In The Not Too Distant Past, Making Rounds For Doctors Often Meant Paying Visits To Patients’ Homes.
But with the rise of hospital-based care (and the requisite office-based diagnostic equipment), the quaint notion of the house call went by the wayside. Instead of doctors coming to the sick, the sick were compelled to venture out and find their way to the doctor’s office.
For citizens in large metropolitan areas like Oklahoma City, that change represented a minor inconvenience. Population centers attract service providers, including doctors, in great enough numbers to accommodate the need. For residents of isolated rural areas, however, diminished access to doctors can lead to damaging deficiencies in basic care. Now changes in technology, which once helped herd us to the doctor’s office, are bringing the doctors back to our doorsteps.
The emergence of widespread, broadband Internet access and the ubiquity of smart phones and other interactive devices is driving medicine back to the future. While doctors aren’t ringing doorbells, they are scheduling online appointments and responding to electronically initiated inquiries. Patients are once again benefiting from professional care in their homes (or at least much closer to them), albeit at their fingertips and not at their bedsides.
Telemedicine is not a trend or a gimmick. A 2014 study by Deloitte estimated that in North America,
1 out of every 8 appointments during the year – some 75 million encounters – would be conducted via “e-visit.” Deloitte tabbed the cost savings at $5 billion compared to conventional patient visits to doctors’ offices. It is tempting to view telemedicine or e-visits as merely a cost saver for providers (and, cynically, as a pocket-liner for shareholders of publicly traded companies). But that would be taking the easy way out.
“We wanted to offer this as part of our mission to improve the health of the people and communities we serve. It allows us to have a more personable experience with our patients.”
– Brooke Cayot
“Telemedicine is an important part of the care we provide to people in rural areas who tend to have to travel for specialized care,” says Kyle Nondorf, Executive Vice President and Chief Operating Officer at St. Anthony Hospital. The Oklahoma City hospital and its affiliate sites’ telemedicine program went live in 2010. The program was initiated in response to its rural partners’ desire for better follow-up care after acute care incidents, such as those involving emergency room visits. St. Anthony predominately uses their service for specialist visits with a focus on chronic disease management.
In short, while a virtual doctor visit won’t help you if you need emergency care for a heart attack, the increased quality in follow-up care can keep you from landing in dire straits again. “If you live in a rural area, you may have to drive four hours one way to see a cardiologist,” Nondorf explains. The reality of lost work time or competing obligations can make that trek difficult at best.
Using technology to take the specialist to the countryside breaks down a contingent of barriers to access. “Continuity of care is extremely important in chronic disease management,” Nondorf elaborates. Accordingly, “[Telemedicine] can be a transformational experience for these patients.”
Online house calls are not restricted to chronic care. Mercy Hospital’s e-visit program and Integris Health’s Virtual Visits provide portals for more mundane afflictions ranging from eye inflammation to bronchitis to urinary tract infections. For Mercy the goal is simple. “We seek to meet patients wherever they are,” says Dr. Jesse Campbell, Division Chair for Primary Care for Mercy Clinic West division. “Many patients feel they are too busy to make an appointment in the middle of a work day,” Campbell continues, “so Mercy was looking for a way to allow medical care to be provided for a certain list of illnesses through the patient portal.”
Mercy patients present their symptoms via the online MyMercy portal, which leads to a series of follow-up questions. Patients submit answers to the provider through a secure electronic health record. A doctor reviews the responses, makes a diagnosis and prescribes medication or gives advice to the patient. In most cases, the response comes within a matter of a few hours. If the provider determines that an in-person visit is required, the patient can schedule an appointment online.
Integris Health’s Virtual Visit program provides around-the-clock access to medical professionals for patients with Internet connectivity and a device with video capability. “We wanted to offer this as part of our mission to improve the health of the people and communities we serve,” says Brooke Cayot, Media Team Lead at Integris Health. The video-based service also makes for meaningful encounters. “It allows us to have a more personable experience with our patients,” explains Cayot.
After a short registration process, the patient sees a board-certified Advanced Practice Nurse or Medical Doctor for a one-on-one consultation. “Face-to-face no longer has to mean in person,” says Cayot. “This is a way for healthcare to meet that expectation.” Integris Health patients do not need an appointment to conduct an online visit, and the entire process usually takes about a half hour. For conditions that cannot be adequately addressed through the Virtual Visit portal, patients may be referred to an emergency room, Access Medical Center or primary care physician.
Online medicine may still smack of gimmickry, but the underlying economics indicate that it is here to stay. Some benefits to patients are clear – convenience for some, access for others – but other societal benefits are less obvious.
Consider again the plight of the country dweller, who may live hours away from a full-service medical center. While the rural hospital may not have everything the big city version has to offer, it is a vital component of its community. Although patients in outlying areas may be virtually visiting a physician in Oklahoma City, most of their care is still administered locally.
“The e-visit concept keeps patient information in one easily accessed record instead of at various urgent care centers across the city.” – Dr. Jesse Campbell
For the cardiology patient in Cordell, for example, that means many routine examinations and tests can still be completed near home. The local healthcare network doesn’t lose their patient and, in return, the patient doesn’t lose access to local healthcare. St. Anthony’s Nondorf explains the attraction of online visits for rural hospitals and healthcare facilities. “[Telemedicine] keeps healthcare they may lose in their local communities,” he says. “Small community hospitals are often vital to rural areas in terms of employment and the local tax base.” Most crucially, in terms of patient care, is access. “If those hospitals don’t exist and you need emergency care, you may have to travel two hours to the next closest facility.”
Internally, electronic visits help providers operate more efficiently and cost-effectively. Says Mercy’s Dr. Campbell, “The e-visit concept keeps patient information in one easily accessed record instead of at various urgent care centers across the city.” Visits are also direct-billed to client credit cards as well, allowing providers to circumvent the occasionally arduous practice of processing claims through insurance companies. Fees for virtual visits typically fall in the range of the average insurance co-payment, so patients aren’t paying a premium for accessibility.
The providers interviewed for this story all report positive responses to their programs and increasing numbers of participants. St. Anthony’s specialists see dozens of patients through their remote telemedicine program each month. Mercy averaged over 250 monthly e-visits from December through February. Visits typically spike up to 400-500 per month in the spring. Integris, which launched its Virtual Visit portal in February, saw double their projected quota for the first month
of live service.
Convenience and efficiency aside, in many cases there is still no substitute for a visit to the doctors’ office. An in-person visit with a specialist, whether cardiologist, dermatologist or endocrinologist, is going to be required from time to time and particularly at the point of initial diagnosis during acute episodes. For specialist patients, the follow-up care allows providers to be better stewards of their financial resources because continuing care can be provided at a fraction of the cost of critical care. By keeping patients with chronic conditions out of acute settings (i.e., emergency rooms), overall costs for healthcare go down.
“Online health care is not a substitute for care at hospitals or primary care clinics,” concurs Integris Health’s Cayot. “Rather, we see it as a chance to enhance the service and care we provide,” she continues. “Our goal is to provide the best access to care, which means the right care in the right place at the right time.” For someone who thinks they have a sinus infection, an online query can yield a diagnosis more quickly than a visit to the doctor’s office – and potentially keep you from sitting in a room full of people who know they are sick.
Hospitals and doctors’ offices won’t be going away anytime soon, so put your inner hypochondriac at ease. By keeping waiting rooms – and emergency rooms – less crowded, electronically instigated healthcare should make those visits more convenient. With better overall care in underserved areas of the state and easier healthcare access in population centers, virtual medicine promises to make Oklahoma a healthier place. A healthier population can keep rising healthcare costs in check. If the twenty-first century version of the house call can keep our collective medical bills lower, that’s a trend worth embracing.