Telemedicine's Effectiveness Questioned By Study

By Christine Kern, contributing writer

One virtual care company challenges findings of study.

A much-referenced study in the May edition of JAMA Internal Medicine, Variation in Quality of Urgent Health Care Provided During Virtual Visits, questions the effectiveness of telemedicine, especially the synchronous (live) variety of telemedicine found in video and phone consults. The study’s authors concluded these methods of providing virtual care to patients often fail to adhere to clinical best practices.

However, not everyone agrees with the findings of the study. Zipnosis, a virtual care company that was not one of the eight studied by the JAMA authors, has provided adherence statistics drawn from over 1,700 patient visits at two large U.S. health systems that demonstrate, unlike with live video or phone-based virtual care encounters, “The use of an evidence-based, best practices-driven virtual health platform can overcome major issues with the consistent delivery of guideline-adherent care” that were identified in the JAMA study.

In fact, clinicians who reviewed online adaptive interviews such as those provided by Zipnosis adhered to clinical protocols nearly 100 percent of the time. By contrast, the companies studied by JAMA authors achieved guideline-adherent care only 33 to 60 percent of the time. Adherence to national best practice guidelines has been shown to produce higher quality care.

In a letter to the editor of JAMA, Zipnosis argues the results indicate video telemedicine is far less effective than standards-based adaptive interviews completed by patients online. Moreover, unlike the companies studied — who use outsourced physicians to respond to patients — results from Zipnosis’ own study of two major medical centers show insourced or staff physicians can be highly effective at providing virtual care.

In fact, clinicians at the medical centers adhered to best practice standards in over 95 percent of all patient encounters, compared to between 13 and 80 percent for the companies studied by the JAMA authors. Moreover, the insourced model helps health systems capture new patients while preventing patient leakage.

“Our findings strongly support our contention that online, adaptive patient interviews and systematic, curated diagnostic pathways assist clinicians in adhering to national best practice guidelines in nearly all cases,” said Rebecca Hafner-Fogarty, MD, Chief Medical Officer of Zipnosis and co-author of the Zipnosis study. “The vast majority of virtual care companies included in the study leverage live video and phone encounters to diagnose and treat patients rather than asynchronous online, adaptive interviews such as those provided by Zipnosis. The findings from the JAMA Internal Medicine study raise doubts about the ability of live telemedicine to consistently deliver high-quality patient care.”