Health system offers access to physicians—without an office visit

Contributing Writer
AMA Wire
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Novant Health executives and physicians did not want to create a traditional patient portal for their nonprofit, integrated health system of more than 460 clinics and 15 medical centers  spread across the Carolinas, Virginia and Georgia. Instead, they approach the technology as a tool to create a new venue of care that focuses on engaging patients, improving patient care and serving patients’ needs.

New offerings on the portal must be innovative and cutting edge. And they must be convenient. If they aren’t convenient, they won’t get used, said Aram Alexanian, MD, a family physician and the “optimization physician champion” across Novant Health’s medical group.

“It has to be high-quality care designed around the patient, not designed around the system of care,” Dr. Alexanian said during a talk at the MGMA/AMA 2017 Collaborate in Practice Conference in Chicago. “We want to be able to connect with our patients outside of our four walls.”

Novant’s patient portal—called MyNovant—has more than 720,000 users, and the number continues to grow. Through the portal, patients can send messages to their clinician, request prescription renewals, schedule appointments and download their entire medical record. New patients can go online and directly schedule an appointment with a primary care physician who is accepting new patients. Novant’s express care and urgent care departments have a “hold my place” feature through the portal that allows patients to schedule a time for an urgent-care visit.

And one feature that has taken off even faster than expected is what is dubbed the e-visit. With insurance companies contracting with companies to provide telehealth visits for their subscribers, Novant launched a video visit and an e-visit through MyNovant. These features allow patients to connect with doctors they have a relationship with instead of unfamiliar clinicians hired by the insurance company, either through real-time videoconferencing (video visit) or through a completed patient questionnaire and clinician response (e-visit). The service also is available to patients whose insurance does not cover telehealth.

Lauren Miller, Novant’s operational engagement project manager for clinical services, said they expected the video visit to be more popular than the e-visit because of the real-time, face-to-face interaction. But “we have been far more successful with the patients being engaged through the e-visits,” she said. So far, patients have completed more than 16,500 e-visits.

There is a finite list of symptoms that qualify for an e-visit. They are:

  • Sinus problems.
  • Red eye.
  • Diarrhea
  • Cough.
  • Vaginal discharge.
  • Urinary issues.
  • Back pain.
  • Pediatric diarrhea.
  • Pediatric ringworm.
  • Pediatric swimmer’s ear.
  • Pediatric lice.
  • Pediatric red eye.

Once a patient clicks on a symptom, a series of questions pops up, Dr. Alexanian said. The patient must answer every question and the information then goes to the physician’s nurse pool. A nurse decides whether the request is a good candidate for an e-visit and forwards it to the physician if it qualifies. The physician then reads the information and determines whether the patient can be treated through the e-visit. The patient receives a response within four hours of the initial request they send.

“It completely eliminates any in-person visit,” Miller said.

The cost: $30 for patients whose insurance companies don’t cover the e-visit. That is down from the $40 Novant initially charged. They lowered the fee after patient feedback showed $40 was too high. But other feedback on the e-visit has been positive, with 95 percent or more of patients rating other aspects of the e-visit as “good” or “very good,” including timeliness of response, likelihood of recommending, receiving the right information for the treatment, ease of initiating an e-visit, and needs being taken care of through the e-visit.

Miller said key to launching patient portals is encouraging patients to log in, gaining executive support before bringing it to the physicians and pushing past the fear of needing to have perfection before rolling out a feature. “We learn as we go,” she said.

The AMA has policy supporting coverage and payment for telemedicine that abides by principles aimed at ensuring quality of care. The Association’s telemedicine campaign includes model bills and resources for those advocating at the state level to use.

A module in the AMA’s STEPS Forward™ collection of practice improvement strategies can help physicians use telemedicine in practice. In the module, physicians will learn the four steps to adopting telemedicine and how to navigate the benefits and challenges of remotely monitoring patients. 

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Comments

Glad a regional system is offering such services. Small offices like ours have the agility to have been offering telehealth visits for years. Although our webportal has been a useful adjunct to patient care for over 10 years, we've found the follow-up of our patients to be invaluable using a telehealt visits. Other useful applications of the platform include co-management of patients with home health agencies. It is useful to see the environment of the patient and see the patient with vital signs, assessment of wounds, etc. Likewise, we've done the same with nursing homes. The telehealth reduces the increased bandwidth of phone calls, faxes and other communique' s from staff with 'real time assessment' in a more timely manner. Luckily, the Commonwealth of Virginia is a 'parity state' which allows for billing the insurance companies for these services or... using Chronic Care Management CPT codes for such services. "Tripp" Bradd, MD Skyline Family Practice Front Royal, VA
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