The doctor is in: Virtual visits make house calls easy

We are IU Health

January 07, 2019

Sleep study physician and patient say the technology lends itself to certain kinds of medical appointments.

House calls harken back to a simpler time -- when the small-town doctor would show up on the doorstep of a patient, black bag in hand.

Today’s “house call” relies on technology, but it’s no less effective in some cases.

Dr. Shalini Manchanda, director of the IU Health Sleep Disorders Center, is an early adaptor of IU Health’s virtual visit tool, part of the wider virtual care system.

“My specialty is perfect for virtual care,” Manchanda said. “It’s not like being a surgeon where you have to feel if there is a lump or whatever. In sleep apnea, there’s a lot of data review, so once we make contact with a patient and get to know them in a personal visit, we can review that data online with them.”

All it takes is a smartphone, tablet or computer and a strong Wi-Fi connection. That and plenty of set-up work in the office on the front end.

Manchanda’s staff has compiled a checklist for the visits, which includes checking in with the patient several days before the virtual visit to ensure they have downloaded the IU Health Virtual Visit app and have an understanding of how the appointment will proceed.

Pamela Starks had her first virtual visit with Manchanda last month and loved it. It was a follow-up appointment to last year’s in-office visit for treatment of sleep apnea.

When the physician asked her if she’d be interested in trying the concept, Starks was on board from the start. Her only concern was that she would be able to download the app and use the technology correctly.

“I didn’t want to be in the middle of an appointment and have something go wrong. Then it’s wasted time for them and for me.”

She intended to call in for her appointment from her home or office, but it so happened that day she was at a family gathering at the home of her mother-in-law, who had recently passed away.

“It took me a fraction of the time to do my appointment,” she said, versus having to get ready, drive the 10 miles to the physician’s office, see the doctor and drive home or back to work.

During the visit, Manchanda reviewed Starks’ sleep habits over the previous several months, turning the charts around so that Starks could see the graphs on her iPhone.

It was convenient, Starks said, “and I still felt exactly the same when I hung up as I did when I left the office last time. I was prepared with instructions for moving forward.”

Next year’s follow-up likely will be in the office because Manchanda still wants to see her patients in person at least every other visit, but Starks said she would definitely be on board for another virtual visit.

“I am so happy that I did this because I could just go in another room on my phone and it took 10 or 15 minutes, then I was back doing what I needed to do.”

If not for the virtual visit option, she said she likely would have canceled the appointment.

Manchanda has been using the technology for more than a year now but confesses she relies on her staff to make it all work.

“I know my part, but I don’t know any of the rest. I have fantastic people. Alone, I would never be able to do it.”

Currently, she sees about four patients per week virtually, but is considering building in another hour of virtual visits to her weekly schedule.

After she sees her patients in clinic and knows that they’re doing fairly well, she will set up a virtual visit if they’re agreeable. “Every other visit I want to make sure they come in so I can set eyes on them, examine them physically. It seems to work very well so far.”

Manchanda says seeing patients in their home via a computer or phone reveals more than a phone call alone can, and it also gives her a window into the patient’s home life.

“The other day, I was speaking to a lady in her 70s, she was sitting in her living room and she had this beautiful quilt on her chair. I learned that she loves to quilt. It’s an amazing connection you can make. It’s kind of like doing a house call. You can make different connections with the patient, connections you can’t make in your office.”

Many of her patients live in southern Indiana, so saving that travel time is a bonus for them as well.

The bottom line for Manchanda is that her patients be comfortable with their care – whether in the office or in their home.

“I think we need to embrace change. If you don’t jump in, someone else will.”

-- By Maureen Gilmer, IU Health senior journalist
Email: mgilmer1@iuhealth.org

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