Are virtual visits consistent and effective? JAMA-published study raises doubts.

A medical/health policy team from University of California-San Francisco (UCSF) studied virtual telemedicine visits and found a “significant variation in quality.” Over a year, 67 trained standardized patients over 599 visits presented their symptoms to the eight largest telemedicine (video and phone) providers (not named in the abstract). Their illnesses were common and acute: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain and recurrent female urinary tract infection. Based on their metrics, histories and physical exams were completed only 70 percent of the time; key management decisions adhered to accepted guidelines 54 percent of the time. Rates of guideline-adherent care (best practices) ranged from 206 visits (34.4 percent) to 396 visits (66.1 percent) across the eight websites. Wide variations were also found in diagnosis of pharyngitis and acute rhinosinusitis, with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time. JAMA Internal Medicine, May issue, published online 4 April: Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits (abstract only without subscription)

The type of telemedicine they studied were the typical live, real-time video appointments. Another ‘virtual care platform’ provider, Zipnosis, offers a contrasting way. They claim that the live simulacrum of the in-person appointment is lacking, and what’s needed is an asynchronous approach–‘store-and-forward’ information in what they call an “online structured, adaptive interview” integrated with health systems’ services.

In preview information released to press and as a letter to JAMA just prior to the start of the American Telemedicine Association’s (ATA) annual meeting, Zipnosis offered its own, far more positive study. Their review of 1,760 patient encounters for treatment of acute sinusitis using the Zipnosis virtual care platform found that clinicians provided guideline-adherent care in 95.4 percent of cases. Further detail will be presented at upcoming major informatics and virtual health conferences. According to their information and website, Zipnosis differs from the standard telemedicine provider in offering a ‘white-label’ platform to health systems which then work out integration with their clinical staff, facilities and EHRs to treat over 90 conditions. Release link to come.

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