The Benefits & Challenges of Using Telehealth Solutions On Vacation

By PokitDok Team,

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When medical attention is called for and patients are away from home, it's not always easy to know where to go or who to call. A local Urgent Care center? An unfamiliar family practice that accepts walk-ins? Do you google it? Look in the white pages? In fact, telehealth solutions are an excellent, new resource that travelers and stay-at-homers alike can use to save time, money and hassle.

While the evidence at this point is largely anecdotal, telehealth technologies are emerging as convenient and effective solutions for sick travelers. Easy access to medical care anywhere, even while traveling, emerges as a key benefit to Telehealth.

"By accessing a doctor directly from your computer, you can get diagnosed and have your prescription sent to your local pharmacy," telehealth startup eVisit writes. "You could either go and pick it up from there in person, or you could ask a friend or a neighbor to stop by and pick it up for you. This method is not only a time saver, but also a way of getting medical attention whenever needed, even if it's 3 AM and you are on vacation in a remote area."

Telehealth companies appear poised to ease one potentially huge challenge travelers face - and success stories can already be found. In this post, we'll outline the opportunity, a few real-life examples and also touch on the early stage of telehealth adoption, complete with what legal hurdles that brings.


The Opportunity

70% of doctor appointments and 40% of ER visits can be handled via telephone. When traveling, people often face common ailments like - getting a cold, food poisoning, overexposure to sun, and sinus infections, to name a few. Telehealth can streamline this often frustrating and confusing on-the-road process with remote diagnosis, low costs and saved time.

"Patients can be seen remotely by physicians in their homes, places of work, or at a dedicated telehealth center, and physicians can treat patients remotely from a hospital, medical facility, or other places of work including their own homes or even while on vacation, as long as they have access to the Internet," the Information Technology & Innovation Foundation wrote in a May 2014 white paper [PDF].

"The ability to connect physicians and patients without regard to their respective locations is one of the most compelling benefits of telehealth services."

A 2014 survey of Americans confirms that these compelling benefits resonate with consumers, not just among industry professionals.

"Americans ... responded the place they would most like to have access to telehealth was while on vacation (35%)," Katie Wike at Health IT Outcomes wrote in her coverage of MDLIVE's Mobile Health Index. "Other answers were while in bed (33%), while at work (23%), and while riding in the car (20%)."

In fact, one company, TravelDok, has already built a platform that connects travelers with doctors via phone call, video chat and the company's mobile app. TravelDok says the average response time for a doctor on its platform is 14 minutes, and the average consultation is 15 minutes. That means on average, patients can request and receive help within half an hour, less time than it might take to search for a provider, let alone make an appointment and get there .


Two Real-World Examples

Freshbenies, a company that helps organizations provide health benefits to their employees, shared a story about one customer's employee, Rita, who used their doctor-on-call service while away from home.

"While on vacation, my daughter came down with strep throat symptoms, so I went to the local Urgent Care center and paid my $125 fee and was waiting to be seen," Rita reported. "My husband called me to see how we were doing and to remind me that we had a freshbenies card with a 24/7 call a doctor service. He had already set up our account with them, so he contacted them and set up a call back. … Within 20 minutes I was talking to a doctor who prescribed a medication and called it in to the local pharmacy."

Rita paid just $12 for her daughter's prescription.

Sherpaa, another platform that connects patients with doctors via smartphone or tablet, shares a similar story. David Landa, head of a Brooklyn-based digital product design studio, and his wife were on vacation in Florida when his wife developed a painful sore throat.

"I had her log on [to Sherpaa] through her phone," Landa said. "The doctor on the other end asked some questions; we took some photos. Within probably an hour, she had been diagnosed with strep throat. Sherpaa found a local pharmacy, ordered antibiotics, and by the next day we were back on track - back on vacation.

"In the past we probably would have gone to some emergency center. It would have been a nightmare. It just felt like Sherpaa pretty much saved our vacation."


Potential Legal Hurdles

Despite the overwhelming benefits, some hurdles still remain for travelers and their doctors. Medical licensing boards operate on a state-by-state level, so a family from Wisconsin seeking a remote consultation from their family doctor back in Madison while spending the winter in Florida could present interstate legal issues.

"Many state medical boards still require physicians to be licensed on both ends of the patient encounter," Shelly K. Schwartz writes at Physicians Practice. "A specialist in Pennsylvania, for example, may not be able to treat a patient remotely if he is unlicensed in the state where that patient resides. Likewise, providers who answer e-mails and have the capacity to conduct telehealth exams from their laptop while at a conference or on vacation could easily run afoul of state licensing laws."

Schwartz spoke to Gary Capistrant, senior director of public policy at the American Telemedicine Association. "We have all these snowbirds, older patients who head to Arizona or Florida during the winter months, who can't be cared for by their physician back home because he or she isn't licensed there," Capistrant told her. "That causes discontinuity of care."

This also brings up questions of jurisdiction that have never applied before. If a patient travels out of state for a week - to Florida, for example - does the destination state have temporary jurisdiction over someone who clearly lives elsewhere?

"On one hand, it seems counterintuitive that a therapist would be prohibited from maintaining a therapeutic relationship with a patient who leaves the state," attorney Alain Montgomery of the California Association of Marriage and Family Therapists says "A patient's diagnosis or condition does not disappear when a patient goes on vacation, takes a business trip, or relocates to another state. In such times, a patient may want and/or need the continued support of their therapist even without the physical face-to-face connection."

As Montgomery notes, though, each state's licensing regulations could make the continuation of a doctor-patient relationship illegal, however ethically justifiable the therapy is.

Psychologist, instructor and consultant Ofer Zur, Ph.D., brought up this issue in a recent article, "Telehealth Services Across State Lines, that specifically deals with the challenges of delivering cross-state psychiatric care. "If the client's residency has not changed, and the client does not want to see another therapist, the therapist can probably continue therapy for a short time with him/her as long as his mental health issues are such that they can be effectively treated via the phone, videoconferencing or other Internet-based or digital technologies," Dr. Zur wrote.

Dr. Zur continued with an example of a patient leaving her home state to attend college, which could bring up questions about the student's residency status.

"Psychotherapists must consider these issues seriously," Dr. Zur wrote. "Therapists may want to consider obtaining a permanent or temporary license in the other state. They must also take into consideration continuity of care issues. For example, an important factor is the client's mental state and if the client's situation is such that he/she may be at risk if therapy with the original therapist is terminated at that time."

As discussed in a previous post, telehealth bumps into licensing requirements that could require a doctor to apply for a license and wait 90 days on a state-by-state basis before he or she could deliver care to a patient who is in that state only temporarily. Some changes are underway, but the rule is innovates faster than relevant laws.

As the telehealth industry grows and evolves over the remaining decade, reaching a compromise between regulations and the needs of patients who are away from home will be a major step forward.

images by:
Chris Sardegna
Darko Stojanovic
Samuel Zeller
David Mark

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.

  Tags: Enterprise, Healthcare consumerism, Telehealth

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