This document discusses eVisits, which are online medical evaluations between patients and providers. It provides an overview of eVisits, including relevant CPT codes, research on their efficiency and patient preferences, and stats on eVisit usage at HealthPartners and UPMC. The presentation notes that eVisits provide benefits to patients, providers, insurers and employers by increasing access and convenience while reducing costs compared to office visits. However, challenges include ensuring understanding of appropriate eVisit cases and aligning compensation with other care modalities like phone visits.

1. eVisits
#evisit
Minnesota Epic User Group
Summer 2009
John Butler MD FACP, HealthPartners
Asst Med Director Informatics; Internal Medicine physician

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. “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. 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. 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. 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. Research?
Efficiency:
It takes 57% less time to complete
an e-visit vs. phone call.
Rosen, Pediatrics 10/07

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. 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. Research?
Emerging:
Currently 68% of Dutch consumers
now bank online. By 2013, 81% of
Dutch consumers will use Internet
banking.
Forester.com

11. Research?
Emerging:
Currently 68% of Dutch consumers
now bank online. By 2013, 81% of
Dutch consumers will use Internet
banking.
Forester.com

12. 2006: What do physicians think about
e-visits?

13. 2006: What do physicians think about
e-visits?
5% 8%
•skepticalgood
nothing
•interested
•enthusiastic!!
39%
48% •

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. Physician focus group 2006
Disadvantages of eVisits:
Patient time expectations- rapid response
Long threads
Why would patients pay for this?…vs phone call

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. 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. 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. e-Visits and gender
male female

20. e-Visits and gender
male female
40%
60%

21. e-Visits and age

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. 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. Online Patient Services Features

27. 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

28. What doesn’t work well
• HealthPartners
– Patient and staff understanding of what is an eVisit
– Compensation
– Disparities with phone care
– Nurse triage

29. 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

30. 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.”

32. Three worlds:
Financial
Clinical
Operational

33. Three worlds:
Financial
Clinical
Operational

34. 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?

35. 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?

36. 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?

37. John Butler, MD
HealthPartners
#evisit