Virtual First Responders: the Role of Direct-to-Consumer Telemedicine in Caring for People Impacted by Natural Disasters

Abstract

D irect-to-consumer (DTC) telemedicine offers patients immediate access to remote physicians via personal devices. These services were originally designed for patients seeking care for minor acute illnesses. In disasters, however, DTC telemedicine may facilitate care that would otherwise be inaccessible due to displacement, unpassable roads, emergency closures, or increased demand for healthcare services. 1 For the first time during the 2017 hurricane season, several DTC telemedicine companies including Doctor on Demand, MDLIVE, Teladoc, American Well, and LiveHealth Online offered free visits to hurricane victims. 2 To understand the role that DTC telemedicine may play in disaster response and recovery, we describe services provided by one DTC telemedicine company during Hurricanes Harvey and Irma.

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“…28 For example, during Hurricanes Harvey and Irma, Doctor on Demand offered visits for chronic conditions, advice, counseling, and refills, and back and joint concerns. 29 Doctor on Demand, Teladoc, and K Health: Primary Care are options available on the Apple Store that provide access to licensed physicians for non-emergency medical problems and are Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant. [30][31][32] Doctor on Demand and Teladoc are considered leaders in telemedicine, and are covered by many insurances including UnitedHealthcare, Aetna, Cigna, and some state Medicaid programs, although coverage may be different, and different insurances have different preferred telehealth destinations.…”

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“…Though the use of telepsychiatry, and indeed telemedicine more broadly, has been limited to date, their benefit in prior widespread emergencies has been documented. Telemedicine has previously been effectively used in simulated and real disaster scenarios (Simmons et al 2008;Doarn et al 2018;Uscher-Pines et al 2018). It was utilised effectively in the aftermath of hurricane Ike which struck Texas in 2009, killing 82 people (Wicklund, 2017).…”

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“…6 Firsttime users comprised 63% of visits, due in part to a 2017 Texas law that eliminated the requirement that an in-person visit was needed to establish a patientphysician relationship. 6,9 Following Hurricane Irma, 1 Florida health system reported a more than 500% increase in downloads of its telemedicine smartphone app, whereas another hospital reported 2700 new telemedicine users in a 3-day period. 10 At least 1 academic medical center (the author's institution) implemented telemedicine specialist consultation from Puerto Rico during the response to Hurricane Maria in 2017.…”