safe during your telehealth visit and what you can do to protect your privacy .

More information:

5 Tips to get health care from anywhere (PDF) — Health Resources and Services Administration

Navigating Your Patient Portal (video) — Health Resources and Services Administration

What Do You Need to Use Telehealth? (video) — Health Resources and Services Administration

What do I need to use telehealth?

For most telehealth visits, you need internet and a device like a smartphone, computer, or tablet.

What if I'm having trouble using telehealth?

Find tips on how to prevent problems and what to do if you experience technical issues.

Virtual health: A look at the next frontier of care delivery

More than a decade ago, virtual health was celebrated as a game changer in the healthcare industry. But while the technology made virtual health possible, providers, payers, and consumers have been slower to adopt than was anticipated. As discussed in “Telehealth: A quarter-trillion-dollar post-COVID-19 reality,” 1 Bestsennyy O, Gilbert G, Harris A, and Rost J, “ Telehealth: A quarter-trillion-dollar post-COVID-19 reality? ,” May 29, 2020, McKinsey.com. COVID-19 has pushed providers, patients, and payers 2 Medicare has temporarily expanded its coverage of telehealth services to respond to the current Public Health Emergency (see “Medicare & coronavirus,” U.S. Centers for Medicare & Medicaid Services, 2020, medicare.gov). over the tipping point into widespread adoption beyond traditional applications.

Our virtual health definitions are across three categories—telehealth, digital therapeutics, and care navigation (Exhibit 1).

These materials are preliminary and non-exhaustive and are being made available on a non-exclusive basis solely for information purposes in response to the urgent need for measures to address the COVID-19 crisis. They reflect general insight and may present potential options for consideration based on currently available information, which is inherently uncertain and subject to change, but do not contain all of the information needed to determine a future course of action. The insights and concepts included in these materials have not been validated or independently verified. References to specific products or organizations are solely for illustration and do not constitute any endorsement or recommendation. These materials do not constitute, and should not be interpreted as, policy, accounting, legal, medical, tax or other regulated advice, or a recommendation on any specific course of action. These materials are not a guarantee of results and cannot be relied upon. Future results may differ materially from any statements of expectation, forecasts or projections. Particularly in light of rapidly evolving conditions, these materials are provided “as is” without any representation or warranty, and all liability is expressly disclaimed for any loss or damage of any kind. The recipient is solely responsible for all of its decisions, use of these materials, and compliance with applicable laws, rules and regulations. Consider seeking advice of legal and other relevant certified/licensed experts prior to taking any specific steps.

During the pandemic, adult primary care and behavioral health showed smaller declines in total visits than surgical/procedural specialties. 3 Mehrotra A et al., “The rebound in visits has occurred across all specialties,” The Commonwealth Fund, May 19, 2020, commonwealthfund.org. These smaller declines may reflect the fact that more primary care and behavioral health visits can be accomplished by evaluation and management only 4 McKinsey estimate of commercial outpatient spend and encounters by primary diagnosis clinical concept (DDC) that could move to virtual based on Truven Health Analytics data (2015–7). than those in the surgical specialties. These differences in specialties suggest an opportunity to continue to open the aperture to other virtual health technologies, such as remote monitoring, which could allow both primary care and specialty care practices to expand their virtual patient interactions. Prior to COVID-19, a 2019 McKinsey survey 5 McKinsey Virtual Health Provider Survey (Nov. 2019) QX8. How likely will you be to use video consult or email messaging in the future to replace an in-person primary care visit? Please assume the virtual primary care provider is available 24/7 to answer your questions and this question refers to visits that do not require a procedure. What are the primary reasons that you would be likely to use video consult or email messaging in the future for an in-person primary care visit? of health system leaders revealed that virtual health adoption was highly concentrated in synchronous telemedicine, with limited investment in the full suite of available virtual health technologies shown in Exhibit 2. Leaders cited remote monitoring as a key area for future investment.

Given the pace and magnitude of current disruptions to care delivery, forward-looking health systems could consider using the next six months to materially scale broader virtual health offerings to create real competitive advantage.

Actions providers can consider to improve access and value through virtual health

Opportunity exists for health systems to enhance their value proposition for consumers in a way that creates new interactions or loyalty. Additionally, providers may build new capabilities that could lead to success in risk-based reimbursement models. Prior to the COVID-19 pandemic, one study found that health systems, under value-based care arrangements, demonstrated 17 percent savings when they provided virtual care with their existing healthcare professionals instead of using an outsourced provider. 6 McKinsey Healthcare Value Digital Opportunity Assessment, 2019. On the acute care side, an opportunity may also exist to promote efficiency through models like tele-ICU and change-capacity use through “hospital at home” (HaH) models. How health systems think about these value drivers and strategies will likely depend on their market position, provider/specialty capacity, and growth objectives.

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A critical channel for health system volume and recovery.

Virtual health may create both threats and opportunities for providers in their local markets, as new entrants offer additional virtual access for consumers, and providers look to quickly resume care as part of their clinical and financial COVID-19 recovery strategies. Virtual health adoption can create opportunities for a variety of providers to attract patients with new service offerings and connections to perceived higher-quality providers. Leaders in the industry have already made strategic investments based on this calculation, with some large providers offering virtual specialty care consults across geographies traditionally covered by other providers. Enabling virtual/cross-geography models of care could also become increasingly attractive to payers if it enables members to access lower-cost settings of care and/or lower-cost providers of equivalent quality.

In other examples, providers are partnering to create new access, such as in rural markets, that benefits the local patients and local hospitals by extending services. Examples of health system strategic moves include: 7 Based on McKinsey 2019 surveys of 60 chief executive officers of mid- to large-sized healthcare companies.

• A regional health system that provides virtual specialist visits and tele-ICU coverage in partnership with local rural health systems to extend access to services
• A regional health system that partners with a third-party provider of virtual primary care to extend its primary care capacity and creates linkages to its specialty practices
• An academic medical center (AMC) that provides virtual specialty care that consumers access directly from different geographies, with some consumers choosing to travel for care
• A regional health system that provides primary and specialty care through physical and virtual applications, and partners with an AMC to access virtual sub-specialty care

Answering the physician and capital productivity imperative

Increasingly, care is being shifted to non-traditional care settings. As discussed in McKinsey’s perspective on The silent shapers of healthcare services , 8 Patel N, Foo L, and Sutaria S, “ The silent shapers of healthcare services ,” October 1, 2018, McKinsey.com. institutional investment in lower-cost, alternative settings of care (for example, ambulatory surgery centers) is expected to continue. Investment will likely focus on areas that can deliver more convenient, lower-cost services for an aging population (for example, orthopedics, gastroenterology, cardiovascular, oncology). Health systems also are moving to reimagine capital investments. In the 2019 McKinsey survey of more than 60 health system executives, one-third of respondents indicated they planned to decrease capital investments as a result of the shift to virtual health. 9 McKinsey Healthcare Value Digital Opportunity Assessment, 2019. As the following analysis shows, an opportunity also exists to use the capacity that virtual care releases to address higher acuity needs, which could be particularly important for capacity-constrained systems.

Virtually enabled models also have implications for acute care capacity. For example, the HaH model is ripe for virtual disruption—especially for elderly patients who are vulnerable to healthcare-associated infections and other complications of inpatient care. According to the Commonwealth Fund, HaH has been well-established in countries such as the United Kingdom, Canada, and Israel, where payment structures incentivize lower-cost settings of care. In Victoria, Australia, approximately 6 percent of all hospital days are provided in a HaH setting and 60 percent of all patients with deep vein thrombosis were treated at home. 10 Klein S, “’Hospital at home’ programs improve outcomes, lower costs but face resistance from providers and payers,” The Commonwealth Fund, commonwealthfund.org.

Several similar programs in the United States have demonstrated savings of 30 percent or more per admission by providing acute care at home through in-person provider visits. 11 Klein S, “’Hospital at home’ programs improve outcomes, lower costs but face resistance from providers and payers,” The Commonwealth Fund, commonwealthfund.org. There are indications that telemedicine-based care delivery can yield similar results. In one HaH study involving 50 patients in Illinois, replacing in-person physician visits with two-way biometrically enhanced televideo visits yielded similar experience, quality, and safety results. 12 Summerfelt T et al., “Scalable hospital at home with virtual physician visits: Pilot study,” American Journal of Managed Care , 2015, Volume 21, Number 10, pp. 675–84. While providers may continue to face HaH reimbursement challenges, a clear opportunity exists to potentially improve both capital and physician productivity with virtual health. It may be one lever to support physician adoption and engagement in the home setting, which can be another core barrier limiting broader scale. 13 Summerfelt T et al., “Scalable hospital at home with virtual physician visits: Pilot study,” American Journal of Managed Care , 2015, Volume 21, Number 10, pp. 675–84.

Virtual options can also allow physician groups and health systems to more optimally allocate provider time. For example, physician schedules can be adapted to utilize unfilled time for virtual coverage, and exam space can be freed up for procedures. Tele-ICU models also allow intensivist capacity to be leveraged over a larger patient population and/or set of facilities in a way that can also enhance outcomes.

Addressing the needs of older patients and those with chronic disease

In addition to serving the needs of a broader consumer base, virtual health can provide an opportunity to improve care and healthcare  value for chronic disease patients in a way that could also position health systems to succeed in risk-based reimbursement models. In a February 2020 McKinsey consumer survey, 48 percent of respondents 50 years of age and older said they would be likely 14 Includes respondents that indicated they would be “somewhat likely” or “highly likely” to seek care via virtual channels. to seek virtual channels of care in addition to or in place of physical visits. 15 McKinsey Virtual Health Consumer Survey (February 2020) QX2. How likely will you be to use video consult or email messaging in the future to replace an in-person primary care visit? Please assume the virtual primary care provider is available 24/7 to answer your questions and this is for visits that do not require a procedure. What are the primary reasons why you would be likely to use video consult or email messaging in the future for an in-person primary care visit? They cited convenience of accessing healthcare from home (including the ability to avoid the commute and time away from work or family) and easier access to a doctor (including shorter wait times and the ability to access care during off hours) as their primary drivers. 16 McKinsey Virtual Health Consumer Survey (February 2020) QX2. How likely will you be to use video consult or email messaging in the future to replace an in-person primary care visit? Please assume the virtual primary care provider is available 24/7 to answer your questions and this is for visits that do not require a procedure. What are the primary reasons why you would be likely to use video consult or email messaging in the future for an in-person primary care visit? Bringing care closer to the patient through the use of virtual health technologies may be critical to capturing growth opportunities as consumers demand more integrated and accessible care solutions.

In addition, chronic care management (including mental health conditions) represents 90 percent of total healthcare spending in the United States and typically involves resource-intensive support along the continuum of care. 17 National Center for Chronic Disease Prevention and Health Promotion, “Health and economic costs of chronic diseases,” Centers for Disease Control and Prevention, last reviewed on March 23, 2020, cdc.gov. As described in McKinsey’s perspective on Chronic disease excellence: ‘Service Line 2.0’ for health systems? , 18 Kunte A, Harris A, Bauman N, and Sutaria S, “ Chronic disease excellence: ‘Service line 2.0’ for health systems? ,” April 2018, McKinsey.com. providers may want to rethink how they care for this key patient segment. Virtual health could be one critical element to address the following projections:

• Increasing number of patients. About half of all US adults have at least one chronic disease, and prevalence is rising in the Commercially insured population. 19 The Centers for Disease Control and Prevention estimates that about 117 million US adults (49.8 percent of the adult population) have at least one chronic disease (see Ward BW, Schiller JS, and Goodman RA, “Multiple chronic conditions among US adults: A 2012 Update,” Prev Chronic Dis , 2014, Volume 11, cdc.com). 20 McKinsey analysis of Truven 2013 commercial claims data. This data set represents approximately 40 million patients. Patients between ages 45 and 64 have 1.8 times the prevalence of chronic disease as do those ages 20 to 44. 21 The percentage of all chronic disease patients that have two or more conditions has been estimated to be about 40 percent in the 20-to-44 age band and more than 60 percent in the 45-to-64 age band (see Anderson G, “Chronic care: Making the case for ongoing care,” Robert Wood Johnson Foundation, January 1, 2010, rwjf.org).
• Higher utilization, rising costs, and stress on the patient. Healthcare utilization is more than twice as high among chronic disease patients as among those without chronic disease; inpatient utilization is as much as four-fold higher. 22 Anderson G, “Chronic care: Making the case for ongoing care,” Robert Wood Johnson Foundation, January 1, 2010, rwjf.org. Chronic conditions compound the stress on patients to attend frequent appointments, undergo regular diagnostics, and maintain complex medication regimens. In an observable study of a population of around 650 seniors, 38 percent of in-person acute care visits were considered amenable to a virtual care platform. 23 Shah MN et al., “Potential of telemedicine to provide acute medical care for adults in senior living communities,” Acad Emerg Med , 2013, Volume 20, Number 2, pp. 162–8.
• Distributed patient geography. The National Center for Health Statistics Research reports that rural areas have a higher prevalence of chronic disease and related mortality. 24 “Chronic disease in rural America,” Rural Health Information Hub, last reviewed on November 12, 2019, ruralhealthinfo.org. Additionally, access to care is threatened by the closure of more than 100 rural hospitals over the last ten years. 25 “ Rural health ,” Center for Societal Benefit through Healthcare, McKinsey.com.

Preparing for the tipping point

As pressure grows to push automation, boost quality of care, and decrease spending—especially in light of changing macroeconomic conditions—more healthcare stakeholders may push for virtual health platforms and find consistent success. As part of a broader strategic investment in virtual health, health systems could consider the following dimensions:

Growth strategy

Consider strategies and rationale to go beyond “telehealth”/clinic visit replacement to drive growth in new markets/populations, scale other applications (for example, tele-ICU, post-acute care integration).

Revisit service distribution/configuration and capital planning to integrate changes in needs for physical sites of care.

Telehealth: A quarter-trillion-dollar post-COVID-19 reality?

Innovation and cost structure.

Segment the patient populations (for example, specific chronic disease) and specialties whose remote interactions could be scaled with enabling home-based diagnostics and equipment.

Reimagine more sites of care with a “virtual first” mind-set and accelerate sites of care experimentation (for example, HaH enabled by remote monitoring). This model of care can inform a new digitally driven capital plan and service delivery models that could achieve significant reductions to current cost structure.

Embed virtual care settings within ambulatory and acute workflows (for example, scheduling, rounding, billing) to ensure a seamless experience for providers; drive scaling decisions based on quantified quality, experience, efficiency, and financial measures, as compared with baseline measures for a physical encounter.

Consumer experience and outcomes

Accelerate development of an overall consumer-focused digital “front door” that provides patients with a seamless digital channel to access their providers, considering what the integrated product will cover beyond what currently exists (for example, finding a doctor, record access, scheduling in-person visits) and integrated with what may have been put in place in response to COVID-19 (for example, e-triage, scheduling virtual visits, virtual clinic visits).

Measure the value of this “front door” by quantifying clinical outcomes; access improvement and patient/provider satisfaction to drive advocacy and contracting for continued expanded coverage.

Physician alignment

Build the capabilities and incentives of the provider workforce to support virtual care (for example, workflow design, continuing education and graduate medical education); align benefit structure to drive adoption in line with health system and/or physician practice economics.

Technology infrastructure

Take stock of virtual applications, interoperability with systems of engagement (for example, electronic health record, revenue cycle, digital front door) and supporting infrastructure. Define approach to move from COVID-19 rapid solutions to a sustainable, secure, integrated virtual health platform.

The COVID-19 pandemic is pushing against many of the structural barriers that had previously slowed health system investment in integrated virtual health applications, including funding mechanisms, consumer adoption, and provider adoption. Healthcare stakeholders may want to create additional buy-in for virtual health platforms in an effort to boost the quality of care and increase efficiency. While providers are juggling a host of challenges around COVID-19 and a “return” to normal operations, virtual health may provide a useful framework for creating the next normal.

Jennifer Fowkes is an associate partner in McKinsey’s Washington, DC, office. Caitlin Fross is a consultant in the Atlanta office. Greg Gilbert and Alex Harris are partners in the Washington, DC, office.

The authors would like to thank Ankur Ghia, David Bueno, Tiago Moura, Elena Chit, Richard Shin, Jenny Rost, and Oleg Bestsennyy for their contributions to this paper.

This article was edited by Elizabeth Newman, an executive editor in the Chicago office.

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Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19 : Unforeseen Opportunity in the Face of Adversity

• 1 Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
• 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
• 3 PRESENCE and The Program in Bedside Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
• Viewpoint Ensuring Quality in the Era of Virtual Care Kurt R. Herzer, MD, PhD, MSc; Peter J. Pronovost, MD, PhD JAMA
• Viewpoint Paying for Telemedicine After the Pandemic Ateev Mehrotra, MD; R. Sacha Bhatia, MD; Centaine L. Snoswell, PhD JAMA
• Research Letter Telehealth Use at Safety-Net Organizations in California During the COVID-19 Pandemic Lori Uscher-Pines, PhD, MSc; Jessica Sousa, MSW, MPH; Maggie Jones, MPH; Christopher Whaley, PhD; Christopher Perrone, MPP; Colleen McCullough, MPA; Allison J. Ober, PhD JAMA

It is a truism in health care that reimbursement shapes practice. The coronavirus disease 2019 (COVID-19) pandemic in its early months has been an exception. Health care shifted substantially and fairly suddenly to virtual visits to meet the needs of patients without compromising their safety during a shutdown, while reimbursement was still uncertain. 1 , 2 Recently, the Centers for Medicare & Medicaid Services reported that between mid-March and mid-October 2020, more than 24.5 million of 63 million eligible patients received a telemedicine service covered by Medicare. 3

While telemedicine trends have plateaued in many settings, patients and many clinicians clearly have an appetite to continue virtual care in some form once the pandemic is under control. For certain conditions such as those treated through mental health counseling, virtual care could be as effective as in-person visits 4 (although robust studies for most other conditions are lacking). For many patients, a hybrid of in-person and virtual care could be envisioned, guided by the nature of their condition, the care that is required, and the patient’s needs and preferences. 5 The benefits of virtual care include convenience and improved access for individuals in remote locations and those with intense work or caregiving demands. But the risks include overutilizing costly tests in the absence of physical examination data, reductions in guideline-recommended preventive care when telemedicine supplants in-person visits, and potential exacerbations in health disparities due to inequity in telemedicine access.

In this issue of JAMA , 2 articles discuss critical issues that will shape the future of virtual care after the pandemic: Mehrotra et al 6 address the dilemma of how governments and insurance companies will fund such care going forward; Herzer and Pronovost 7 focus on the challenges of ensuring quality.

Although short-term funding became available at the start of the COVID-19 pandemic in response to the urgent need, the issue is what happens when the need subsides. Mehrotra et al 6 suggest that funding decisions should be based on value, which they define as improvements in care outcomes or access for a given cost. At present, sufficient data are lacking to inform these decisions, which may lead to a scenario in which payments tied to arbitrarily defined parameters will influence clinician practices. Fortunately, a substantial body of evidence is likely to emerge from research that was jumpstarted by the pandemic.

Herzer and Pronovost 7 offer a complementary perspective, focusing on quality of care, a critical component of the value equation. They present 3 guiding principles for telemedicine implementation, arguing that virtual care should achieve safety and effectiveness that is comparable to traditional care, improve efficiency without increasing costs, and respect patient preferences and values without exacerbating health care disparities. These practical suggestions will be particularly helpful as payers and systems identify specific services that achieve concrete outcomes (eg, medication refills, behavioral health counseling) and can be implemented virtually with minimal complexity and at low risk to patients and clinicians. The more challenging scenarios will require individualized decision-making to determine if a given patient with complex medical or social needs will derive greater benefit (in terms of short- and long-term clinical outcomes, as well as safety, efficiency, and experience) from an in-person or virtual appointment.

Although the quality and cost of virtual care are certain to drive the future scale and spread of telemedicine, a third domain that merits study is the way in which virtual care influences human connection, the bond that is built during a visit between patient and clinician. The shift in care from in-person to virtual encounters risks jeopardizing the human interaction that is pivotal to effective clinical care and that is deeply meaningful to both patients and clinicians. Little is known about the effects of removing physical presence and contact from conversations that often include personal, emotional, and stressful content.

A number of humanistic practices may help clinicians foster meaningful connections with patients during telemedicine visits. 8 , 9 For example, during a video visit, clinicians can adopt nonverbal communication strategies that accommodate limitations in audio or video quality, such as sitting up and leaning forward, using heightened facial expressions and head gestures, and optimizing eye contact by gazing into the web camera. Similarly, given that the phone or a small video screen might obscure emotional cues such as a patient’s closed body posture, nervous toe-tapping, or wringing hands, clinicians need to pay closer attention to a patient’s tone and volume of speech and should consider using intentional words and gestures, such as putting a hand over the heart, to help convey emotion. 9 The Academy of Communication in Healthcare has developed training videos with practical tips for telemedicine visits, offering strategies to be present, identify a patient’s needs, listen, respond with empathy, and share information. 10

The major limitation of virtual care is the difficulty of extracting phenotypic information ranging from vital signs to significant findings on the physical examination that can be of consequence. In addition to the risk of delayed or missed diagnosis of readily recognizable disease, the skilled physical examination represents an important ritual for the patient-clinician relationship, one that can have a salutary effect. 11 The future of telemedicine will depend in part on the adaptation of some aspects of the physical examination to virtual modalities. Medical societies are identifying opportunities to integrate self-examination maneuvers into video visits to aid in diagnosis. 12 With appropriate equipment, many patients can measure and transmit information about their blood pressure, oxygen saturation, and other vital signs. While these steps address a few diagnostic features of the in-person examination, they do not replace it, nor do they make up for the ritual of the physical examination with its attendant benefits. Future research and innovation might allow the patient’s home to function as an extension of the clinic, with simple and reliable tools of visualization, monitoring, and measurement to maximize the virtual examination. 13

The stunning, pandemic-related expansion of virtual care has also had the unexpected consequence of offering clinicians humbling insights into the lives of patients. Many clinicians schooled in the social determinants of health are getting their first real glimpse into their patients’ homes, their living conditions, their food and medication security, the numbers of family members restricted to one space, as well as their extant support systems—none of which are easily grasped when patients sit in paper gowns, stripped of much of their personal identity, in a sterile examination room. Learning that a patient is calling into their visit from a car for privacy reasons or because of an absence of reliable internet connection is telling. Being introduced to a cherished family member or pet, or viewing possessions that are important to a patient’s identity, is both rewarding and helpful in making recommendations that are tailored to the individual. 9 The family history and social history in the electronic health record (EHR) of even an established patient struggles to be as rich as these glimpses into the patient’s actual world.

Five years ago, we wrote in JAMA 14 about the ways in which technology in medicine—most notably the EHR—detracts from a clinician’s ability to be present and to connect with patients. Cost and quality were the drivers for adoption of the EHR, while the patient-clinician relationship took a backseat. One of the ironies of the COVID-19 pandemic is that technologies that could potentially challenge human connection in medicine are the very ones that have kept clinicians, patients, and their caregivers connected amid social distancing, travel bans, and lockdowns. It is imperative to preserve beneficial elements of this new means of connection, while ensuring that it fulfills metrics of cost-effectiveness and quality.

Corresponding Author: Abraham Verghese, MD, Department of Medicine, Stanford University, 300 Pasteur Dr, S102, Stanford, CA 94305-5110 ( [email protected] ).

Conflict of Interest Disclosures: Dr Zulman reported receiving research grants from the US Department of Veterans Affairs (VA) Health Services Research and Development, the VA Office of Rural Health, and the Gordon & Betty Moore Foundation, outside of the submitted work. Dr Verghese reports receiving royalties from Simon & Schuster and Knopf Random House and serving on the speakers bureau for LeighBureau.

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Zulman DM , Verghese A. Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19 : Unforeseen Opportunity in the Face of Adversity . JAMA. 2021;325(5):437–438. doi:10.1001/jama.2020.27304

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Telehealth, What It Is, and Its Pros and Cons

• Telehealth Overview
• What It Treats
• Disadvantages
• Preparing for an Appointment

Telehealth is a way to receive healthcare services remotely through electronic devices like your computer, tablet, or smartphone. Telehealth services come in different forms, such as live video or audio appointments, secured text messaging with your healthcare provider, or remote monitoring devices that allow your healthcare provider to track things like your blood sugar.

This article describes how telehealth started and the different ways that telehealth can and cannot be used. It also explores the advantages and disadvantages of telehealth and whether it is the best option for you.

d3sign / Getty Images

Telemedicine vs. Telehealth

Telehealth is sometimes referred to as telemedicine, but there are subtle differences. Telehealth refers to a variety of services, like connecting providers (such as labs and pharmacists), providing remote training, coordinating staff (like home health workers), and handling remote admissions. Telemedicine is just one aspect of telehealth focused solely on patient care.

Telehealth Overview and History

Telehealth has been around since long before the COVID-19 pandemic, but it was arguably during the lockdowns of 2020 that telehealth came into the public's consciousness.

Telehealth, as we know it today, began over 50 years ago when NASA developed telehealth services for astronauts on long-duration missions.

By the 1990s, telehealth was introduced as a means to deliver remote care to specific occupations, such as a system called Mednet that connected healthcare providers with workers on ships. Remote devices were soon after introduced that allowed healthcare providers to monitor people with sleep apnea or keep track of people with Alzheimer's disease using GPS technology.

The advent of high-speed internet, webcams, video chats, and specialized smartphone apps spurred the rapid adoption of telehealth in the early-2000s.

Services became sophisticated so that by the early part of the COVID-19 pandemic , the federal government not only aggressively adopted and increased awareness of telehealth but passed legislation that allowed for Medicare coverage of many at-home telehealth services.

A 2020 review published in BMC Public Health concluded that telehealth improved the delivery of healthcare during the pandemic, minimizing COVID-19 transmission and potentially reducing morbidity and deaths.

Telehealth Today

Today, telehealth encompasses a variety of virtual services that you can access through personal electronic devices, secure web portals, or dedicated monitoring devices. Although many people associate telehealth with "virtual health visits," it has come to mean much more than that.

Today, telehealth can serve many different purposes, such as:

• Enabling real-time visits with multiple providers or patients (such as for group therapy)
• Taking and sharing photos or videos of a skin rash, eye infection, or other symptoms
• Allowing you to direct message your provider with questions or requests (such as about medication doses, refills, or side effects)
• Receiving an email, phone, or text reminder about prescription refills or recommended health screenings
• Providing you with video instructions on how to use a medical device, such as a self-injector or at-home dialysis machine
• Remotely monitoring your blood sugar, heart rate, blood oxygen, sleep patterns, and other functions
• Providing you immediate secure access to electronic health records (EHRs)
• Linking you with an urgent care provider to get immediate treatment for uncomplicated conditions (like a cold sore )

Telehealth is even being explored as a way for surgeons to perform remote robotic surgery (" telesurgery ") for conditions like kidney tumors.

What Can Telehealth Treat?

Due to advances in video and medical technology and online security, telehealth can be utilized in many fields of practice once thought unimaginable. These include primary care, dermatology, dietetics, mental health, cardiology, endocrinology, and others.

Common conditions treated or managed with telehealth include:

• Headaches or migraines
• Colds, flu, or stomach aches
• Skin conditions such as acne or rashes
• Musculoskeletal conditions such as backaches
• Recurring conditions such as urinary tract infections or herpes
• Mental health problems such as anxiety or depression
• Gastrointestinal symptoms such as constipation
• Chronic medical conditions such as diabetes

Types of visits appropriate for telehealth include:

• Wellness visits
• Nutrition counseling
• Psychotherapy
• Physical or occupational therapy
• Some urgent or emergent care
• Obtaining referrals or prescriptions
• Fertility counseling
• Prescription management
• Lab test or X-ray results
• Post-surgical follow-up
• Follow-up appointments

Which Providers Use Telehealth Most?

According to the American Medical Association, the medical practitioners who utilize telehealth the most are radiologists (39.5%), psychiatrists (27.8%), and cardiologists (24.1%). The medical practitioners who utilize telehealth the least are obstetrician-gynecologists (9.3%), gastroenterologists (7.9%), and allergists/immunologists (6.1%).

Advantages of Telehealth

There are many benefits to telehealth as evidenced by its impact during the COVID-19 pandemic. Even after the pandemic officially ended, many of the benefits remain.

Increased Accessibility

Telehealth is particularly beneficial for people in rural or isolated locations who might otherwise skip checkups or have limited access to urgent care. Telehealth is also more accessible for people who have mobility issues or are restricted to bed because of illness or infection.

Telehealth can also help people with conditions like agoraphobia or social anxiety who find it difficult to leave the house or those with long or inconvenient work hours who can benefit from a telehealth appointment after normal office hours. People with chronic illnesses that are often stigmatized like major depression or HIV/AIDS may also be more likely to seek care through telemedicine.

Telehealth may also be a faster way to access services. In many cases, a telehealth provider can see you right away, sometimes within minutes or hours of making an appointment.

Reduced Hospitalizations

Telehealth may lead to reduced hospitalizations, in part because people can access care earlier before severe symptoms develop.

A 2015 study in the American Journal of Managed Care reported that among people with a prior cardiovascular event, those who used telehealth for follow-ups had 31% fewer hospital admissions than those who didn't.

A 2020 review in the Journal of Medical Internet Research similarly concluded that high-quality telehealth reduces the risk of all-cause or condition-related hospitalization by 4.8% and 15.6% respectively.

Cost-Effectiveness

Generally, telehealth appointments are less costly than in-person because more patients can be seen in the same timeframe with fewer support staff.

Beyond the actual out-of-pocket costs, telehealth can also be more cost-effective. Research indicates telehealth can offer additional cost-savings such as:

• Less work absenteeism and/or loss of income
• Reduced childcare costs
• Reduced travel expenses

Telehealth is also linked to increased independent living and better quality of life for those who are older or frail.

Avoiding Waiting Rooms

During the COVID-19 pandemic, access to healthcare services through telemedicine was implemented to help limit the spread of the virus. This is still an important reason why you may want to choose telemedicine services over in-person visits.

By using telemedicine during flu season or at times when these viruses are known to be spreading in your community, you may be able to avoid exposure to COVID-19 and other illnesses such as influenza and respiratory syncytial virus (RSV). This is particularly important for older people, people who are unvaccinated, or those who are immunocompromised.

Disadvantages of Telehealth

While telehealth may be more accessible for many people, it has its limitations and drawbacks that may make it less appropriate for certain groups.

Technical Barriers

Telehealth requires a certain level of technical literacy. Older populations and those with cognitive problems may not be able to utilize the services without a caregiver's help.

Older age is also associated with lower technology use. A 2022 study in Clinical Liver Disease reported that only 53% of adults 65 and over in the United States own a smartphone and only 59% have broadband access .

Other technical barriers include slow broadband speeds and unreliable internet service (particularly in remote regions) that can cause video calls to drop or interfere with streaming.

Telehealth requires a personal electronic device such as a computer or smartphone as well as internet access. Socioeconomic disparities alone may stand in the way of this.

A 2023 study from the University of Central Florida found that ethnic minorities and people with lower incomes are far less likely to access telehealth for economic reasons.

In Black communities especially, where poverty rates run high, people were less likely to engage in telehealth services than other ethnic groups. (In the same way, Black people are less likely to access healthcare in clinics due to cost and other social or economic reasons .)

Similarly, unemployed people are 15% less likely to access telehealth than those with a job.

Limitations in Care

There are also limitations as to what can and cannot be done via telehealth. In the end, some health services can’t be replicated virtually and require in-person visits.

These include appointments for:

• Blood and urine tests
• Physical diagnostic tests
• Physical examinations
• Shots or vaccinations
• Contraception placements
• Physical therapy

Because telehealth providers can't conduct a physical examination, there is also a greater risk of misdiagnosis associated with telemedicine services.

Regulations and Insurance Restrictions

Different states and insurance providers have different regulations and restrictions when it comes to telemedicine. For example:

• State regulations may create barriers to accessing telehealth, such as in-person visit requirements for people who need prescribed medication
• Health insurance companies may not cover telehealth services from providers located out of state
• There may be confusion about what types of telehealth services are covered by your provider

Privacy Concerns

Telehealth also comes with a broad range of privacy concerns, which may affect some groups more than others. For example:

• Data security can't always be guaranteed when using personal or public Wi-Fi networks, which means sensitive health information could be accessed by third parties.
• Some people do not have access to private spaces where they can use telehealth services.

There are steps you can take to ensure your privacy when using telehealth services:

• Make sure you are in a private location, such as a room with a locked door or a parked car.
• Turn off any devices that could record your conversation, such as security cameras, web cameras, smart speakers, etc.
• Avoid using a public computer, a work computer, or a public Wi-Fi network. Whenever possible, use your own device such as a phone, tablet, or laptop.
• Make sure your device has the latest operating system, including all recommended security updates.
• Choose a strong password when setting up your telehealth account. Your password should contain a mix of numbers, lowercase letters, capital letters, and symbols and should not be used on any other websites.
• Use encrypted email services when sending sensitive health information to your provider.

The Future of Telehealth

Telehealth was popular during the COVID-19 pandemic when lockdowns kept people confined to their homes and the healthcare system was overburdened. By 2022, however, telehealth use was significantly down, with an overall usage of around 31% compared to around 39% the previous year.

Other studies have found that there is still a preference for in-person telehealth services, with around 80% of providers saying they would rather provide limited or no telehealth services in the future, and only 36% of patients saying they prefer telehealth over an in-person visit.

Some analysts believe this indicates a trend towards limited telehealth services in the near future, though changes in access and improvements in home-based diagnostic tools could change this.

How to Use Telehealth

Before scheduling a telehealth appointment, speak with your provider and ask what platform or service they are using. It may be FaceTime on your iPhone, a Zoom call on your computer, or a secure portal on the internet.

If possible, do a test run to see if you can use the platform without freezing, dropped lines, sound problems, or pixelation (when the image breaks up).

How to Find a Telehealth Provider

If you have insurance, check directly with your insurance carrier when looking for a provider to see if they've partnered with any organizations that provide telehealth.

Some health insurance companies also provide searchable directories of healthcare providers with telehealth options. The providers in your health insurer's directory should also accept your insurance, though it's always a good idea to confirm this with the provider.

If you have Medicare or Medicaid, make sure that the service you plan to use is covered. While most telehealth services were covered by Medicare and Medicaid during the COVID-19 pandemic, some of those emergency concessions have since been withdrawn.

How to Prepare for a Telehealth Appointment

Once you are comfortable with the technology and out-of-pocket expense, you can prepare for the appointment by:

• Finding a private space where you can speak openly and confidentially
• Locating a well-lit spot so that your healthcare provider can see your face clearly
• Turning down any background noise
• Closing all other applications on your smartphone or laptop before the appointment begins

As with all other appointments, you can better prepare by writing down any symptoms or concerns you'd like to discuss. It is also important to be patient if your provider is running late as the same can happen with an in-office visit.

Telehealth involves the use of technology to deliver medical care remotely. This not only includes virtual visits on your smartphone, laptop, or tablet but also the sharing of electronic records, management of prescriptions and lab results, and the remote monitoring of conditions like diabetes.

The advantages of telehealth include convenience, generally lower costs, and more consistent management of medical conditions. Disadvantages include a lack of access to technology, a lack of technical literacy, the cost of telehealth for low-income people, and privacy concerns.

There are also limitations to the types of conditions that telehealth can and cannot treat.

National Aeronautics and Space Administration. A brief history of NASA's contributions to telemedicine .

Cuffia A. The Medical Library Association guide to developing consumer health collections .  J Hosp Librarianship . 2019 Jan;19(1):84-5. doi:10.1080/15323269.2019.1568127

Telehealth.HHS.gov. Telehealth policy changes after the COVID-19 public health emergency .

Monaghesh E, Hajizadeh A.  The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence . BMC Public Health . 2020;20(1):1193. doi:10.1186/s12889-020-09301-4

Li J, Yang X, Chu G, et al. Application of improved robot-assisted laparoscopic telesurgery with 5G technology in urology . Eur Urol. 2023 Jan;83(1):41-4. doi:10.1016/j.eururo.2022.06.018

American Medical Association. Which medical specialties use telemedicine most?

Hirko KA, Kerver JM, Ford S, et al. Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities . Journal of the American Medical Informatics Association . 2020;27(11):1816-1818. doi:10.1093/jamia/ocaa156

Obisike EE. The effectiveness of telemedicine on stigmatization and treatment burden in patients with health compromising lifestyles and chronic diseases: A critically appraised topic . Open Sci J . 2018;3(1).

Pande RL, Morris M, Peters A, et al.  Leveraging remote behavioral health interventions to improve medical outcomes and reduce costs .  Am J Manag Care . 21(2):e141-e151

Peters GM, KooijL, Lenferink A, van Harten WH, Doggen CJM. The effect of telehealth on hospital services use: systematic review and meta-analysis . J Med Internet Res. 2021 Sep;23(9):e25195. doi:10.2196/25195

Avidor D, Loewenstein A, Waisbourd M, Nutman A. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review . Cost Effectiveness and Resource Allocation . 2020;18(1):16. doi:10.1186/s12962-020-00211-1

White-Williams C, Liu X, Shang D, Santiago J. Use of telehealth among racial and ethnic minority groups in the United States before and during the COVID-19 pandemic . Public Health Rep . 2023;138(1):149-156. doi:10.1177/00333549221123575

Price JC, Simpson DC. Telemedicine and health disparities . Clin Liver Dis (Hoboken). 2022 Apr;19(4):144–7. doi:10.1002/cld.1171

Centers for Disease Control and Prevention. Telehealth in rural communities .

Williams C, Shang D. Telehealth usage among low-income racial and ethnic minority populations during the covid-19 pandemic: retrospective observational study .  J Med Internet Res . 2023;25:e43604. doi:10.2196/43604

Holčapek T, Šolc M, Šustek P. Telemedicine and the standard of care: a call for a new approach? Front Public Health . 2023;11:1184971. doi:10.3389/fpubh.2023.1184971

American Academy of Family Physicians. Legal requirements for using telehealth services .

Houser SH, Flite CA, Foster SL. Privacy and security risk factors related to telehealth services - A systematic review . Perspect Health Inf Manag . 2023;20(1):1f.

U.S. Department of Health and Human Services. Telehealth privacy and security tips for patients .

Shilane D, Lu TH. Declining trends in telehealth utilization in the ongoing COVID-19 pandemic . J Telemed Telecare . 2023:1357633X231202284. doi:10.1177/1357633X231202284

SteelFisher GK, McMurtry CL, Caporello H, et al. Video telemedicine experiences in COVID-19 were positive, but physicians and patients prefer in-person care for the future . Health Aff (Millwood) . 2023;42(4):575-584. doi:10.1377/hlthaff.2022.01027

By Sarah Bence, OTR/L Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.

How do virtual visits work?

Consumers expect convenience with just about everything they do these days – from streaming TV shows on-the-go to ordering groceries without ever walking into a store. But many people don’t realize that seeing a doctor may be just as simple. 

Telehealth, or virtual visits is helping make access to health care more convenient. People can see and talk to a doctor through their smartphone, tablet or computer, meaning they don’t have to go to a doctor’s office or sit in a waiting room. Instead, they can visit with a doctor from the comfort of their own home.

Beyond the convenience, virtual visits may also save consumers time and money. According to a  study , a virtual visit may save consumers more than an hour of their time. These visits may cost much less than a trip to urgent care or an emergency room. 

Some examples of health issues that can be addressed with a virtual visit include:

• Bladder or urinary tract infections
• Migraines or headaches
• Seasonal flu
• Sinus problems
• Sore throat
• Stomachache

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Connecting the World of Healthcare Virtually: A Scoping Review on Virtual Care Delivery

Cindy (zhirui) li.

1 School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada

Elizabeth M. Borycki

2 Michael Smith Foundation for Health Research, Vancouver, BC V6H 3X8, Canada

Andre W. Kushniruk

Associated data.

Not applicable.

Virtual care extends beyond the walls of healthcare organizations to provide care at a distance. Although virtual care cannot be regarded as a solution for all health-related inquiries, it provides another care delivery channel for specific patient populations with appointments that do not require in-person physical examinations or procedures. A scoping review was conducted to define the meaning of virtual care, understand how virtual care has influenced the healthcare industry and is being expanded to complement the existing healthcare system, and describe the outcomes of using virtual care for patients and providers. Findings from the scoping review suggest that virtual care encompasses the provision of care using advanced video conferencing technology to support remote care that takes place between patients and providers and the use of virtual reality technology to simulate care environments. Some of virtual care’s use in healthcare includes application to pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services. Lastly, from a provider and patient perspective, while both saw benefits of virtual care and scored the service relatively high on satisfaction after using virtual care, the greatest barrier to using virtual care may be technological challenges.

1. Introduction

Self-management of health is an essential part of everyday life. Historically, provider-centric models have been used by healthcare organizations (e.g., hospitals). In provider-centric models, patients seek care by visiting a provider’s office or making trips to healthcare facilities. For example, a patient wishing to receive diabetes education for insulin management would need to visit a diabetes education clinic with data from their glucometers to show a registered nurse (RN), dietician, or physician so that they are able to receive the necessary support from their providers. With technological advances in healthcare, there is an opportunity to enhance existing patient–provider relationships by creating new tools to support a patient-centric model of care. This patient-centric model of care occurs when providers and healthcare organizations are trying to provider better access to care from a patient’s perspective, which can include offering services such as telehealth visits. Virtual care provides the opportunity for the description above to become a reality, as virtual care is able to increase the level of convenience for patients to access care from their providers.

Many technologies exist in the global communications market to support virtual connections through real-time asynchronous communication, such as Skype ® or FaceTime ® . These technologies connect family and friends regardless of geographic location and/or time differences. When it comes to healthcare, there are privacy concerns in using these common tools in terms of Personal Identifiable Information (PII) and Protected Health Information (PHI). PII refers to information that recognizes individuals based on unique identifiers, such as a name, social insurance number, and/or driver’s license [ 1 ]. A person’s PHI refers to information generated from medical records, such as name, medical record numbers, or biometric identifiers, but it may also contain many of the identifiers in PII, such as name, driver’s license number, or passport number [ 1 ]. With this in mind, companies from all around the globe have developed tools specifically for use in healthcare. These tools allow for compliance with local privacy regulations; for example, companies in the U.S. comply with the Health Insurance Portability and Accountability Act (HIPAA) [ 2 ]. In Canada, virtual tools comply with the Freedom of Information and Protection of Privacy Act (FIPPA) according to the Office of the Information and Privacy Commissioner and the Personal Information Protection and Electronic Documents Act (PIPEDA) [ 3 ]. Hence, around the globe, countries have different regulations that vendors must comply with in order to produce technologies that are acceptable by the privacy and security standards of these various countries. These acts serve the purpose of protecting an individual’s private information from wrongful use or distribution into the black hole of our information-heavy world.

As the use of many of these tools does not require the physical presence of both the patient and provider, virtual care has become the generic term used to refer to this model of care. Although virtual care is not a new concept, it is not well understood by the general public in terms of the types of the services virtual care can offer or how virtual care services are provided compared to traditional telehealth or even face-to-face visits. The major difference between these three modalities of services is the location of patients. Face-to-face visits are obvious in that the patient would be collocated with their provider, whether it is in their provider’s office, or a provider in the community, such as a community health worker who visits a patient in the patient’s home. For traditional telehealth, it means that a patient will be attending their remote consultation with their provider from a healthcare facility through a designated space where video conferencing equipment has been set up on both the patient and provider’s side to have a video consultation. Finally, virtual care in this particular context means that the patients and providers can be anywhere, such as in the comfort of their own home rather than having to travel to the hospital. Hence, the objective of this research is to explore the world of virtual care and the tools that are specifically designed to be applied to healthcare services. This study will (1) define the meaning of virtual care; (2) understand how virtual care has influenced the healthcare industry; (3) understand how virtual care is being expanded to complement the existing healthcare system, and (4) describe the outcomes of using virtual care for patients and providers.

2. Materials and Methods

The protocol followed for this scoping review aligns with a five-step framework outlined by Arksey and O’Malley, and advanced by Levac et al. [ 4 ]. The framework includes identifying the research questions and relevant studies, selecting studies, data extraction from the selected articles, and a dissemination of the results [ 4 ]. An ethics review was completed at the University of Victoria by the Research Ethics Coordinator and Research Ethics Vice-Chair from the Office of Research Services. Upon review, it was deemed that this project does not involve human subjects and is limited to the use of publicly available data or articles; hence, it is exempt from a full human research ethics review.

2.1. Identifying Research Questions

The scoping review answered the following research questions:

• How is virtual care defined?
• How has virtual care influenced the healthcare industry?
• How is virtual care being expanded to complement the existing healthcare system?
• What are the outcomes of virtual care for patients’ and caregivers’ perspectives?

2.2. Identifying Relevant Studies

As part of this scoping review, literature from the following databases were searched: Medline ® , PubMed ® , CINAHL ® , IEEE Xplore ® , ISI Web of Science ® , Biomed Central ® , Applied Science ® , and Technology Index ® . Two important search criteria to note are publication dates and keywords. The published literature from the past 10 years was reviewed in depth and breadth in the topic area (i.e., virtual care). Keywords that were searched in these databases include but are not limited to those shown in the Table 1 below.

Keywords for database search.

2.3. Selecting Studies

Covidence ® is the online platform used for systematic review management. Zotero ® is an electronic reference management system used to store all potential studies to be included in this scoping review. Zotero ® provides the ability to store all studies in a virtual library, which can then be imported into Covidence ® to complete an initial title and abstract screening. Following a title and abstract screening in Covidence ® , a number of irrelevant articles were eliminated, resulting in a list of articles that would require full-text reviews. Two investigators were involved with approving articles for inclusion in the scoping review. A meeting was set up via video conference to discuss any discrepancies between the investigators when deciding to include or exclude an article. Articles were included if they touched on at least one of the research questions and involved the use of virtual care technology at a distance, and excluded otherwise. Articles were also excluded if they were not a full study. As a result, a PRISMA diagram was produced, visually depicting the process of elimination. Duplicate articles were automatically removed from Covidence ® if they had the same author and title. Studies deemed irrelevant were summarized with the reasons for their exclusion. Following the selection of studies, data charting was performed to list the authors, date, title, method, results, limitations, and any other fields as necessary for each article that was screened.

2.4. Data Charting

Data charting was completed on all 34 studies included from the PRISMA Diagram in Figure 1 . Information extracted from each article included the: authors’ names, the publication date, title, method, results, limitations, and any other fields as necessary for each article that was screened. Full results of data charting are consolidated into tables below in Appendix A and Appendix B .

PRISMA diagram.

2.5. Dissemination of Results

As part of the data-charting process, themes for each article were documented in the table that relate to one or more of the four research questions this scoping review answers. These themes include consumer perspectives on virtual care, whether it be a provider or a patient, how virtual care can be defined, as well as applications of virtual care. Consumer perspectives include user experience, both from the provider side of care and from the receiver end. This helps inform the direction of virtual care in the future. Currently, virtual care is a relatively broad topic, as can be seen from the keywords table in Section 2.2 ; therefore, a selection of care services provided remotely, or are simulated, such as through virtual reality, can all fall under the umbrella of virtual care. Lastly, given the broad definition virtual care can encompass, applications of virtual care can also thrive or fail in various settings, such as pain management or follow-up visits. The results section below will further discuss the details uncovered from data charting with references.

The PRISMA diagram generated from the elimination of articles throughout the screening process is shown in Figure 1 below.

Given that the range of articles searched in this scoping review was relatively large, there were no search criteria that limited how recent an article had to be in order to be included in the project. This produced an interesting result in that the majority of articles included in this study were published within the last five years (≥015); only 29.41% (10/34) were published before 2015. Even including the percentages of excluded articles, that decreases to just 20.79% (21/101) of the articles on the topic of virtual care being published before 2015. Based on these statistics, it can be seen that more research on virtual care has been done in recent years. Then, the articles were reviewed with attention to the following themes: (1) the definition of virtual care, (2) the influence of virtual care on the healthcare industry, (3) the expansion of virtual care to complement the existing healthcare system, and (4) consumer perspectives of virtual care.

3.1. Definition of Virtual Care

Based on the selection of articles uncovered in this scoping review, virtual care can encompass the provision of care through using advanced video conferencing technology between patients and providers remotely or using virtual reality technology to simulate care environments. De Jong et al. [ 5 ] defined virtual care and its application as, “integrated web-based technology that combines self-management, data sharing, and communication between patients and professionals”. Others, such as Gordon et al. [ 6 ] also noted that virtual health can be defined as the utilization of real-time video consultation with a provider over the Internet, and that they expect the need for virtual care will continue to grow as the use of mobile devices and patient demand for immediate and convenient access to care increase. However, virtual reality is typically not defined as virtual care. Virtual reality is a tool that can support virtual care. This will be discussed in more detail in the following sections.

3.2. Influence of Virtual Care on the Healthcare Industry

In recent years, virtual care has expanded. It now touches on multiple aspects of healthcare, including pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services.

3.2.1. Pain and Anxiety Management

Virtual care has been applied to the management of pain and anxiety associated with the diagnosis of hematologic diseases; for example, the examination of bone marrow is an essential step in the diagnosis and management of hematologic diseases; hence, “patients undergoing bone marrow aspiration and biopsy procedures commonly experience pain, anxiety and stress” [ 7 ]. Nevertheless, distraction has proven to be an effective nonpharmacologic intervention to decrease pain and anxiety [ 7 ]. Virtual reality goggles were used by adults in an outpatient cancer center to determine whether the visual and auditory stimuli provided by the goggles “would decrease the amount of pain and anxiety experienced by patients during bone marrow aspiration and biopsy procedures, as compared to the practice of viewing a television with sound” [ 7 ]. Vital signs were collected from both groups; however, the results showed that there were no significant decreases in the level of pain experienced by the group wearing goggles versus the group watching television [ 7 ]. Although distraction through virtual reality did not prove effective in this scenario, other studies further investigate the appropriateness of using virtual reality in clinical environments.

According to Birnie et al. [ 8 ], “needle procedures are among the most distressing aspects of pediatric cancer-related treatment. Virtual Reality (VR) distraction offers promise for needle-related pain and distress given its highly immersive and interactive virtual environment.” The researcher studied the ease of use and acceptability of using a VR intervention with children diagnosed with cancer who were undergoing the implantation of an intravenous access device (IVAD) for needle insertion [ 8 ]. The researchers found that 82% of study participants found the intervention easy to use, 94% found the intervention easy to understand, and 94% indicated they would like to use the intervention for subsequent needle procedures [ 8 ]. In addition to this, the study findings revealed no adverse events such as nausea or dizziness were reported by the participants; hence, with the right refinements based on the need of each clinical procedure, VR can still provide an alternative intervention for pain management.

Pain intensity has also been observed with VR treatment in a study by Scapin [ 9 ]. Scapin [ 9 ] studied the effect of VR treatment upon the perception of pain in two burned children who were hospitalized in a Burn Treatment Center in Southern Brazil. “For assessing pain, a facial pain rating scale was applied at four times; just before the dressing, during the dressing without the use of VR, during the dressing with VR, and after the use of VR” [ 9 ]. The researcher found that the application of VR during burn treatments showed relevant effects, as the children were immersed in the VR environment during the dressing procedure [ 9 ]. This also meant that the amount of sedation that was originally required was also decreased; hence, VR could be used as a nonpharmacological intervention for pain management.

Schneider et al. [ 10 ] studied the use of VR as a distraction intervention to relieve the levels of distress in adults undergoing chemotherapy for breast, colon, and lung cancer. Similar to an earlier study, no significant decrease in stress levels was observed; however, 82% of respondents in their study preferred to use VR for future treatments. The study participants “stated that using VR made the treatment seem shorter and that chemotherapy treatments with VR were better than treatments without the distraction intervention” [ 10 ].

In summary VR has been used to distract individuals while they are undergoing painful treatments such as burn care. VR has also been successfully used to help individuals manage their anxiety. The approach holds considerable promise for use in managing pain and anxiety associated with other types of treatments. With the right amount of refinement to this technology, it can adapt to any clinical setting. Although this intervention may not result in significant levels of pain or anxiety reduction, it does help in making complex procedures less difficult to experience.

3.2.2. Virtual Consultations and Follow-Up Visits

In a study by Abbot et al. [ 11 ], virtual consults were found “to expedite diagnostic and therapeutic interventions for veterans with incidentally discovered pulmonary nodules”. A total of 157 virtual consults were completed, and a comparison between virtual visits versus in-person visits spanned a duration of 6 months [ 11 ]. Findings from this study indicate a decrease both in cost and the time required to complete each visit virtually. “For all virtual consults, the mean time to completion of consultation was 3.2 days. Subsequent in-person consultations during the first 6 months of virtual consults occurred within a mean time of 20.5 days. The average thoracic surgery outpatient facility visit was $228 per in-person consultation, whereas the virtual consult cost was $120 per episode, a 47.4% decrease [ 11 ]. In another study, Schneider and Hood [ 12 ] compared telephone-based virtual outpatient clinics with traditional in-person outpatient clinics as they were used to follow up on general surgery patients. “Of 107 subjects randomized to virtual follow-up, 98 (92%) were successfully contacted by telephone, of which 10 (10%) had postoperative issues and 3 of whom ultimately attended a conventional clinic for follow-up. Of 102 subjects randomized to the conventional outpatient clinic follow-up, 83 (81%) attended the appointment, of which 16 (19%) had postoperative concerns” [ 12 ]. From both these studies, feedback has been positive, and most participants also expressed preference for virtual follow-up visits in the future.

As virtual healthcare continues to expand, Gordon et al. [ 6 ] examined the costs of virtual visits over a period of three weeks compared to in-person visits in retail health clinics, urgent care centers, emergency departments, or primary care physician visits. They applied a cross-sectional, retrospective analysis of insurance company claims with a total of 4635 virtual visits and 55,310 non-virtual visits included. The costs for retail health clinics, urgent care centers, emergency departments, and primary care physician visits were estimated to be $36, $153, $1735, and $162 higher in non-virtual visits than virtual visits, respectively [ 6 ]. Trends observed from these studies indicate an overall patient and healthcare provider satisfaction with virtual visits. In particular, follow-up visits may be one of the most appropriate appointment types to be conducted virtually, given that physical assessments are often not required. In addition to this, there was also a substantial decrease in the costs associated with completing virtual versus in-person visits.

3.2.3. Rehabilitation and Therapy Services

Tele-rehabilitation allows patients to access rehabilitation services remotely through video conferencing in their own homes. Virtual reality (VR) has been applied to patient balance training in the past, “which [has] been shown to reduce postural instability in patients with Parkinson’s Disease (PD)” [ 13 ]. In the multi-centered study by Gandolfi et al. [ 13 ], 38 PD patients were assigned to receive telerehabilitation treatments using the Nintendo Wii Fit system in their homes, while another group of 38 PD patients were assigned to in-clinic sensory integration balance training (SIBT). Analysis revealed that “static and dynamic postural control was improved in the PD patients who had received in-home VR-based balance training (TeleWii), while improvements in mobility and dynamic balance were greater, on average, in those who had received in-clinic SIBT... In addition, the total cost of rehabilitation using TeleWii was lower than that of SIBT”. The study did lack instrumental evaluations to assess balance performance, postural reactions, and changes in muscle strength; however, virtual reality is still considered a feasible alternative to in-clinic SIBT [ 13 ].

In a similar study, researchers examined the “effects of VR augmented balance training on the sensory integration of postural control under varying attentional demands and compared the results to those in a conventional balance (CB) training group and an untrained control group.” A longitudinal, randomized controlled trial was used with sensory organization tests (SOTs), and verbal reactions times (VRTs) were recorded [ 14 ]. “Both VR and CB training improved sensory integration for postural control in people with PD, especially when they were deprived of sensory redundancy” [ 14 ].

Finally, a study by Klein et al. [ 15 ] described the application of virtual reality over 5 weeks to “improve gait and mobility in people with a history of falls, poor mobility, or postural instability.” In their study, a retrospective data analysis was conducted on clinical records of patients who were recruited to training by walking on treadmills while dodging virtual obstacles. The results after 5 weeks indicated time to completion increases in three tests—the Up and Go Test (TUG), Two-Minute Walk Test (2MWT), and Four-Square Step Test (FSST)—by 10.3%, 9.5%, and 13%, respectively. Therefore, the combination of treadmill training and virtual obstacles appear to be both practical and effective for physical therapy treatments, especially if patients do not need to leave the comfort of home [ 15 ]. As can be seen from the examples in the studies described above, there is an opportunity to successfully integrate remote rehabilitation interventions, also known as tele-rehabilitation, into healthcare. For patients who require this service, reducing the need to travel to an in-person clinic also provides greater convenience and an opportunity to improve physical function (if they are already physically challenged).

3.2.4. Outpatient Care

A virtual outpatient clinic was established as a cloud-based, multicomponent outpatient clinic and studied by De Jong et al. [ 5 ] to assess the feasibility and functionality of virtual outpatient clinics. “The [virtual outpatient clinic] consists of 6 digital tools that facilitate self-monitoring (blood pressure, weight and pain) and communication with peers and providers (chat and videoconferencing) connected to a cloud-based platform and the hospital patient portal to facilitate access to (self-collected) medical data” [ 5 ]. Feasibility, adherence, usage statistics, technical issues identified, and qualitative responses were assessed, indicating that most participants successfully used all options of the virtual outpatient clinic and expressed positive attitudes to the use of the various tools within the virtual outpatient clinic. “The adherence was 7/19 for weight scale, 11/19 for blood pressure monitor, and 14/20 and 17/20 for pain score and daily questions, respectively. The adherence for personal health record was 13/20 and 12/20 for the patient portal system” [ 15 ]. The participants in this virtual outpatient clinic were more technically savvy. As a result, the findings from this study may not be generalized to the greater population, as people who are comfortable with more technology are more likely to accept the use of various tools within a virtual outpatient clinic.

Healey et al. [ 16 ] conducted a randomized trial aimed at determining whether a virtual outpatient clinic is an acceptable alternative to a traditional outpatient clinic for a range of general surgical patients’ post-discharge. All patients who were admitted under one general surgical service over the span of the study period were assessed and randomized to receive either virtual outpatient clinic or outpatient clinic appointments. The following points summarize the results obtained from a follow-up questionnaire sent to the participants:

• 98/107 (91.6%) patients in the virtual outpatient clinic group were successfully contacted.
• 83/102 (81.4%) patients in the outpatient clinic group were successfully contacted.
• 10 patients in the virtual outpatient clinic group reported ongoing issues.
• 6 patients in the outpatient clinic group reported ongoing issues.
• 78/82 (95%) of patients in the virtual outpatient clinic group were happy with their overall experience.
• 34/61 (56%) of patients in the outpatient clinic group were happy with their overall experience.
• 68/81 (83%) of patients in the virtual outpatient clinic group preferred a virtual outpatient clinic appointment in the future.
• 41/61 (67%) of patients in the outpatient clinic group preferred a virtual outpatient clinic appointment in the future.

It is standard practice to follow-up with patients from surgical discharge; however, the demand and resource balance typically tips to the demand side. Therefore, a virtual outpatient clinic can help reduce unnecessary in-clinic visits to provide the resources to patients who are more in need of physical care.

3.2.5. Emergency Services

Research suggests that VR may be useful in the context of emergency services such as those provided to children who have sickle cell anemia when they experience a vaso-occlusive crisis. In America, approximately 100,000 of the total population are affected by sickle cell disease, and about 300,000 infants are born with sickle cell disease each year. “Children require prescriptions for pain medication, often opioids, during a vaso-occlusive crisis experienced at home, but they seek medical care in the emergency department when the pain is not improving” [ 17 ]. In their study, the investigators attempted to determine the effects of using virtual reality on acute pain in pediatric patients with sickle cell disease experiencing a vaso-occlusive crisis. A sample of 15 participants were either assigned to a control group that received standard intravenous narcotics treatments or an intervention group that received virtual reality along with standard treatment [ 17 ]. “Pain was assessed using the Numerical Rating Scale (NRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Data were analyzed using an independent sample t test” [ 17 ]. The results suggest that although there was no significant statistical difference between the pain scores of both control and intervention groups, the study does help confirm that introducing nonpharmacologic treatments may be beneficial for pediatric patients experiencing pain, as it is a distraction technique to help ease pain [ 17 ].

3.3. Expansion of Virtual Care to Complement the Existing Healthcare System

Virtual care, in all shapes and forms, have also been used in health professional training and education (in addition to patient care). VR has been used for remote training of healthcare professionals. Remote training has taken the form of online training platforms, virtual reality, as well as use of virtual patients.

3.3.1. Online Training Platforms

In a study by Tong et al. [ 18 ], a post-treatment investigation of the effectiveness of five automated “self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders” was undertaken. Participants (n = 255) were asked to evaluate each of five online therapy programs [ 18 ]. Overall, there were significant observed reductions on all five anxiety disorder clinical severity ratings, a decreased number of clinical diagnoses, and an increased confidence in the self-management of mental healthcare [ 18 ].

In a study conducted by Trong et al. [ 19 ], the researchers provided an overview of an online training program for health professionals aimed at enhancing their skills in supporting pregnant women attempting to stop smoking. The online program offers “5 interactive case simulations and comprehensive discussion of patient visits, short lectures on relevant topics from leading experts, interviews with real patients who have quit, and a dedicated website of pertinent links and office resources” [ 19 ]. The incentive for health professionals to undergo training is up to 4.5 h of continuing education credits, but other benefits include understanding the 5As (ask, advise, assess, assist and arrange) counseling approach [ 19 ]. “Although clinical guidelines consistently recommend screening and counseling by prenatal care providers, only half or pregnant smokers receive counseling... Reasons for the low level of cessation counseling include providers’ self-reported lack of awareness of or agreement with existing guidelines, lack of self-efficacy, lack of training, lack of systems to support counseling activities, and lack of patient and provider materials” [ 19 ]. Therefore, an online training program improves time management for both patients and providers (increases flexibility in scheduling training) and helps sharpen the skills of providers aimed at encouraging pregnant women to quit smoking and remain smoke-free post-partum.

3.3.2. Virtual Reality

Virtual reality has been used for medical use cases, such as therapy treatments as discussed in earlier sections. “Applications of VR in pharmacy include adjunctive or replacement treatment for pharmacotherapy in pain management, anxiety and other disorders, pharmacological modeling for drug discovery, pharmacist education and training, and patient counselling and behavior modification” [ 20 ]. The results obtained from many clinical studies indicated that the majority of the subjects reported positive experiences with VR, as it alleviates stress and anxiety from certain illnesses through providing distraction [ 20 ]. Despite the positive results, Ventola [ 20 ] notes the fact that the younger populations tend to be more willing to use VR compared to older populations. However, this is understandable, as there can never be a solution that satisfies everyone.

Dyer’s research work [ 21 ] involved using the technology to teach medical students and other health professionals’ empathy toward older adults through virtual reality by allowing them to “simulate being a patient with age-related diseases and to familiarize medical students with information resources related to the health of older adults.” The software used in the study created an immersive virtual environment. Each virtual reality kit contained an Alienware ® laptop, Oculus Rift ® headset with a sensor and a Leap Motion ® hand-tracking device, which cost a total of $2000–$2500 [ 21 ]. As a result, not only did the project successfully introduce an innovative teaching modality, VR also “enhanced students’ understanding of age-related health problems and increased their empathy for older adults with vision and hearing loss or Alzheimer’s disease” [ 21 ]. This is a great segue into the next study, as [ 22 ] evaluate the use of virtual patients to supplement education for health professionals in pediatric dentistry.

3.3.3. Virtual Patients

According to Papadopoulos et al. [ 22 ], a child virtual patient (VP) was programmed and called Erietta. Erietta is an 8-year-old girl who visits the dentist with her mother for the first time. “Communication techniques such as Tell–Show–Do and parents’ interference management were the basic elements of the education scenario on which the VP was based” [ 22 ]. A total of 103 dental students were placed into an experimental group, which was exposed to the simulation, and a control group, which did not receive the simulation. Both groups were asked in the end to complete a questionnaire following their participation in the research [ 22 ]. The majority of participants provided a positive evaluation of the simulation. There was a 69% satisfaction rate among the experimental group who expressed preference for using VP to supplement traditional training [ 22 ]. In another study by Papadopoulos et al. [ 23 ], the researchers created a virtual patient to support learning processes; however, this time, the virtual patient that was created was specific to a primary care context. From this follow-up research, the researchers found they could visualize the following aspects of the students’ learning process, namely clinical reasoning and reflections in the context of the learning cycle. The research demonstrated that VP models could complement clinical and theoretical teachings and help fill the gaps of traditional education. As a result, students found the new VP model interactive and straightforward, and it also encouraged self-directed learning plus reflective abilities [ 23 ].

3.4. Consumer Perspectives on Virtual Care

Given the previous sections discussed applications of virtual care and some of the positive aspects of adopting virtual care in varying aspects of healthcare, the following section digs deeper into consumer perspectives, including opinions of both patients and providers, as satisfaction has become an increasingly important measure in the deployment of any solution.

3.4.1. Patient Perspectives

In another study [ 24 ], researchers compared “the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference (virtual care) compared to those who received 12–14 face to face visits in clinic with their physician/midwife.” Satisfaction surveys were sent out to 378 patients from the virtual care cohort and 795 patients who received traditional obstetric services between 2013 and 2015 [ 24 ]. The virtual care cohort reported significantly higher overall satisfaction; however, the researchers noted that the virtual care model was selected more by those who were not experiencing pregnancy for the first time [ 24 ]. Therefore, one can conclude that although virtual care can provide a great alternative to traditional care, it may not be the most optimal choice for all patients.

Nalverro’s research group [ 25 ] implemented a Virtual Health Room (VHR) initiative in a village in Sweden. The study evaluated patient perceptions and the usability of the VHR as well as its contributions to their healthcare. Study participants were asked to complete a 13-question version of the Patient Activation Measure (PAM), patients’ demographic information, as well as a questionnaire that asked for information about their satisfaction with their VHR visit [ 25 ]. The researchers found that “respondents with lower PAM scores were less satisfied with the technical performance of the VHR, but equally likely to think the VHR made a good contribution to access to healthcare...In contrast, older patients were less likely to value the contribution of VHR, but no less likely to be satisfied with its technical performance...There were no relationships between level of education and distance travelled and perceptions of the VHR” [ 25 ]. Again, even though virtual care services have overall been well accepted by patients, they can never address the needs of all individuals.

A final example to provide patient perspectives of virtual care is in the area of postoperative education, discharge instructions, and follow-up appointments for new ostomates post-discharge. White et al. [ 26 ] studied 10 patients who attended two outpatient virtual visits following hospital discharge. The virtual visits were completed through advanced video conferencing software. “All patients successfully completed two virtual visits from their homes... 90% felt these visits helped with ostomy management and agreed they should be part of a discharge plan...All patients felt comfortable with a virtual format...Common themes discussed included poaching and skin irritation” [ 26 ]. The researchers concluded that virtual visits are feasible, and patients are also satisfied with the virtual format when addressing certain types of care goals. As mentioned before, virtual visits may be very beneficial for consult-type visits, but they are still limited if physical assessments are required [ 26 ].

3.4.2. Provider Perspectives

A group of investigators at the Nemours Children’s Health System launched a Nemours App for Asthma as part of their new digital strategy to provide tools in a single platform. “This kind of an app provides immediate access, another thing that millennial consumers look for. And then we also measure costs and people and growth. We are looking at one or two other chronic conditions that we would want to market, but immediately thereafter we are going to work on a well child. This is how families have a healthcare coach in the palm of their hand” [ 27 ]. The app helps clinicians to create an asthma plan for asthma patients in their patient record; however, the plan will only be provided to the family unless clinicians put the plan into the notes section for families to easily access and print out at home [ 27 ]. At first, clinicians anticipated themselves to be overwhelmed with extra work they needed to complete; however, the results of the research suggest that not only was the volume manageable, but it was also an effective way to address questions from patients and their families [ 27 ]. “It became apparent how absolutely critical telehealth was going to be to provide instant access to a physician who could see and hear the child, and provide guidance in the case of early exacerbations” [ 27 ].

In another study, Mammen et al. [ 28 ] discussed physician perceptions of virtual visits for Parkinson’s disease (PD). Delivering care remotely has become increasingly valuable and beneficial; however, there is a lack of qualitative data from both patients and providers on how they perceive virtual visits; therefore, the researchers conducted a qualitative analysis about how patients and providers perceived virtual visits related to Parkinson’s disease. “The sentiment analysis for patients was strongly favorable (+2.5) and moderately favorable for physicians (+0.8). Physician scores were lowest (−0.3) for the ability to perform a detailed motor examination remotely” [ 28 ]. As a result, although both patients and providers perceived virtual visits favorably, technical challenges varied on a case-by-case basis, which affected their satisfaction with remote care [ 28 ].

The results of this scoping review suggest there is an overall positive reaction to virtual care approaches by healthcare providers and patients. Based on this review, it can be stated that virtual care, whether in the form of video conferencing technology that supports remote consultations or as a supplementary care tool in the form of virtual reality, has expanded to many differing aspects of healthcare. This expansion has influenced pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services. Although the findings in each of these areas have not proven virtual care to be a significantly effective intervention, the recipients of care have mostly expressed their interest to incorporate virtual care services into their future care. Technological barriers cannot be neglected either, as with the elderly and frail population, virtual care may not be the most suitable; hence, millennials will be the drivers for the future of virtual care.

4. Discussion

From the scoping review, it can be seen that virtual care refers to the use of video technology to connect patients and healthcare providers together regardless of where each party is located. The use of this technology has also influenced a variety of clinical settings, such as pain management, mental health, rehabilitation and therapy services, outpatient clinics, and emergency services. With mostly positive perceptions of the technology, virtual reality technology has also become a part of virtual care by augmenting the virtual care experience. “VR technology has become increasingly affordable, flexible and portable, enabling its use for therapeutic purposes in both inpatient and outpatient environments” [ 20 ]. The expansion of tools and technology that support virtual care have complemented the traditional “bricks and mortar” medical practice while at the same time improving healthcare education. Remote training of health professionals using online modules or simulations of virtual patients have been well received by students, with the majority of health professionals expressing interest in using a similar mode of training in the future or applying virtual care to their practice. As Shumaher et al. [ 29 ] state, “It is known that the creation of a web-based educational system consists not only in the digitization of texts or printed materials, but in providing its own language, principles, tools and methods, which makes the virtual learning environment (VLE) a space dynamic and interactive, current, closer to the reality of the user and extremely rich, as it allows the use of different media resources that make the teaching-learning process more creative, interesting and powerful.” Lastly, consumer perspectives on virtual care from both patients and providers have been positive as well, especially among patients. It is undeniable that convenience and efficiency play a great factor in patients’ choice for virtual care. However, the technology can still be a barrier to receiving care for some groups such as the elderly.

To list a few of the efficiencies of virtual care compared to traditional visits, wait time is often decreased, and the need to travel to an onsite location for care is removed, hence also decreasing or eliminating transportation costs. As previously mentioned in the study by Gordon et al. [ 6 ], the costs associated with patients visiting in-person health clinics, urgent care centers, emergency departments, and primary care physician visits were estimated to be $36, $153, $1735, and $162 higher in non-virtual visits than virtual visits, respectively. Aside from cost and wait times, the satisfaction level in patients who have received care virtually did not decrease compared to traditional visits. In fact, depending on the type of visit required, patients often expressed interest to include virtual visits in their future care plan. Other efficiencies and benefits that do not directly relate to care can be the environmental impact.

As many are familiar with the 2020 global pandemic caused by coronavirus, this has led to some dramatic changes in the way people live and work [ 30 , 31 ]. Governments all around the world have mandated the closure of non-essential services, such as restaurants and entertainment venues, while essential services, such as clinical programs, pharmacies, public transportation, and grocery stores continue to remain open during the pandemic. Given the risks of the pandemic, many countries also began the practice of social distancing, hence reducing the need to visit a care facility, and having virtual visits where possible became the public’s preference [ 30 , 31 ]. With an increase in virtual visits, the need to travel decreased; therefore, this is a perk in terms of environmental impacts and decreasing the carbon footprint on this planet [ 32 ]. Progressively, virtual care can become the norm for many patients and providers, and it may be hard for some to revert back to traditional practice. If it was not for COVID-19, virtual care uptake and expansion may not have occurred at such speeds.

In terms of the implications of virtual care on health informatics practice, we can expect there to be many collaborations between health informatics professionals and healthcare organizations in joint research projects on the implementation of virtual care [ 30 , 31 ]. This can include being a consultant for healthcare organizations as they implement a new virtual care technology or conducting evaluations of the post-implementation of virtual care technologies. If evaluations produce positive outcomes (e.g., [ 30 , 31 , 32 , 33 ]), the government may also devote more funding toward future virtual care research or wide-scale implementations. This will also affect the training and education for health informatics programs.

Health informatics is a relatively new program in many universities, and some do not even offer this program. Most students benefit from this program if they have career interests to work in the healthcare sector as an informatics professional. It is common for graduates of the program to become a liaison between technology and medical professionals, as they implement technological solutions required by clinical workflows [ 34 ]. Given that virtual care will potentially transform the way care has been delivered, it would be worthwhile to incorporate courses as part of the curriculum that cover the successes and failures of virtual care implementations. As an example, the Health Information Science program at the University of Victoria is planning to add an elective course on virtual care to trial the popularity of this topic prior to further embedding this as part of their mandatory course structure. Contents of the course can entail the implementation process of a virtual care tool, with real-life examples or guest speakers who have the knowledge and experience of virtual care implementations [ 31 ]. Future learning experiences in work settings terms can also include opportunities to work on virtual care projects [ 31 ], which can ultimately open up new employment opportunities for students.

Limitations of the study include the selection of articles. The majority of the articles selected were from the United States or other countries around the globe, with very little from Canada. Therefore, the results of the scoping review reflect the status of virtual care elsewhere and will not accurately reflect its state in Canada. Given this is a scoping review, often the more articles included, the less biased the results will be. Even though the study began with a search of 111 articles, only 28 articles were included in the end results. Hence, the accuracy of this study can be improved if more articles were included.

Future research can expand on the knowledge built from the scoping review to conduct an observational research study on the implementation of virtual care technologies at a clinic, hospital, or even at a broader level, such as healthcare organizations in Canada. This will allow oversight from initiation of implementation to the final uptake of the virtual care technology by end users. Both challenges and benefits of the implementation process can be documented, along with the drivers for implementation, and the goals to be achieved as a result. Upon uptake, end user satisfaction can also be measured to produce a comprehensive research of a virtual care implementation project, which can ultimately provide a foundation for additional virtual care projects in Canada given one of the limitations of this study was the lack of Canadian articles.

5. Conclusions

By connecting patients and providers remotely, virtual care has made its presence in different aspects of healthcare, including healthcare education, as well as positive impressions from end consumers. As technology advances, virtual care becomes more accessible, and utilization will increase; hence, acceptance of virtual care and the technology that supports it can also increase in parallel. The technology supporting virtual care, such as video conferencing tools and virtual reality, will also mature to enhance patient and provider experience in using those tools.

Acknowledgments

Elizabeth Borycki’s received a health professional investigator award from the Michael Smith Foundation for Health Research, Canada at https://www.msfhr.org . Accessed on 4 October 2021.

Covidence ® articles excluded.

Data charting full results.

Author Contributions

C.L. conceptualized the research questions, methodology, and wrote the article. E.M.B. helped to conceptualize the research questions, methodology, review articles, and assisted with the writing. A.W.K. reviewed the paper and provided feedback on the content and methodology for finalizing the paper. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The chair of the Research Ethics Board at the University of Victoria has concluded that the project is exempt from a human research ethics review under the national ethics policy (TCPS2) and the University of Victoria’s human research ethics policy and guidelines. The reasons for exemption are that the study is limited to accessing publicly available data from journal articles and publicly available sources, and there are no human participants.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Virtual Visits in Healthcare: The Past, Present, and Future 

Before the COVID-19 pandemic transformed the digital needs of the healthcare industry, 0.01% of visits were delivered virtually. Virtual visits were a supplementary strategy for health systems, and they were not heavily relied upon or frequently used. COVID-19 rapidly changed that. In 2020, the number of consumers who had a virtual visit tripled to 22%, and 80% of physicians completed a virtual visit.

With many providers operating at a limited capacity during the pandemic, asynchronous and synchronous virtual visits became essential for health systems to offer care to patients. Synchronous visits involve the healthcare provider and patient talking in real-time over video, phone, or chat. Asynchronous visits allow patients and physicians to communicate based on their own schedules, without necessarily needing to be on video. Patients can communicate symptoms and send data or medical imaging to the provider to review through email, text messaging, apps, or an online portal. 

While virtual visits faced tough regulatory hurdles before the pandemic, a shift in regulations during COVID-19 made it easier for health systems to treat patients virtually, with post-pandemic regulations evolving as well. 

After COVID-19, 92% of providers and 76% of consumers report they plan on continuing to use virtual visits. According to an AVIA survey of health systems, 56% of participants are exploring additional synchronous visit capabilities, both now and in the future. As health systems look to make virtual visits a core component of their care delivery model, it’s important to consider existing barriers, “what good looks like” in a post-COVID world, and how virtual visits in healthcare could evolve in the future.

Now: What are the challenges surrounding virtual visits in healthcare?

Health systems currently face both operational and clinical challenges in delivering virtual visits. These include providing technical support, determining the right modalities, care models, and staffing models, and navigating reimbursement regulations. Asynchronous visits have not been widely adopted even during the pandemic, due in part to patients typically expecting e-visits to be video meetings, not text messages or communicating through an app.

Additionally, health systems face competition from payers, employers, and big tech companies offering their own versions of telehealth services directly to consumers. Systems looking to compete with those new entrants must offer the same, if not better, virtual care options to consumers in a financially sustainable way. 27% of health systems expect to lower the cost of virtual visits to be below the costs of in-person visits. 

Patient support also becomes increasingly challenging for high-acuity patients who present challenging medical conditions and unpredictable needs, as they often require consistent monitoring. Additional barriers include technology access, EHR database compatibility with the health system, internet connectivity challenges, and difficulty diagnosing patients without an in-person examination.  

Now: What does a successful virtual visit program look like?

To effectively provide virtual care and overcome the issues outlined above, health systems must utilize three virtual capabilities: triage, navigate, and treat. 

Virtual triage enables consumers to search for symptoms and browse suggested diagnoses. Ideally, patients are guided to engage with the health system based on their symptoms. When done effectively, triage allows health systems to provide the right care to the right patient at the right time. 

Care navigation helps consumers select from an inventory of providers and services based on location and cost, as well as provider availability. Patients can easily transition between reviewing symptoms in triage to finding a provider to engaging in asynchronous and synchronous visits. 

Finally, effective treatment through virtual visits relies on synchronous and asynchronous care. Pre-COVID, up to 30% of providers’ ambulatory capacity could go unused. Leading health systems are now utilizing virtual visits to maximize providers’ time and reduce cost. Asynchronous visits present care opportunities with fewer resources and eliminate the possibility of a missed in-person appointment. Synchronous visits allow physicians to conduct an examination and diagnosis similar to an in-office visit while diverting patients from more expensive care settings . 

Now: How have virtual visits improved during COVID-19?

Demand increased during COVID for synchronous virtual visits, and leading health systems recognized and filled the need for multilingual, accessible, and omnichannel visits for both patients and their families. 

Virtual waiting rooms, which allow patients to check into appointments and complete necessary paperwork, are vital to the virtual visit process. Prior to starting the actual visits, support staff can educate patients about technology use and guide them through technology issues. The average consumer may not be experienced with video visits, so seeing a queue and setting up technology before the encounter is vital.

Future: How will virtual visits in healthcare evolve?

In September and October, 75% of systems surveyed conducted at least 10% of their primary care visits virtually and 50% of systems had at least 10% of their specialty care visits virtually. 

Surveyed health systems speculate that in 2021 their specialty care virtual visits will increase and they’ll maintain their primary care rate from 2020. To support that, 47% of systems expect to replace their current synchronous virtual visits digital solution. Additionally, over half of the health systems surveyed are developing 3-5 year virtual health roadmaps, hiring new team members to support virtual health programming, and creating new roles to support clinical and admin functions.

Future: Strategic questions to ask when creating your virtual visits strategy

As your organization begins planning for the future of virtual visits, it’s essential to consider the following questions when creating your strategy: 

• What are your organization’s virtual health goals , and how will you measure ROI?
• What is the ideal consumer, provider, and staff experience for virtual visits at your health system?
• How do you optimize current virtual health workflows for sustainability and scale?
• What are key levers to determine the best staffing models and configurations?
• How do you prioritize amongst various emerging care and access models ? 
• How can you optimize and scale digital solution(s) to meet your needs, business drivers, and key criteria?

If your health system wants to become a leader in the virtual visits space, AVIA can help. Our experts have partnered with over 50 health systems to guide them through implementing virtual visits during COVID-19 and beyond. To learn more, talk to an expert today or join our virtual visits workshop series to build a strategic virtual health plan with peers. 

Madison Daum, Marketing Intern, contributed to this post.

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Virtual Visits: What Are They and What Can They Be Used For?

These days you can do almost everything online. Why shouldn’t you be able to see a doctor online too? Virtual visits or video visits make that a reality.

According to the American Telemedicine Organization , more than half of all U.S. hospitals use telemedicine, including Ochsner Health. A virtual visit is a video conference between you and your provider.

Virtual video visits are possible through two different Ochsner services:

• Ochsner Connected Anywhere offers urgent care on demand visits and  behavioral health scheduled appointments.
• Virtual Visits through MyOchsner are secure video appointments with an Ochsner provider.

What is Ochsner Connected Anywhere?

With an urgent care virtual visit, you can be seen by an expert provider 24 hours a day, seven days a week via a video connection just like Zoom, Skype or Facetime.

What conditions can be treated with an Ochsner Anywhere Care urgent care virtual visit?

• Cold/flu and cough
• Allergies and sinus issues
• Urinary tract infections
• Sore throats
• Stomach aches
• Shortness of breath

What behavioral health and well-being conditions can be treated with a scheduled virtual visit?

• Adolescent, marriage, family and grief and loss counseling
• Anxiety and panic attacks
• Attention deficit disorder
• Depression and mood disorders
• Eating disorders
• Postpartum depression
• Post-traumatic stress disorder (PTSD)

When necessary, your Ochsner Connected Anywhere provider will recommend you go to an emergency room. And the provider may recommend you make a follow-up appointment with a primary care provider or a specialist.

What is a MyOchsner virtual visit?

For some visits, your provider may be able to see you virtually through MyOchsner. Your care team may reach out to you if this is appropriate for your visit.

A virtual visit is a secure video appointment with your provider via your smartphone, tablet, laptop or desktop computer. This allows patients to conduct a traditional office visit with their provider electronically through the MyOchsner app or website portal without leaving home or work.

What are the technical requirements for a MyOchsner virtual visit?

• You must have a smartphone, mobile tablet, laptop and/or desktop computer.
• Microphone and webcam capabilities on your device
• iOS or Android operating system
• You can find the MyOchsner app in the App Store (iPhone) and Google Play Store (Android

Learn more about MyOchsner virtual visits.

You may also be interested in:

Augmented reality, virtual reality and medicine, telemedicine program treats stroke victims when time is crucial, what is ochsner on call.

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On-Demand Virtual Visits

Easy, convenient access to see an iu health provider 24/7, important notice, on-demand virtual visits suspending upfront charges (march 11, 2024).

On-Demand Virtual Visits has temporarily suspended upfront charges. You may receive a bill for these services at a later date. If you have further questions in regards to your visit cost, please call 1.888.IUHEALTH (1.888.484.3258) and choose option 2.

When you're sick or not feeling well, we're there for you. IU Health offers on-demand virtual visits 24 hours a day, 7 days a week, for patients in Indiana 2 years and older.

You will be connected with an IU Health provider who will review your history, assess your symptoms and answer questions. A few minutes later you'll have a diagnosis and instructions for treatment.

Need Care Now? On-Demand Visits

IU Health On-Demand Virtual Visits makes taking care of you and your family easy with three simple steps:

• Download the free IU Health Virtual Visits app ( Google Play or App Store ) or enroll on your computer .
• Enroll by creating a free login and completing your personal profile.
• Connect with a highly skilled provider and get you and your family healthy and well.

View our step-by-step guide for full details (PDF) .

Each person's health is unique, and so are their treatment needs. In some cases, we may need you to complete lab tests to diagnose your condition.

Be sure to allow access to your camera and microphone if you are using the app. If you are connecting via desktop, be sure to test your computer settings. A strong Wi-Fi connection is recommended so you can experience the full benefits of our on-demand virtual visits. If using a mobile connection, find a strong signal and stay in one location.

Scheduled Virtual Visits

IU Health offers a variety of visit options for your virtual doctor appointments. These include regular, follow-up, pre and post-operation, triage visits, pre-visit information sessions, medication review and more. From primary care and pediatric health appointments to specialized care, you can get your virtual health appointments from the comfort of your home.

Contact your provider or find a provider , and we will provide you care setting options based on your healthcare needs.

If you are eligible for virtual care with one of our highly skilled providers, an IU Health care team member will schedule your virtual visit and provide setup instructions.

Would you rather schedule a visit for later?

Save your spot for an On-Demand Virtual Visit now to ensure minimal wait time when you're ready to consult with an On-Demand provider. It's simple!

• Access our virtual visit platform • Sign up or login with your username and password • Select who is being seen on your account • Then select Schedule Appointment to save a spot for a visit later in the day or choose Get Started to start your visit now. • If you schedule a visit, you will be emailed a link so you can login at the time slot you've saved.

On-Demand Visits: What We Treat

• Acid reflux • Allergies • Arthritic pain • Asthma exacerbation • Athlete's foot • Cold sores • Cough • COVID-19 • Dermatitis/skin rashes • Diarrhea • Eye pain, redness and styes • Fever • Flu/influenza • Insect bites and stings • Laryngitis • Lice • Minor burns, cuts and scrapes • Nausea • Pink eye • Poison ivy/oak • Ringworm • Scabies • Sinus congestion • Sprains/strains • Sore throat • Stomach flu • Sunburns • Toothache • Upper respiratory infection • Urinary/bladder infections • Vomiting • Yeast infection (adults only)

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View our symptom guide for treatment options if you experience any of the following:

• Bone breaks • Coughing or throwing up blood • Chest pain • Cuts that are deep or bleeding that won't stop • Ear infections • Passing out or blacking out • Severe burns • Traumatic brain injury

Frequently Asked Questions

I need care now. how do i start an on-demand virtual visit.

Typically visits with our providers will last about 10 minutes. Our experts will review your history and answer questions. A few minutes later you’ll have a diagnosis and instructions for treatment.

Are you having trouble with the app or your account? Our customer Support team will be happy to assist you. Please call 855.269.3553 .

What ages are seen for on-demand virtual visits?

We see any patient 2 years or older for on-demand virtual visits.

How much does a virtual visit cost?

Self-pay visits are $59. If you choose to bill through your insurance, it may cost more, or it may cost less, depending on your specific plan.

What insurance options do you accept?

We accept the following insurances:

• IU Health Plans
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Are prescriptions available through on-demand virtual visits?

If a prescription is required, we will send it to a pharmacy of your choice.

When it comes to antibiotics, it's crucial to understand their proper usage and potential risks. Antibiotics do not work against viral infections, such as the common cold or flu. When antibiotics are taken when they aren't needed, resistance to them can develop. Using antibiotics responsibly keeps their effectiveness when needed later.

In some cases, we may need you to complete lab tests to diagnose your condition.

Are virtual visits private and secure?

Much like your online banking transactions, your medical information and virtual connection are secured with end-to-end 128-bit encryption per the National Institute of Standards and Technology’s security requirements for cryptographic modules.

The security and privacy program was built to the highest standards and has passed extensive federal and independent security audits to be HIPAA compliant.

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Related resources, adding child (under age of 18) to your account, virtual visits: desktop & mobile requirements, on-demand visits: step-by-step instructions, scheduled visits: step-by-step guides, visitas programadas: instrucciones paso a paso, visitas a pedido: instrucciones paso a paso, thăm khám theo yêu cầu: hướng dẫn từng bước, thăm khám theo lịch hẹn: hướng dẫn từng bước, booqashooyinka la mudeeyay: tilmaamaha talaabo talaabada ah, booqashooyinka la dalbado: tilmaamaha talaabo talaabada ah, الزيارات حسب الطلب: التعليمات خطوة بخطوة, الزيارات المجدولة: التعليمات خطوة بخطوة (العربية).

Virtual doctor, virtual waiting room: New tech holds promise of speeding up ER wait times

Many hospitals in n.s. will have virtual urgent care station in place by june, official says.

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A few steps inside the front door at Twin Oaks Memorial Hospital there's a new sign on the wall directing people to "Virtual Urgent Care."

What was once a conference room for hospital administration has been turned into a private space with large padded chairs and two iPad stations. 

It's part of licensed practical nurse Samantha Langer's job to seat patients in the chair and connect them to a video call with an emergency-room doctor working far from the hospital in Musquodoboit Harbour, N.S. 

"A lot of [patients] say pretty positive things," said Langer in a recent interview. "They're like, 'That's so cool, didn't know this even existed.' I get a lot of that."

As the Canadian health-care system struggles to deal with staffing shortages, many hospitals are increasingly seeing patients without access to primary care showing up in emergency rooms and facing long waits for relatively simple health issues. 

To deal with the problem, some hospitals are turning to virtual technology, which they believe could move patients through the emergency room more efficiently. 

• Staff shortages still a limiting factor in improving N.S. health care
• Ontario hospitals warn of patient surges, long wait times

The province didn't use virtual care much before the pandemic and "might have been quite late in the uptake even across Canada," said Tara Sampalli, a senior director at Nova Scotia Health whose work deals with science, innovation and health-systems planning.

But after the pandemic hit, the number of virtual visits jumped by 200 per cent, she said.

"All of us were surprised at how much we were able to [set] up in a rapid timeline."

100 visits a week so far

The iPad stations at Twin Oaks are one of nine up and running at hospitals around the province. The first started operating in November 2023 and the others started to come online in February.

The facilities are meant for "low-acuity" patients with problems such as coughs, colds, sprains, ear infections or urinary tract infections. Doctors who are working from home or even from another province are able to see patients, and prescribe next steps such as medication, tests or a referral for other hospital services. The doctors have to be licensed to practice in Nova Scotia.

The virtual-care sites are currently seeing about 100 visits per week, Sampalli said. She expects many emergency departments in Nova Scotia will have the capacity to offer a virtual urgent care station by June. 

Three hospitals also have a different virtual program  in which a nurse or paramedic stays in the consulting room with the patient to assist the remote doctor. It's for patients whose symptoms are more severe, but still within the scope of what remote medicine can handle. The eventual goal is to combine the two programs.

Program must be evaluated

Some front-line staff agree that virtual care in emergency rooms is the way to go.

Last fall, the province ran a contest to gather ideas from health-care workers, and many of the respondents wrote about the issue of patients coming to emergency rooms for routine matters such as prescription refills or blood work. Some suggested virtual care could solve that issue. 

"I think placing a virtual care 'booth' in emergency rooms would improve the efficiency of patient care greatly," one submission said. "Something like a phone or computer station that would connect patients to a care provider that can handle minor ailments."

Homing pigeons? Here are some health-care ideas that didn't win a Nova Scotia contest

Since the program expanded in February, Sampalli said Nova Scotia Health has been calculating the costs and needs to analyze whether it's a net gain in terms of the financial investment and the amount of staff time it saves.

It is also too early to measure the effect of the program on wait times, she said, because it's being rolled out together with other measures like mobile clinics. But reports so far suggest the experience has been positive, she said.

The health-care ideas contest also received at least eight versions of a suggestion inspired by the restaurant industry.

"Give them a buzzer or send them a text or call when it's their turn," one person wrote. "Then patients can wait from the comfort of their own home where they'll be more comfortable, and waiting rooms will be less crowded." 

Humber River Health, a large hospital in Toronto, has been reconsidering the issue of where patients should wait for treatment since 2019. Chief information officer Peter Bak said they even briefly considered the idea of using a buzzer, similar to one you might receive when waiting for a table at a restaurant.

"We thought, why do we do this to people? Why can't you sit at home or go to a Tim Hortons, or whatever it might be, and have a more relaxing time than sitting in a waiting room?" 

Bak said the pandemic's arrival made the idea even more attractive.

In October, Humber River Health received a $1.5-million grant from a federal innovation fund to develop an online platform that would tell people coming to the emergency room to arrive immediately or give them a time slot to arrive, after asking a set of triage questions.

"Essentially we're just saying, 'stop waiting for us, don't come into the [emergency room] and wait. Wait at home,'" Bak said. "So it isn't changing the amount of time that you need to wait, but it's changing where you're waiting."

Bak said the hospital's clinical team has evaluated the platform and doesn't believe there's any increased risk to patients. He said it asks the same questions as standard telehealth services, and patients are encouraged to come in person if they feel their condition is getting worse.

Virtual urgent care available at some N.S. hospitals

The platform will be piloted this summer, Bak said. He hopes it will allow the emergency department to better understand when patients are coming and what type of treatment they will need.

"I think the greatest measure is whether citizens adopt this and are comfortable and trust it," he said.

"The other measure of success is, if we are seeing the benefits back in the department itself: that we're seeing smoother flows, we're getting patients in and out faster."

• People waiting for a family doctor in Nova Scotia could face years without finding one
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If Humber River Health can make the technology work, its goal is to scale it up for other hospitals.

At Twin Oaks Memorial Hospital, so far the patients who are diverting from the emergency room into virtual urgent care have said they are open to receiving virtual treatments, according to Langer.

"Some people can still have a bit of a wait with virtual care, especially if there's a few patients that need to be seen before them. But so far it's been much quicker than the typical emergency department wait times," she said. 

Do you have an experience with virtual emergency-room care in Nova Scotia to share? Write to us at [email protected].

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Corrections

• A previous version of this story said that Nova Scotia's 48 hospitals will have a virtual urgent care station in place by June. However, a spokesperson for Nova Scotia Health says many emergency departments in the province will have the capacity to offer the program by June. Some hospitals are not equipped with emergency departments. Apr 16, 2024 11:56 AM AT

ABOUT THE AUTHOR

Shaina Luck is an investigative reporter with CBC Nova Scotia. She has worked with local and network programs including The National and The Fifth Estate. Email: [email protected]

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