Although the days of doctors making house calls have long since passed, telemedicine is bringing some of that personal touch to modern-day health care. Many doctors today visit their patients virtually — via Skype, texting, telephone, or online chat — and eHealth is also a business, with plenty of “commercial virtual visit” companies around to serve patients via smartphone app.

While all this convenient access to doctors sounds dandy, there are still some unknowns about whether the quality of care provided virtually holds up to the standards set by seeing patients in person within the doctor’s office. In a new study published in JAMA Internal Medicine, researchers set out to measure quality of care provided by commercial virtual visit companies, with the intention that this information could be of value to improving the care provided.

“Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses,” the researchers wrote. “In commercial virtual visits, patients access a website to be connected synchronously — via videoconference, telephone, or webchat — to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed.”

For the study, the researchers tracked 67 patients who attended a total of 599 commercial virtual visits from 2013 to 2014. Some 157 different doctors were included in the study; they were either internal medicine, emergency medicine, or family practice physicians. The patients presented their virtual doctors with one of six different conditions: ankle pain, streptococcal pharyngitis (strep throat), viral pharyngitis (sore throat), acute rhino sinusitis (sinus infection), lower back pain, and recurrent female urinary tract infection.

Throughout the study, the patients underwent a total of 372 videoconferences, 170 telephone talks, and 57 online chats with their doctors. The researchers reviewed these, in addition to patients’ medical history and physical exams, correct diagnoses, and the doctors’ adherence to guidelines. They found that the doctors asked all the recommended history questions and completed the right physical exam measures 69.6 percent of the time, made accurate diagnoses 76.5 percent of the time, and maintained guidelines for key management decisions 54.3 percent of the time.

It’s tough to determine whether these results mean that virtual doctor visits are worse than in-person visits. The researchers didn’t compare it with results from in-person visit studies, so it’s difficult to gauge whether they offer significantly lower quality of care or not.

What they could conclude, however, is that there isn’t much consistency between different virtual visit companies. “We found a significant variation across companies and by condition,” the authors wrote. “The patterns of variation we observed imply an opportunity to improve and point toward approaches to determine how to make these improvements.”

In an editorial published alongside the study, Dr. Jeffrey Linder and Dr. David Levine discuss the results, pushing for the technology aspect of medicine to improve its continuity. “[H]ealth information technology is in an awkward adolescence,” they wrote. Comparing current health information technology with popular communication sites like Facebook and Snapchat, they noted that “there are few ‘sticky’ experiences where people return again and again in health care.” They continued: “Health care in general and primary care in particular care would benefit from providing improved convenience and access, such as self-scheduling and expanded hours, but must also work to facilitate relationships or it will risk further fragmenting care.”

Source: Schoenfeld A, Davies J, Marafino B, Dean M, DeJong C, Bardach N. Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits. JAMA Internal Medicine , 2016.

Linder J, Levine D. Health Care Communication Technology and Improved Access, Continuity, and Relationships. JAMA Internal Medicine , 2016.