Evisit Mneug B

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  • I like the potential of evisit but it poses 2 problems for me. It looks like it will cost me $20 when it should have a minimal cost if any at all. Isn't it really e-mail? Also, recent experience showed that nurses read my messages to Dr. Butler and I found that embarassing because of the sensitivity of the medical issue.
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Evisit Mneug B

  1. 1. eVisits #evisit Minnesota Epic User Group Summer 2009 John Butler MD FACP, HealthPartners Asst Med Director Informatics; Internal Medicine physician
  2. 2. HealthPartners Medical Group & • Integrated health system • Non-profit health plan: member governed, over 1,000,000 members • 600 physicians • 35 medical & surgical specialties • 31 clinics • 435 bed Level 1 trauma center • 10,645 Epic users • Minnesota & Western Wisconsin
  3. 3. “For everywhere we look, there is work to be done. The state of the economy calls for action, bold and swift, and we will act - not only to create new jobs, but to lay a new foundation for growth. We will build the roads and bridges, the electric grids and digital lines that feed our commerce and bind us together. We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost. … All this we can do. And all this we will do.”
  4. 4. Online Medical Evaluation - eVisits • CPT Codes – 99444 or 98969 • E/M Service provided by a physician (or other qualified) to a patient using Internet resources, in response to the patient’s online inquiry • Used for advice, diagnosis and/or therapy that previously would have required a face-to-face interaction in the office • The patient and provider must have a previously established therapeutic relationship
  5. 5. Online Medical Evaluation - eVisits physician non-physician • CPT Codes – 99444 or 98969 • E/M Service provided by a physician (or other qualified) to a patient using Internet resources, in response to the patient’s online inquiry • Used for advice, diagnosis and/or therapy that previously would have required a face-to-face interaction in the office • The patient and provider must have a previously established therapeutic relationship
  6. 6. What an eVisit is not • Conditions with a significant visual component • Clarify issues from previous visits - 7 days • Diagnostic results reporting • Message from patient seen in person afterward as a result • Discussion of chronic problem with no change in management • Medical advice from a nurse
  7. 7. Research? Efficiency: It takes 57% less time to complete an e-visit vs. phone call. Rosen, Pediatrics 10/07
  8. 8. Research? Patient centered care: Where as 72% of physician statements were devoted to information exchange, the remaining communication responds to emotions and acts to build a therapeutic partnership. Roter. Health Communication 2008
  9. 9. Research? Preferences: In a study of MyChart users, telephone was never the preferred channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. Hassol JAMIA 11/04
  10. 10. Research? Emerging: Currently 68% of Dutch consumers now bank online. By 2013, 81% of Dutch consumers will use Internet banking. Forester.com
  11. 11. Research? Emerging: Currently 68% of Dutch consumers now bank online. By 2013, 81% of Dutch consumers will use Internet banking. Forester.com
  12. 12. 2006: What do physicians think about e-visits?
  13. 13. 2006: What do physicians think about e-visits? 5% 8% •skepticalgood nothing •interested •enthusiastic!! 39% 48% •
  14. 14. Physician focus group 2006 Advantages of eVisits: Time to consult, research problem Pt concerns not interpreted/abridged by message recorder More concise. No, “Oh, by the way” Easier to do when time allows
  15. 15. Physician focus group 2006 Disadvantages of eVisits: Patient time expectations- rapid response Long threads Why would patients pay for this?…vs phone call
  16. 16. Physician focus group 2006 What they said about disadvantages… “It is a sad state of affairs to see the proud practice of medicine reduced to typing on a computer.” “We will never get away from work. Where ever there is computer access, we will be caring for patients.” “Designed as a marketing tool, not for better patient care.”
  17. 17. Target Audience for eVisits • Busy patients can save 3 hours spent on an office visit • Parents with young children • Patients who are chronically ill • Adult children taking care of their aging parents • Patients who are traveling
  18. 18. Message handling Messaging Options Any provider with whom completed office visit within 3 years Message Routing Pools (reception, triage/RN, care team) Expected Response 1 business day Time Actual Response 96% within 1 business day Time Compensation .5 WRVU
  19. 19. e-Visits and gender male female
  20. 20. e-Visits and gender male female 40% 60%
  21. 21. e-Visits and age
  22. 22. e-Visits and age 50.0 37.5 25.0 12.5 0-18 18-24 25-34 35-44 0 45-54 55-64 >65
  23. 23. Messaging Stats UPMC HealthPartners Messages 1,218 9,241 Volume per Month eVisit Volume 57 93 Per Month Top Diagnoses 1.Sinusitis/ URI 1. Behavioral Health for eVisits 2. Back Pain 2. Hypertension 3. Dysuria 3. Diabetes 4. Cough 4.Hypercholesterolemia
  24. 24. Online Patient Services Features
  25. 25. What works well • HealthPartners – Patients love to be able to access the clinic this way – Chronic care model, patient centered – Some staff find it faster – In some cases, more cost effective than an office visit – Nursing triage
  26. 26. What doesn’t work well • HealthPartners – Patient and staff understanding of what is an eVisit – Compensation – Disparities with phone care – Nurse triage
  27. 27. Benefits • Patients – Better access to physician/provider – Fast, convenient service – Available 7 x 24 – Affordable • Providers – Faster/easier than phone care; it’s asynchronous- fits in – Enhance the patient and provider relationship- continuous care – In-between care for chronic conditions • Insurers – Cheaper than an office visit • Employers – Reduced absenteeism
  28. 28. Patients Quotes “I LOVE the ability to contact my physician electronically!!!! I sent a message last night around 7pm & received a response already at 10am this morning. I sent detailed information that would answer most questions... The doctor sent a response AND send a script...! It was so great not to take time off of work just to go to the clinic …Thank you!” “You folks always do take good care of us... Thanks for your prompt reply! This MyChart business is just a miracle! I'm so grateful for it! (:>)” “Once again, I'm really pleased with the Online Patient Services. These message exchanges save a lot of time, yours and mine.”
  29. 29. Three worlds: Financial Clinical Operational
  30. 30. Three worlds: Financial Clinical Operational
  31. 31. Clinical ✤ Institute of Medicine... ✴“Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face to face visits.” ➡How can this tool among other tools help us achieve this goal for acute and chronic care?
  32. 32. Financial ✤ Our reimbursement system supports face to face and procedural care. ➡How can we use this tool for care within the bounds of our current system? ➡What changes in the reimbursement system might better support this new kind of care?
  33. 33. Operational ✤ Our traditional clinic model is based on a schedule... ➡How might e-visits be integrated into our current flows? ➡What changes in our current flow would better support IOM goals?
  34. 34. John Butler, MD HealthPartners #evisit

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