Taking Electronic Portals One Step Further
We know consumers increasingly prefer “on demand” care and it’s often the young, wealthy and busy who are the strongest potential telehealth targets. According to a 2014 Primary Care Consumer Choice Survey and Marketing and Planning Leadership Council interviews and analysis, 49 percent of those making more than $71,000/year like the convenience of telehealth so they don’t have to leave work early or take the day off. What’s surprising to some, but that plays out in my practice, is that those who are retired or nearing retirement are just as interested in learning about new technology, starting with our electronic patient portals.
Really, engaging patients through an electronic portal is the foundation of how we can make telemedicine work efficiently. It’s all about the ability for patients to view all their information, make sure it’s up to date, have a method to suggest changes or edits and then be able to reach back out to their provider not only electronically through telehealth, but also by easily scheduling an appointment.
Allowing patients to enter requests or schedule appointments through the portal is something we’ve been offering for the last five years. We’ve implemented this functionality as an integral part of patient engagement, but now we want to take it one step further.
Our approach is a stepwise workflow implementation, from patient messaging via phone to asynchronous care through e-visits and tele-consults and eventually to synchronous care with video visits and point-to-point video consults. The future state will also bring us remote monitoring capabilities including eICU, home monitoring and personal devices.
It’s not one-size-fits-all, though. Rather, it’s important to act in a way that’s most appropriate for the patient and the provider, under the right circumstances and in a way that fits a patient’s lifestyle. If she wants to receive care from her physician while still at work or at home – rather than having to take time out of her day to sit in traffic, skip lunch or arrange childcare – we should be able to use telehealth to make that happen.
Patient Visits of the Future
When we participate in asynchronous e-visits today, we do so over a series of questionnaires that help patients determine when a virtual visit is appropriate and when an in-office appointment is best. If a patient answers that they’ve had a fever of 103, we say they need to be seen, or if a patient is pregnant, we need to step up their care to the next level through manual intervention or automation, depending on the type of e-visit a patient is interested in.
There are self-triage programs available and some systems use them, but the challenge is they contain patient-entered information only, without references to data points, patient charts, history and multiple risk factors that are required to paint a complete picture of the appropriateness of care.
In the future, I believe we can take visits one level further by using information already available in patient electronic records. I envision a day when, if I have a patient who needs a follow-up for diabetes, I can rely on technology to determine the logical next steps by packaging information known about blood results, eye exams, and other risk factors, with the built-in logic to decipher whether a virtual visit can take the place of an office visit. A system that can operate using a sophisticated algorithm to look at multiple risk factors and data in a patient record and guide care is one that will work better, for all of us.
The future of telehealth will also offer the ability to filter information through a deliberate approach that doesn’t overwhelm physicians struggling to review an avalanche of messages and data points in a meaningful way. Clinicians and vendors alike have the opportunity to inject logic into an already complicated process, in a way that lets us continue to treat patients in the best way possible before crossing the threshold of an office’s front door.
These systems are still in their infancy but smarter days are ahead.
Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Informatics Officer at Mercy Health (www.mercy.com). He has nearly 20 years of experience in planning, implementation, training and follow-up of EHR installations in civilian and military populations and was one of the first physician users of a fully integrated EHR in Southern Ohio. He is a Fellow of both HIMSS and the American College of Physicians and serves on the HIMSS Quality, Cost and Safety Committee. Email him at firstname.lastname@example.org or follow him on Twitter (@StephenBeckMD).
Mercy Health (formerly Catholic Health Partners) is the largest health system in Ohio and one of the largest health systems in the United States, employing more than 32,000 employees in Ohio and Kentucky. With $6 billion in assets, Mercy Health operates about 450 health facilities, including 23 hospitals, eight senior living communities, five hospice programs and seven home health agencies.
Opinions expressed by HIT Consultant Contributors are their own.