The virtual physician visit is becoming a reality.

Companies that promise patients the chance to see a physician through video linkups are pushing into the mainstream. One is making it possible for anyone in the state of Hawaii to talk to a doctor of his or her choice via a webcam -- in a visit that could be reimbursed by the patient's health plan.

Meanwhile, in an effort to cut costs, a chain of retail clinics in Houston has replaced in-person visits to a nurse practitioner with online, webcam-enabled visits with doctors across town.

Telemedicine started as a way to remove access barriers. But it is now driven by people who value the convenience it offers, said Joseph Kvedar, MD, director of the Center for Connected Health, a Boston-based nonprofit group, affiliated with Partners HealthCare, whose stated mission is to expand the availability of medical care outside traditional settings.

The improved quality of the technology, the scale of adoption and the idea of health plans reimbursing for those visits have the potential to be game-changing, experts say. Proponents of telemedicine don't believe it will ever replace traditional practice-based care, but they do see it as a way to ease the load for busy physicians and overcrowded emergency departments, Dr. Kvedar said.

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