Question: Doctor on Demand Enables Physicians to Make House Calls

In addition to cost, provider availability and travel time are barriers for many Americans seeking access to healthcare services. In fact, a recent study of 4,000 patients determined that, on average, patients spend 38 minutes on travel time to and from outpatient appointments. Improving patient's access to care continues to be a priority for healthcare providers and government agencies across the United States, and an increasing number of companies have begun offering telemedicine services, such as video-based doctors' appointments, as a potential solution.

Founded in 2013, Doctor on Demand, offers the possibility of increasing access to health care through video visits with doctors who can diagnose and treat a range of noncritical symptoms for patients who are unable or unwilling to visit a clinic. Using the Doctor on Demand services, patients can connect with one of more than 1,400 licensed physicians through the company's Web site using a Chrome, Firefox, or Safari browser or via an Android or iOS app. In addition to video conferences, the Doctor on Demand app allows patients to upload high-resolution images so that doctors can better assess certain conditions.

The top conditions treated by the service are cold and flu symptoms, sore throats, urinary tract infections, skin rashes, diarrhea and vomiting, eye issues, sports injuries, and travel related illnesses. The site also offers video visits with board certified lactation consultants for women who are breastfeeding. In addition, patients who need psychological or psychiatric services can consult with mental health professionals via the service.

According to Adam Jackson, CEO of Doctor on Demand, the most frequent users of the company's services are working mothers, who often have questions about their children's health but aren't always able (or willing) to take time off to get every question answered. According to Jackson, 92 percent of video consultations require no in person follow-up.

Although Doctor on Demand suggests that patients have access to Wi-Fi to ensure the highest quality appointment, the company promises a smooth experience as long as patients have a 4G or LTE connection. Patients who have connection problems can also switch to audio only to complete a visit, if necessary. The Doctor on Demand network runs on a cloud based platform run by Amazon Web Services. Due to the nature of the communication, the company had to go through several steps to ensure that all of its infrastructure was compliant with HIPAA (Health Insurance Portability and Accountability Act) requirements.

Most experts predict a shift to telemedicine, including video doctors' visits, will continue. In fact, a report by analytics company IHS Technology predicts that video consultations will increase from 2 million in 2015 to 5.4 million by 2020. For some patients, however, technology limitations will continue to impede their ability to access health care through telemedicine services. A grainy connection or one that cuts out in the middle of an appointment is unlikely to result in a high quality of care. Other hurdles that will also need to be overcome include patient's privacy concerns, patients' uncertainty about when a video appointment is appropriate in terms of symptoms, and patients' lack of trust that a virtual provider can accurately diagnose and treat them. That concern was reinforced by a recent study published in the JAMA Internal Medicine that found significant variations in the quality of care provided by different companies offering virtual visits for the diagnosis and treatment of common acute illnesses.

Critical Thinking Questions

1. Would you consider using Doctor on Demand or a similar service to access treatment for a minor healthcare issue? If not, which aspects of the service are most concerning to you (privacy, quality of care, security or other technology issues, etc.)?

2. Do more research online about Doctor on Demand and two of its competitors (such as Amwell, MD Live, and Teladoc). What information does each company provide on its Web site that is designed to ease patients' concerns about privacy, quality, and technology related issues? Which company does the best job of convincing you that their service is safe and secure?

3. In the study on patient travel time, researchers found that minority patients and those who were unemployed faced longer travel times when visiting a doctor. Rural Americans also often have more difficulty accessing health care. Is a video-based telemedicine app likely to improve access for those populations? How might this technology be used in a way that would be more likely to improve healthcare access for those populations?