Virtual Care

Half of face-to-face clinical office visits can be conducted virtually.

990M

face-to-face clinical office visits every year1

459M (46%)

can be conducted virtually

The top 15 types of encounters (like routine checkup, medication refill, joint pain) account for 50% of face-to-face clinical office visits.

Armed with a smartphone or device, 13 of the top 15 encounters can be virtual visits.
The other two visits that remain face-to-face are Gynecological examinations and Well baby examinations.

The table below documents whether an encounter can be virtual or face-to-face, how it would be conducted using a spectrum of tools, and what health information is necessary to collect.

The Top 15 Encounters Breakdown

Reason for VisitEncounter & DeviceTextImageAudioVideoVitalsLabsImagingOther% of Visits
Routine checkupSmartphoneRequiredOptional24.5%
Medication, other and unspecifed kindsSmartphoneRequiredOptional3.6%
Joint pain (knee, shoulder, etc.)SmartphoneRequiredOptionalOptionalOptional2.9%
Postoperative visitSmartphoneRequiredOptional2.6%
CoughSmartphoneRequiredOptional2.1%
Gynecological examinationOffice VisitGynecologic exam (specialist)2.1%
Prenatal examination, routineSmartphoneRequiredOptionalOptional
Ultrasound
1.8%
Back painSmartphoneRequiredOptionalOptional1.6%
HypertensionSmartphoneBlood Pressure CuffRequiredOptionalOptionalRequired
Blood pressure
Optional1.6%
Stomach and abdominal pain, cramps, and spasmsSmartphoneEKGRequiredOptionalOptionalOptionalOptionalOptional1.5%
Well baby examinationOffice VisitMilestones exam (specialist)1.3%
Diabetes mellitusSmartphoneRequiredOptionalOptional
Every 3 months Hemoglobin A1C. Every year fasting lipid profile, liver function tests, urine albumin excretion, serum creatinine.
1.3%
Skin rash, lesionSmartphoneRequiredRequired
Photo of rash/lesion
Optional1.0%
Preoperative visitSmartphoneEKGRequiredOptionalRequiredEKG1.0%
Symptoms referable to throatSmartphoneRequiredOptionalOptionalStrep test0.9%
All other reasons50.2%
Smartphone
Virtual Visit
Office Visit
Face-to-face Visit
EKG
EKG Monitor
Blood Pressure Cuff
Blood Pressure Cuff
Required
Required
Optional
Optional

"Healthcare delayed is healthcare denied"2

On average, it takes 24 days and 59.21 minutes for a patient to complete an office visit with their clinician.

Time-to-diagnosis
Waiting for appointment24 days3
Waiting for clinician in office41 minutes4
Consultation with clinician18.21 minutes4
Total24 days and 59.21 minutes

Given the time investment for receiving care, it's no surprise that 15.6%5 of patients avoid medical care due to time constraints.

Physicians don't scale.
Patients and software scales.

Care must go virtual

  • For patients to have better access, cost, and outcomes.
  • For clinicians to provide timely care for more people.
  • For personalized medicine and services.

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Methodology

The Virtual Care diagram documents which clinical office visits could be virtual, how they could be conducted, and what health information is necessary. The diagram examines the top 15 reasons for clinical office visits from Table 11 in the National Ambulatory Medical Care Survey in 2015.

Our working document of research is available for review and comment.

v1 - 31.Jan.2019

The section below documents how we consolidated the 20 reasons for office visits down to 15.

'Routine checkup' label is new and represents:

  • Progress visit, not otherwise specifed
  • General medical examination
  • Counseling, not otherwise specifed.

'Joint pain' label is new and represents:

  • Knee symptoms
  • Shoulder symptoms

'All other reasons' label existed but now also represents:

  • For other and unspecifed test results
  • Other special examination

The section below documents how we calculated the 'Percent distribution' due to the consolidation of reasons for office visits.

Routine checkup (24.4% | 242,782,000) = Progress visit, not otherwise specifed (14.1% | 140,842,000) + General medical examination (7.6% | 75,412,000) + Counseling, not otherwise specifed (2.7% | 26,528,000)

Joint pain (2.9% | 28,860,000) = Knee symptoms (1.6% | 16,241,000) + Shoulder symptoms (1.3% | 12,619,000)

All other reasons (50.2% | 498,058,000) = For other and unspecifed test results (1.5% | 15,159,000) + Other special examination (0.9% | 9,092,000) + All other reasons (47.8% | 473,807,000)

The section below documents how we calculated the 46% (rounded down) and 459M (rounded up) of office visits that can be conducted virtually.

Virtual office visits (46.4% | 458,798,000) = Routine checkup (24.5% | 242,782,000) + Medication, other and unspecifed kinds (3.6% | 35,232,000) + Joint pain (2.9% | 28,860,000) + Postoperative visit (2.6% | 25,441,000) + Cough (2.1% | 20,984,000) + Prenatal examination, routine (1.8% | 18,152,000) + Back pain (1.6% | 15,875,000) + Hypertension (1.6% | 15,762,000) + Stomach and abdominal pain, cramps, and spasms (1.5% | 15,026,000) + Diabetes mellitus (1.3% | 12,432,000) + Skin rash, lesion (1.0% | 9,464,000) + Preoperative visit (1.0% | 9,443,000) + Symptoms referable to throat (0.9% | 9,346,000)

Authors

Cameron Gettel, Resident Physician, Brown University

Cameron Gettel is an Emergency Medicine physician with interests in improving healthcare through evidence-based practices, quality improvement, and clinical research.

Eric Benoit, GoInvo

Eric Benoit is the Creative Director of GoInvo, leading the studio’s UX creation process from concept to production. Eric works as an interaction designer, experience designer, and information architect, designing better products by thoroughly understanding user behaviors, expectations, and goals. Eric’s background and love for design in the context of human experience helps him transform complex information systems in healthcare and the enterprise into responsive and adaptive human-centered designs.

Contributors

Juhan Sonin, GoInvo, MIT

Juhan Sonin leads GoInvo with expertise in healthcare design and system engineering. He’s spent time at Apple, the National Center for Supercomputing Applications (NCSA), and MITRE. His work has been recognized by the New York Times, BBC, and National Public Radio (NPR) and published in The Journal of Participatory Medicine and The Lancet. He currently lectures on design and engineering at MIT.

About GoInvo

GoInvo is a healthcare design company that crafts innovative digital and physical solutions. Our deep expertise in Health IT, Genomics, and Open Source health has delivered results for the National Institute of Health, Walgreens, Mount Sinai, and Partners Healthcare.

Reach out with feedback.

References

  1. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. (2015). Retrieved January 24, 2019: https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdf
  2. Why You Have to Wait Longer to Get a Doctor’s Appointment. (2017). Retrieved January 24, 2019: https://www.healthline.com/health-news/why-you-have-to-wait-longer-to-get-a-doctors-appointment
  3. 2017 Survey of Physician Appointment Wait Times. (2017). Retrieved January 24, 2019: https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/
  4. BA Ahmad, K Khairatul, and A Farnaza. An assessment of patient waiting and consultation time in a primary healthcare clinic. (2017). Retrieved January 24, 2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420318/
  5. Jennifer M. Taber, Ph.D., Bryan Leyva, B.A, and Alexander Persoskie, Ph.D. Why do People Avoid Medical Care? A Qualitative Study Using National Data. (2015). Retrieved January 24, 2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/