Health care in Northwest Indiana goes virtual

Dr. Jay Joshi, a Munster primary care doctor, offers his patients virtual visits through the Fruit Street mobile app.

Whitney Trimble's two small children always seem to come down with an illness when their doctor's office is closed.

But Trimble discovered a way around that: Teladoc, a service that allows users to reach a physician around the clock, by mobile app, web or phone. No matter the time of day or where she is in the country, she logs on through her phone or the website, describes or shows her child's symptoms, and has a prescription sent to a nearby pharmacy.

"My kids always get sick on Sundays, which is when your doctor is not available, and you either have to go to the urgent care or emergency room," says Trimble, 30, a Munster financial adviser. "For your normal sickness or if I'm traveling or don't have time to take them in, it's really convenient."

Trimble is one of an increasing number of Americans who no longer only visit their doctors in person, choosing instead to access health care through their smartphones, largely by video. Several local physicians' offices now offer virtual doctor visits. And some Region hospitals use telemedicine to access specialists who practice outside of Northwest Indiana.

"There are significant benefits to telemedicine or a virtual approach," says Dan Prater, a Cedar Lake naturopath who does about 90 percent of his client visits virtually. "It's a time and money saver for the client. They're not losing a day of work. They're not losing travel time. Most of them choose that option if it makes sense for why they're coming."

In the U.S., the number of virtual doctor visits is expected to rise to 1.2 million this year from 1 million in 2015, according to the American Telemedicine Association. Meanwhile, 9 in 10 employers are expected to offer telemedicine in 2017, a National Business Group survey found, up from 74 percent in 2016 and 48 percent last year. Still, many Americans don't know virtual medicine is available: A survey by the consumer health company Health Mine found that more than a third of tech-savvy people have never even heard of it.

More NWI providers have telemedicine as option

Dr. Jay Joshi, a Munster primary care doctor, has been offering his patients virtual visits since he opened his office in September, through the Fruit Street mobile app. While the online appointments have been slow to catch on, he expects them to become more popular as patients realize the convenience and cost-savings benefits. "If patients feel like their conditions are significant, they'll make the effort to come to the office. If they feel like it's not significant enough, they wait and let it fester. Patients see it as either/or," Joshi says. "But there are a lot of conditions that seem harmless and grow significant and the patient ends up in the ER. They should communicate through telemedicine and meet in the middle."

He believes telemedicine has the ability to improve health outcomes and reduce wasteful spending, in the form of unnecessary emergency room visits and hospitalizations. "Patients will start to realize that it's a better alternative to be proactive rather than wasting money going to an immediate care center," Joshi says. "But behavioral change takes a while."

Franciscan Health, which has hospitals in Crown Point, Dyer, Hammond, Michigan City and Munster, recently launched its own physician-on-demand service to compete with national brands like Teladoc and MDLive and insurer-operated services, like those of Anthem and UnitedHealthcare. Chris DiGiusto, vice president of ambulatory services for Franciscan Health, says Franciscan On Demand is similar in price to those national companies—$49 a visit—but offers Indiana-based, Franciscan doctors for patients who know and trust the Catholic health system. He says the average wait time is about seven minutes.

DiGiusto says Hoosiers have been slow to utilize telemedicine because the state has lagged in clearing the necessary regulatory hurdles. Indiana just started letting doctors prescribe medications virtually in July. "Telemedicine has yet to become prolific in Indiana," he says, estimating that only about 5 percent of Hoosiers have used it. "In California, 40 percent of the primary care visits are done by virtual health. But it's been happening so much longer there."

Franciscan, like other hospitals, also monitors thousands of patients remotely. The hospital system currently has monitoring devices on about 2,500 people, whose conditions include chronic obstructive pulmonary disorder, congestive heart failure, diabetes, pneumonia and hip fractures.

A benefit for rural America

Telemedicine also keeps patients, particularly from rural areas, from having to travel long distances to see specialists not available in their communities.

Whenever a patient shows up at a Porter Health Care System emergency room complaining of stroke-like symptoms, the ER staff pages the neurology department at Loyola University Medical Center, located outside of Chicago. The staff wheels a machine with a TV screen and camera into the patient's room. The Loyola stroke specialist sets out to make a diagnosis, even though he's roughly 60 miles away. Patients who need surgery are flown to Loyola.

The hospital system averages about 25 virtual stroke visits a month. "In the past, we would have done our best to diagnose them," says Antoinette Whited, stroke coordinator for Porter Health Care System. "But it's great to have a specialist say, 'This is what this is.' It's better for the patient."

At LaPorte Physician Network Pediatric Care, patients who need to consult with a pediatric dermatologist are connected, virtually, with one based in Indianapolis. A scope attached to the camera magnifies the child's skin for a more accurate diagnosis. "Because she is a specialist in dermatology, she can give us a definitive diagnosis and treatment plan," says JoEllen England, clinic manager of LaPorte Physician Network Pediatric Care. "Before, the patients would have had to go to Indianapolis."

England says there are other benefits to patients seeing a specialist in their own doctor's office. "We're their pediatric home, so the compliance is much higher," she says. "They're following through because they're able to not only access the physician from an office where they feel comfortable, but ask us any additional questions. It has raised patient compliance in treatment."

More to come in the future

Dr. Thomas Devine, an internist with St. Mary Medical Center in Hobart, has started offering virtual visits to his nursing home patients, for whom it's particularly difficult to get to doctor's appointments. He says his telemedicine program is in its "beta" version, as it's only live in one nursing home and he's only had a few virtual appointments to date. He communicates with the patient using an iPad and Skype.

He notes that these types of informal virtual visits aren't currently billable to insurance. "I'm looking to be able to do this as a practice extender so my nurse practitioner and I can handle things more efficiently from my office," Devine says. "If we're booked at the office and have an issue at the nursing home, this saves the patient a trip to urgent care or the emergency room for problems that can more simply be handled with telemedicine."

Once issues surrounding privacy and insurance reimbursement are worked out, Devine envisions telemedicine becoming a big part of health care in the Region. "I think it'll become a fairly common way for patients to get medical care fairly nearly down the road," he says. "Whether that's five years, 10 years, I don't know."


Health Reporter

Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World. He is a graduate of Northern Illinois University.