Most ED-based telemedicine pilots focus on providing care to patients who present to the ED with low-acuity conditions. Administrators of these programs note that the goal is to reduce wait times and allow on-site providers to focus on patients with more complex and acute care needs. However, what if patients with less acute needs don’t need to present to the ED or any other care setting? Several health systems believe that giving patients the ability to link with a provider from any location at any time has the potential not only to positively address the kinds of access problems that drive people to the ED, but also to deliver the type of convenience that healthcare consumers crave.

Miami-based Baptist Health South Florida is among a growing number of health systems that are unveiling telemedicine programs to deliver precisely this kind of care. With its new Care On Demand program, consumers are able to secure online access to board-certified physicians at any time of the day or night, with no need for an appointment.

David Mishkin, MD, serves as medical director of the Care On Demand program.

“This program is not for high-acuity conditions, but if [patients log in with an acute problem], I will handle them appropriately, make sure they go to an appropriate setting to be treated, and give them the best advice I can,” he explains. “It really creates the ability to virtually triage these patients, and that is a great opportunity.”

Mishkin still works as an emergency physician, but he also has spent time seeing patients virtually for the past two years.

“At the end of the day, what I always tell clinicians is that being a clinician is all about communication, so it is really no different whether you are at the patient’s bedside or not,” he says. “The [Care On Demand] application also enables the patient to submit questions to the provider, and the provider can actually receive those questions through the platform site, and there can be further correspondence.”

Providers in the virtual program have access to a patient’s clinical information, and they are able to make recommendations and prescribe medications as needed. Further, non-English-speaking patients can be directed to providers who speak their native language, Mishkin observes.

The program is new, so it is not yet clear what, if any, effect it will have on ED volume or any other aspects of healthcare delivery. However, Mishkin believes the approach will expand access to quality care.

“There is a lot of opportunity to educate patients,” he says. “The visit is uninterrupted and patients appreciate it.”


  • David Mishkin, MD, Emergency Physician and Medical Director, Care On Demand, Baptist Health South Florida, Miami. Phone: (786) 596-6284.