Can you get a rash diagnosed by taking a selfie? Can you get treated for strep throat by opening up wide into your iPhone camera?
A growing crop of companies that offer doctor consultations using a free app and the camera on a tablet or smartphone say you can. And patients, weary of urgent care waiting rooms, have turned in growing numbers to doctor consultation apps to treat minor, but annoying ailments.
"Patients are demanding mobile and on-demand health services, like everything else in their lives has become -- car services, food delivery and banking," said Adam Jackson, co-founder of Doctor on Demand, a San Francisco company that launched in 2013. "We used to keep a spreadsheet of our competitors, and just gave up. It's a crowded space."
The proliferation of doctor consultation apps, which allow patients to see a doctor through their desktop, smartphone or tablet camera for a flat fee of $40 to $50, has outpaced state regulators still grappling to figure out how to regulate telemedicine. The Federation of State Medical Boards recently offered a model policy for states -- aimed at supporting the growth of telemedicine -- but states still have varying and often difficult-to-interpret rules, creating a vague regulatory framework that some experts say these companies have exploited. Currently, 19 states, including California, have regulations that allow doctors to practice medicine over video in some form, yet most apps say they operate in more than 40.
"Just because a company is operating in a particular state does not mean that the company is in compliance with that state's regulations, but just that there hasn't been a complaint filed in that state yet," said Greg Billings, director of the Robert J. Waters Center for Telehealth and e-Health Law. "We're concerned about the bigger picture, which is that someone is going to get seriously hurt."
With little oversight or information about the quality of care -- most patient lawsuits are settled in private -- virtual doctor apps could be a gamble for consumers, some experts say. But it could be a gamble worth taking, say some health care professionals, for certain patients in certain circumstances -- if you don't have health insurance; if you have a condition that can be diagnosed on sight, such as pink eye; if you're feeling lousy on Christmas and every doctor's office in a 50-mile radius is closed.
"The point is you're giving people better access to care without compromising quality and without promoting over-utilization of health care resources," said Dr. Ian Tong, a Stanford University clinical professor who works for Doctor on Demand. "If we already know that the doctor in the emergency room is going to say that you don't need an X-ray for this particular type of injury, why should you go into the emergency room and spend all that time waiting room just to be sent home and told the same thing that I would have told you in less than 15 minutes through the app."
But experts warn patients are using the apps for illnesses that can't be diagnosed through a screen. Many companies say strep throat is one of the most common conditions they treat, but experts say that diagnosis requires a strep test, which means going to a hospital or clinic. Making it trickier yet, the Centers for Disease Control reports that just 5 to 10 percent of people who tell their physician they have a sore throat actually have strep.
"You are basically diagnosing without having a diagnostic test, and you are prescribing medicine for someone who has a 10 percent chance of having the condition," Billings said.
Ear infections, bronchitis and urinary tract infections are also commonly treated through these apps, although doctors skip the standard clinical diagnostic tests that ought be done to confirm them, Billings said. And doctors may ask patients to take their own temperature and blood pressure or feel their lymph nodes -- an invitation for errors and misdiagnosis.
Doctors can prescribe antibiotics and other common medications, but not controlled substances or addictive drugs such as sleeping pills.
Still, companies argue that they can treat the majority of the patients who use the app, or will send them to the emergency room if they can't.
"If you wipeout riding your bike, our physicians can't diagnose if you broke your arm," said Jason Gorevic, chief executive of Teladoc. "And we're not going to be doing any diagnosis of significant chronic diseases. But our physicians are very good at diagnosing things that occur everyday in people's lives and are highly inconvenient."
Teladoc started in 2002 as a phone-a-doctor company, but it, like most other virtual doctor companies, have exploded in the past couple of years. The company expects to have 300,000 visits this year, a 100 percent increase over 2013.
Tablets have made the services more popular and the Affordable Care Act opened up health care to millions of previously uninsured people in need of a primary care physician.
The growth has also been fueled by venture capitalist investments, endorsements from celebrities such as TV personality Dr. Phil, and big employers including eBay and Comcast that add virtual doctor services to employee health plans. Doctors on Demand announced last week it raised $21 million, and Palo-Alto-based HealthTap, which last month launched a video consultation app, has raised $35 million from investors including Google Chairman Eric Schmidt.
The apps range in the quality of technology and medical care. Doctor on Demand is widely considered one of the best new entries, with doctors from Stanford and other prominent medical centers, and offers among the best-quality video on iOS, Android, Kindle and desktop. HealthTap has a network of more than 62,000 doctors, MDLIVE offers specialists, including cardiologists and therapists, and some experts have praised American Well for meeting standards of care similar to in-person visits.
But others have room for improvement. Patients who sign up for the MeMD app -- which only works on a smartphone when additional applications are downloaded -- will have to contend with phone calls from a customer service agent who repeats all of the same questions the patient has already answered in the app. PlushCare will launch next month and has just nine doctors and work do to on its app before then.
But not all doctors would prescribe video apps as the best medicine. Dr. Darren Phelan, who has a private practice in Menlo Park, said he's offered consultations over Skype for the past four years, and only used it five times: "Over the computer, I can't listen to someone's lungs, or to their heart."
Contact Heather Somerville at 510-208-6413. Follow her at Twitter.com/heathersomervil.
Doctor on Demand (San Francisco)
Number of doctors: 1,400
Cost: Sells direct to consumers. $40 for 15 minutes visit, or covered by some HSA plans
Platforms: iOS and Android for tablet and smartphone, Kindle, desktop Web
PlushCare (San Francisco, launching in September)
Number of doctors: 9
Cost: Sells direct to consumers. $45 one-time visit or $20 per-month subscription fee. Users may extend their 15-minute consultation at no cost.
Platforms: Desktop and mobile Web, with iOS app to follow.
Number of doctors: More than 500
Cost: Sells to employers and health insurance plans. Single consultation is $40.
Platforms: iOS and Andorid for tablet and smartphone, desktop Web
Number of doctors: 2,000
Cost: Sells to employers and health insurance plans, and direct to consumer for $49.95 per consultation. No time limit on consultations.
Platforms: iOS and Andorid for tablet and smartphone, desktop Web. App can get readings from Internet-connected medical devices.
HealthTap (Palo Alto)
Number of doctors: 62,000 (not all available for video consultation)
Cost: Subscription only, $99 per month plus $10 per month for each additional family member. Consultations are limited to 30 minutes.
Platforms: iOS and Android for tablet and smartphone, desktop, Android wearables
guidelines for video consultations
Doctors who treat patients through video apps are expected to follow these guidelines from the Federation of State Medical Boards. If they don't, that could be red flagged.
Provide clear identification and appropriate credentials
Conduct an appropriate evaluation of patient's current condition in a way that is keeping with the level of evaluation in a face-to-face visit
Ensure that patient's privacy is protected and medical records are kept confidential
Obtain proper consent for any treatment proposed
Provide evidence they are properly licensed in the state in which you are receiving treatment
Fully document patient's telemedicine encounter and have a plan for emergency care if needed
Allow patients to select a physician, rather than being assigned a physician at random. Patients should also be able to seek, with relative ease, follow-up care or information from the physician.
Read more: http://www.fsmb.org/pdf/FSMB_Telemedicine_Policy.pdf.
Source: The Federation of State Medical Boards