These virtual office visits use artificial intelligence and text messaging to allow real physicians to diagnose patients, write prescriptions, and order clinical laboratory tests

Clinical laboratories may soon be receiving test orders from physicians who never see their patients in person, instead evaluating and diagnosing them through a smartphone app. In response to major changes in the primary care industry—mostly driven by consumer demand—mobile app developers are introducing new methods for delivering primary care involving smartphones and artificial intelligence (AI).

Medical laboratories and pathology groups should prepare for consumers who expect their healthcare to be delivered in ways that don’t require a visit to a traditional medical office. One question is how patients using virtual primary care services will provide the specimens required for clinical laboratory tests that their primary care providers want performed?

Two companies on the forefront of such advances are 98point6 and K Health, and they provide a glimpse of primary care’s future. The two companies have developed smartphone apps that incorporate AI and the ability to interact with real physicians via text messaging.

Virtual Primary Care 24/7 Nationwide

Dark Daily has repeatedly reported that primary care in America is undergoing major changes driven by many factors including increasingly busy schedules, the popularity of rapid retail and urgent care clinics, consumer use of smartphones and the Internet to self-diagnose, and decreasing numbers of new doctors choosing primary care as a career path. 

Writing in Stat, two physicians who had just completed internal medicine residencies, explained their own decisions to leave primary care. In their article, titled, “We were inspired to become primary care physicians. Now we’re reconsidering a field in crisis,” Richard Joseph, MD, and Sohan Japa, MD, cited factors that include long hours, low compensation in comparison with specialty care, and deficiencies in primary care training. At the time of their writing they were senior residents in primary care-internal medicine at Brigham and Women’s Hospital in Boston.

They also pointed to a decline in office visits to primary care doctors. “Patients are increasingly choosing urgent care centers, smartphone apps, telemedicine, and workplace and retail clinics that are often staffed by nurse practitioners and physician assistants for their immediate health needs,” they wrote.

One solution to declining populations of primary care physicians is a smartphone app created by Seattle-based 98point6. The service involves “providing virtual text-based primary care across the entire country, 24/7 of everyday,” explained Brad Younggren, MD, an emergency physician and Chief Medical Officer at 98point6, in a YouTube interview. “It’s text-based delivery of care overlaid with an AI platform on top of it.”

The service launched on May 1, 2018, in 10 states and is now available nationwide, according to press releases. 98point6 offers the service through individual subscriptions or through deals with employers, health plans, health systems, and other provider organizations. The personal plan costs $20 for the first year and $120 for the second, plus $1 per “visit.”

Here’s how it works:

  • Subscribers use text messaging to interact with an “automated assistant” that incorporates artificial intelligence. While messaging, they can describe symptoms or ask questions about medical topics.

“After the automated assistant has gathered as many questions as it deems necessary, it hands [the information] off to a physician,” Younggren said. In most cases, all communication is via text messaging. However, the doctor may ask the subscriber to send a photo or participate in a video meeting.

  • The doctor then makes a diagnosis and treatment plan. Prescriptions can be sent to a local pharmacy and the subscriber can be referred to a clinical laboratory for tests. LabCorp or Quest Diagnostics are preferred providers, but subscribers can choose to have orders sent to independent labs as well, states the company’s website.

Younggren claims the company’s physicians can resolve more than 90% of the cases they encounter. If, however, they can’t resolve a case, they can refer the patient to a local physician. And because most of 98point6’s interactions with subscribers are text-based, that messaging serves as reference documentation for other doctors, he said.

“We’ve set out to dramatically augment the primary-care physician with deep technology by delivering an on-demand primary-care experience,” Robbie Cape (above), CEO and co-founder of 98point6, told Modern Healthcare. (Photo copyright: Seattle Business Magazine.)

The 98point6 physicians are full-time employees and work with the company’s technologists to improve the AI’s capabilities, Younggren said. The company claims its doctors can diagnose and treat more than 400 conditions, including: allergies, asthma, skin problems, coughs, flu, diabetes, high blood pressure, and infections. For medical emergencies, subscribers are advised to seek emergency help locally.

98point6 also can function as a front end for interacting with patients in health systems that have their own primary-care doctors, Younggren said. The company’s health system clients “don’t actually have a good digital primary care front end to deliver care,” he said. “So, we can essentially give them that, and then we can also get some detailed understanding of how to coordinate care within the health system to drive patients to the care that they need.” For example, this can include directing the patient to an appropriate sub-specialist.

Leveraging Patient Data to Answer Health Questions

K Health in New York City offers a similar service based on its own AI-enabled smartphone app. The app incorporates data gleaned from the records of more than two million anonymous patients in Israel over the past 20 years, explained company co-founder Ran Shaul, co-founder and Chief Product Officer, in a blog post.

The software asks users about their “chief complaint” and then compares the answers with data from similar cases. “We call this group your ‘People Like Me’ cohort,” Shaul wrote. “It shows you how doctors diagnosed those people and all the ways they were treated.”

The K Health app is free, but for a fee ranging from $14 for a one-time visit to $39 for an annual subscription, users can text with doctors, the company’s website states.

Unlike 98point6, K Health’s doctors are employed by “affiliated physician-owned professional corporations,” the company says, not K Health itself.

“The doctor you chat with will discuss a recommended treatment plan that may include a physical exam, lab tests, or radiology scans,” states K Health’s website. “They may send you directly for some of these tests, but others will require you to visit a local doctor.”

These are just the latest examples of new technologies and services devised to help patients receive primary care. How a patient who uses a smartphone app gets the necessary clinical laboratory tests performed is a question yet to be answered.

Clinical laboratory leaders will want to watch this shift in the delivery of primary care and look for opportunities to serve consumers who are getting primary care from nontraditional sources.

—Stephen Beale

Related Information:

Bringing Primary Care to Smartphones

We Were Inspired to Become Primary Care Physicians. Now We’re Reconsidering A Field in Crisis

How K Delivers Free Personalized Healthcare Information

Robbie Cape Wants Everyone to Have Access to Affordable Primary Care

98point6 Inc.’s Hot Health Care App Is Attracting Investors

Consumer Trend to Use Walk-In and Urgent Care Clinics Instead of Traditional Primary Care Offices Could Impact Clinical Laboratory Test Ordering/Revenue

JAMA Study Shows American’s with Primary Care Physicians Receive More High-Value Care, Even as Millennials Reject Traditional Healthcare Settings

As Primary Care Providers and Health Insurers Embrace Telehealth, How Will Clinical Laboratories Provide Medical Lab Testing Services?