e-visits: more evidence that they are a good idea

I first worked on e-visits more than a decade ago when I consulted to Healinx, later called RelayHealth, on the development of its business model. The appeal of the webVisit was pretty clear even then, and early studies showed that electronic interaction with a physician’s office was effective, less expensive and more convenient, especially for established patients. Interestingly, webVisits seemed to keep patients out of the ER by providing easier access to physicians. Electronic visits have caught on slowly, though and in 2013 are still treated as somewhat novel.

A new study in JAMA Internal Medicine compares e-visits with in-person visits for suspected sinus infections and urinary tract infections. (I don’t have access to the article so I’m referencing the Reuters story about it instead.) Rates of follow-up visits for the same condition were identical for the in-person and the e-visit groups, which “suggests that misdiagnosis and treatment failure weren’t any higher with e-visits.” Overall costs were lower: $93 v. $74.

Interestingly, almost everyone in the e-visit for urinary tract infections received an antibiotic prescription compared to about half in-person. That may indicate overprescribing of antibiotics, which is a problem.

It’s interesting that there was more prescribing in the e-visits. Perhaps it’s the nature of UTIs that this happens. Looking at the broad spectrum of e-visits I would expect the situation to be reversed. When someone makes the effort to go into an office and see a physician they expect to walk away with something to show for it. That’s usually a prescription but could also be additional lab testing, which may or may not be needed.

Therefore I would be hesitant to generalize the findings from UTIs to e-visits as a whole.

January 17, 2013

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