The recent rise in 'Uber' inspired programs and advancing telecommunication systems has been transforming the medical care experience for both doctors and patients alike. Technology now plays an integral role as these innovative initiatives continue to gain popularity across the country. Though these mobile applications and programs have brought about groundbreaking improvements, they have also raised some important questions regarding best medical standards and practices.
These emerging trends appear to consist of two distinct services: virtual consultations and house calls. Virtual consultations are otherwise known as a form of Telemedicine among professionals in the field. According the American Telemedicine Association (ATA) this new practice consists of "the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using Internet, wireless, satellite and telephone media." A subsection of Telehealth includes mHealth, which exclusively refers to health services accessed on mobile or wireless devices. Some forms of Telehealth are quite advanced. In Florida, certain school districts and offices now have Telemedical booths on their campuses that function as private spaces for basic triage testing and virtual appointments. Though proponents of these services affirm that the services do not replace emergency or primary care, they can provide a convenient method by which to consult a doctor for non-urgent matters. These services may also provide guidance as to when it is necessary to seek further help. According to the ATA, these Telemedical services are gaining popularity as "[t]here are currently about 200 telemedicine networks, with 3,500 service sites in the US [and] . . . [o]ver half of all U.S. hospitals now use some form of telemedicine."
Some Telemedical companies are distinguishing themselves by providing specialized mobile application services. Just a few examples include Doctors on Demand, a telemedicine company that is now backed by Google and has expanded its practice to include psychological services. Maven is a 'digital health clinic for women' that provides affordable virtual services exclusively relating to women’s health and offers additional support on college campuses, and Spruce is a company that provides digital dermatological care.
Many elements of Telemedicine are also incorporated into companies that function as coordinators for doctor house calls by means of mobile applications. This physician by demand model has been coined "Uber for doctors." Though different companies offering these services vary slightly, Destination HealthEU has found that generally patients request a doctor on these apps similarly to the way one might call an Uber or Lyft ride. Patients then participate in a brief consultation to establish their specific concerns and to determine if a house call is appropriate. The majority of the sites we saw stated that their health care providers are comfortable treating a range of ailments from cold/flu, eye infections, sprains, cuts requiring stitches, and immunizations. Wait time ranges but generally appears not to exceed 2 hours
Many mobile application companies have been entering the market, and most are focusing on servicing different local areas. Some of the most successful apps have been Pager in New York, Heal in California, Dispatch in Colorado, and Dose in Tennessee. Oscar Salazar, who was a key cofounder for Uber, also worked to cofound Pager. Some big names are tied to many of these apps. For example, Lionel Ritchie is a primary investor in Heal, the application serving the Los Angeles and San Francisco areas.
Insurance coverage for these house calls varies to a certain extent. However, the vast majority of these services are not included under most plans. Prices generally range from 20 to 200 dollars, depending on if a customer is a first time client and the range and type of services required. Though these estimates may be higher than the average co-pay, users have reported that they appreciate the price transparency and do not have to spend time negotiating with insurance providers.
This new model provides some undeniable benefits for both healthcare providers and patients. For some doctors, these apps have allowed for increased flexibility in their schedule and more one-on-one time with patients. Some physicians have expressed that house call provides a more holistic understanding of a patient’s lifestyle that can contribute to their medical opinions and recommendations. For patients, house calls eliminate waiting rooms where there may be increased pathogen exposure and provide them with an added sense of comfort. These phenomena have been especially important for children who may feel more comfortable in their own home.
Critics of these services are wary of these restrictions. An LA times article outlined concerns pertaining to inefficiencies in these new systems. The journalist expressed that more patients might be served with improved optimization. Other critiques have included questions regarding quality control and regulation. A doctor’s office or medical facility allows for greater oversight and reduces the risk of corruption or medical malpractice. There are financial concerns as well. Apps such as Uber and Lyft have perpetuated the commoditization of taxi and ride services. Because these Telemedical apps are reminiscent of their ride-sharing counterparts, some individuals fear that the apps may harm the fragile economic dynamic of healthcare. If these house call apps are truly to function following the same principles as Uber and Lyft then they may be subject to phenomena such as surge pricing or price quality discrepancies.
These concerns speak to larger questions at play in the healthcare dialectic within the United States. How will insurance companies grapple with changing practices? How will these new programs reach rural and underserved populations? How can they reach the growing senior population who may benefit most from an improved house call based network?
Though these apps may not provide solutions for all of these questions, it is exciting to see this fusion between advancing technology and healthcare practices. Future innovations such as this appear to have the potential to redefine our medical system, improving outreach and access. Though house call and Telemedical services may not provide a replacement for primary and emergency healthcare, they are serving as a critical adjunct supporting current practices and filling some of the gaps.
1. "ATA Main - FAQs." American Telemedicine Association. American Telemedicine Association, n.d. Web. 17 Nov. 2016.
2. BRIAN K. UNWIN, COL, MC, USA, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and PAUL E. TATUM III, MD, MSPH, University of Missouri–Columbia School of Medicine, Columbia, Missouri. "House Calls." House Calls - American Family Physician. American Family Physician, 15 Apr. 2011. Web. 17 Nov. 2016.