A hospital system in Ohio is trying to alleviate some of the most common patient complaints by helping them avoid a trip to the hospital or physician’s office. Instead, patients can interact with a physician by email or a live video encounter.
OhioHealth recently began a program in which four of its employed doctors see some of their established patients for primary care visits via video and online consultations. The program started in November 2015 and, if successful, OhioHealth plans to expand it to other physicians. Each of the doctors is expected to see 10 patients via video and complete 30 online exchanges during the pilot period.
Doctors at OhioHealth and Ohio State University’s Wexner Medical Center have used telemedicine for several years to care for stroke victims at outlying community hospitals across the state, notes David Applegate II, MD, chief of primary care transformation at OhioHealth. Implementing the telemedicine option was made possible by the hospital’s conversion over to an electronic medical record (EMR), which allows easier patient access for billing, scheduling, test results, and other information. The EMR allows the patient to create an account that is used for establishing secure connections online.
OhioHealth is offering both video consultations and what it calls “e-visits.” Video consultations are face-to-face with the physician in real time, and e-visits are email exchanges with the physician. Both can improve patient satisfaction by eliminating the hassle of a trip to the hospital or doctor’s office when an in-person examination is not really necessary.
For appropriate patients, it will save patients hours of drive time and getting off of work or making it to a doctor’s office in the middle of winter, Applegate notes.
“These are for conditions that usually do not require a physical exam and the encounter is more a series of questions,” Applegate says. “If we ask 18 to 30 questions and update their allergy and medication lists, we can often make a determination that a visit is not necessary and we can respond with advice by email. But if you answer some of the questions in a certain way, it will trigger a response that says you have to come see us in person. Those questions are up front so that if you can’t do an e-visit, it tells you up front and you don’t have to do the rest of the questions.”
E-visits are for these non-urgent medical conditions: back pain, cough, eye redness, indigestion and heartburn, urinary problems, cold and sinus, diarrhea, headache, tired (fatigue,) and vaginal discharge/irritation. To initiate an e-visit, the patient fills out a questionnaire and sends it in. The physician then responds within 24 hours, and usually much faster.
Other conditions, such as diabetes management, can be addressed with video visits. These encounters require a conversation between the patient and physician, but usually not a hands-on physical exam, Applegate notes. For video visits, the physicians have video exam rooms in their offices. Patients are able to make appointments for video visits and are billed the same as for an office visit.
“We try to be sensitive to the fact that patients might be at work or have other constraints, so we tend to schedule video visits first thing in the morning or right after lunch, and we try to make sure physicians are on time for those,” Applegate says.
The doctor sits in the room looking at two large monitors, the patient on the left and the chart on the right, so the doctor can take notes as they go.
In addition, OhioHealth is expanding how the video visits can be used. If a patient is at the physician’s office but a family member elsewhere wants to join the discussion and hear what the doctor says to the patient, that family member can join them through the video connection. Similarly, Applegate explains, the doctor could bring a pharmacist into the conversation with the patient.
“The quality of the experience is being monitored, and we’re watching how many patients end up coming to the office within three days of the e-visit or video call,” Applegate says. “The goal here is to get patients a quick answer when that is feasible and responsible, so that they don’t spend half a day sitting in a waiting room to spend just a few minutes getting an answer from the doctor. That has to improve the patient experience.”
