Online medical clinic Virtuwell now available in Virginia

Internet users in Virginia afflicted with the flu — or about 50 other common ailments — can now get drug prescriptions online, thanks to a new service.

Virtuwell, an online clinic operated by Minnesota-based health-care provider HealthPartners, lets nurse practitioners prescribe some medications online to patients with conditions such as colds, allergies and some sexually transmitted diseases. Last week, Virtuwell made its service available to people living, working or traveling in Virginia. It also operates in Iowa, Minnesota, Wisconsin, North Dakota and Michigan.

This system of administering care via electronic communication — often called “telemedicine” — is growing in the Washington region. Another service called NowClinic, a subsidiary of the UnitedHealth Group, offers prescriptions to users after short phone, video or online chat conversations, and operates in the District, Virginia and Maryland, among other states. Because telemedicine is often limited by state medical boards that determine whether physicians need to be licensed in the state before providing online medical care to residents, the technology is spreading slowly, said an industry expert.

For instance, though telemedicine is allowed in Virginia, the Virginia Board of Medicine expects that online encounters in the state meet the same standard of care as in-person ones, said the board’s executive director William Harp. For most services, health-care professionals must hold a Virginia license to practice telemedicine in the state, he noted.

“Some of the state professional licensing boards . . . have not yet gotten comfortable with the advances in technology, with developing a physician-patient relationship in this type of online setting,” said Ellen Janos, a member of the health-law practice at the Boston office of MintzLevin, Cohn, Ferris, Glovsky and Popeo, P.C. “As a general matter, states that have policies that recognize that the standard of care for telemedicine is the standard of care for an office space visit . . . those are just the most enlightened.”

On Virtuwell, users pay a flat fee of $45 per consultation — or less, if their insurance covers online visits. On the Web site, patients answer a series of automated questions about their symptoms. If patients believe they have the flu, for instance, they may be asked how often they experience nausea.

“Essentially we’re asking the same questions you’d ask in an office visit, only we ask them online,” said Kevin Palattao, vice president of HealthPartners and Virtuwell.

The service is staffed by about 20 nurse practitioners scattered throughout the country; they take about 12 minutes to respond to each case and text a treatment plan and prescription, when necessary, to the patient’s phone. In some cases, nurse practitioners may ask to talk to patients on the phone or to send photos of their conditions beforehand.

Patients take Virtuwell’s prescriptions for some medications — antifungal or antibacterial drugs, for instance — to their regular pharmacy. Virtuwell, like NowClinic, emphasized that it does not prescribe birth control or medications controlled by the Drug Enforcement Administration.

Virtuwell and similar services must approach each state’s medical licensing boards before operating there, which is why, since Virtuwell’s launch in Minnesota in 2010, the company has only expanded to six states, Palattao said.

“It’s taking longer than we all thought to try to standardize some of this, to try to get the state professional boards to act in a more consistent, modern manner,” Janos said.

And though the American Medical Association encourages telemedicine, it also recommends that "[c]linical issues that require physical examinations and diagnostics, such as those treated with the prescription of antibiotics, should continue to be managed in-person to maintain patient safety,” the group said in a statement to The Washington Post.

For other companies providing virtual care, telemedicine’s growth, however slow, is welcome, said Joe Peterson, chief executive of Specialists on Call, a Reston, Va.-based company that schedules on-call physicians to consult via telecommunication with patients across the country.

“Every time an organization demonstrates that effective clinical encounters can be delivered online for many conditions . . . the acceptance by everyone else improves, the acceptance of interactive technology grows in the marketplace,” he said.

Mohana Ravindranath covers IT and small business for the Washington Post and its weekly Capital Business publication.
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