The future of health care is already here. Today, right now, you can download an app, have a “virtual appointment” with a physician and obtain medical advice, often including a prescription medication, within a couple minutes. This is fantastic, mostly. No more spending the entire morning taking your child to the pediatrician’s office to determine whether a cut needs sutures or to receive reassurance regarding a common rash, and perhaps no more driving several hours to a major medical center to have a specialist consultation with a leading physician.
Health care forecasters predict there will be 75 million mobile health (mHealth) consults in the United States this year, a number up 400 percent from 2012. Patients are demanding this service. Being able to rapidly and conveniently connect with your doctor or a needed specialist in communication with your doctor is a remarkable improvement to be celebrated.
In North Carolina, unfortunately, mHealth is not being used frequently to connect patients to their own doctors. Rather, patients are connecting to a physician in another state whose only job is to take calls from across the country and prescribe the medications the patients are requesting. Although licensed in N.C., these physicians don’t know the patients, have no access to their medical records and don’t plan on communicating with the patient’s physician.
This is dangerous. Improved access does not mean just making it easier to get sometimes dangerous prescription medications. It should mean improved access to excellent care that is integrated with the patient’s overall health care plan.
As a North Carolina physician and medical professor advising a local startup company, TouchCare, that connects patients to their own doctors using their smart phones, I feel strongly that there are some important things to consider as we incorporate mHealth in our state.• Governing standards for electronic heath care interactions (HIPAA) need to be followed to ensure the security of private medical information. Currently, doctors and patients are frequently connecting via insecure systems because the need for patient access is so great and most physicians haven’t acquired the needed technology, though now affordable and easy to implement.
• Physicians using mHealth must be able to arrange an in-person visit when needed for the safety of the patient. Some conditions, like possible skin cancers, need a more thorough physical exam than video facilitates, and some symptoms, like chest pain, may indicate dangerous conditions that need an emergent in-person visit. All mHealth companies should state clearly that if an in-person visit is required, the health care provider is expected to help direct the patient to the care he needs. Large national telemedicine providers, which often hire physicians licensed in many states without knowledge of the health care systems the patients use, may subtly persuade their employed physicians to convince the patient that almost all health care can be provided through their virtual service.
• mHealth providers need to further integrate the health care system. Our patients do not need more silos of health care that do not communicate with one another even when caring for the same patient. More than half of U.S. women age 65 and greater take at least five medications per day, and the more doctors you see the more medications you are likely to take. This is dangerous. If a doctor does not know all the medications a patient is taking, the physician may prescribe a medication that is dangerous when combined with others. Also, patients may receive conflicting advice from physicians not in communication with one another. All companies and health care providers who offer mHealth or telemedicine services directly to patients should be required to have a plan for sharing the medical records from the virtual visit with the patient’s regular physicians.
mHealth is here to stay. In a world where my children read their bedtime stories to their grandmother over Facetime and where the number of Americans needing health care is increasing faster than the number of physicians, the convenience and efficiency brought by connecting to your doctor and needed specialists using video technology are too important not to embrace them. We need, however, to ensure that we embrace them safely.
By focusing on secure communications, supporting local physicians to incorporate mHealth into their practices and ensuring that medical records created are shared with the patient’s other doctors, we will incorporate mHealth in a manner that serves and protects the people of North Carolina.
Kevin Biese, M.D., is associate professor of Emergency Medicine at the UNC School of Medicine in Chapel Hill.