Milestone 22 Summary

Description: Practice uses technology to offer scheduling and communication options that improve patient access by including alternative visit types and electronic communication approaches.


What does success look like?

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Practice relies on face to face encounters and phone interactions with patients. Practice is considering the use of technology to offer alternatives to face to face visits but has not yet formalized this practice nor communicated the options to patients. Practice has the capability of providing alternative visit types or communication media but these are in limited use. Practice offers multiple forms of alternative visit types (e.g. email, Skype, or tele-visits) or communication media (e.g. portal, texting) and has integrated these alternatives into regular practice.

Note: numbers are PAT scores


Why is this important?

As healthcare becomes increasingly more integrated with technology, it is important to utilize non-traditional avenues to increase patient access to their care team. Telemedicine can be used to consult, diagnose, monitor and treat patients across geographic regions.1,2 For rural patients, geographical barriers can inhibit access to care.3 These individuals experience lengthy travel times over long distances and many rural clinics cannot afford to staff specialty clinicians. Telemedicine decreases this isolation by connecting rural clinics to multi-specialty clinics and is particularly effective for mental health, dermatology, and other specialties.1-4 While especially effective for rural America, telemedicine can also provide services for patients who need care that may not warrant an in-office appointment. By providing alternatives, practices can increase patient access, reduce unnecessary ED visits, readmissions or misdirection of health care utilization. These outcomes lead to reduced cost of health services, openings in the schedule for patients who do need to be seen in the office , and the ability to provide timely and effective care to patients in a more convenient setting.2-4

Studies have indicated that telemedicine is especially effective for specialties like psychiatry or neurology where assessments can be conducted verbally and for dermatology where diagnoses are predominantly dependent on visuals such that photographs or video conference calls are comparable alternatives to in-person assessments.2 Patients have reported satisfactory interactions with video-conferencing and this alternative can be more cost effective for the patient and provider.4 In addition to consultations and appointments, with the right equipment, telemedicine provides an opportunity for home monitoring.  Devices can monitor vitals and send that data to clinicians who can adjust the treatment as needed.4 Home monitoring can be useful for patients who are recovering from surgery and for whom the travel time and effort for in-office check-ins may be detrimental to their recovery.


Potential Tactics

  • Use secure email visits
  • Use telemedicine visits for patients in rural areas or for specialty consultations
  • Establish processes for receiving payment for e-visits and e-consults
  • Develop protocols for monitoring specific non-urgent conditions with phone calls
  • Use of portal and electronic reminders
  • Use patient portals to avoid unnecessary visits to provider and answer questions by appropriate care team member
  • Have portal messages go to the team, not just provider
  • Implement a system for ongoing review of workflows and train on updates
  • Assess access in rural areas and consider alternative web access approaches
  • Use web-based video technology for home-bound patients

 


Tools and Resources

 


What might this look like in practice?

Telemedicine basics begin with patients understanding the technology currently available. While a growing number of practices have EHRs in-place, it is important to maximize patient education on the functions and capabilities these tools possess. By reviewing the features briefly at check-in or providing a printed ‘how-to guide’ that is placed in common waiting areas, patients can learn about these alternatives to in-person provider contact. Patient portals, when optimized to their greatest ability, can allow for patients to contact the provider and team throughout the day (including non-clinic hours), provide a written record of the concern, notify the care team to respond and provide a secure avenue for follow-up. Appropriate uses for portal contact can include (but are not limited to): diagnosis/treatment inquiries, medication follow-up and adjustments to prescriptions, photographs of progress (e.g., suspicious mole inquiries, follow-up on site healing, etc.) all of which can decrease the time, resources and cost spent for both the care team and patient on unnecessary in-office visits. From here, practices can further develop their telemedicine capabilities by adding designated hours for HIPAA-compliant video conferencing appointments and by incorporating home monitoring devices into the treatment plan. For rural clinics, providers could possibly designate an exam room for video-conferencing specialty consultations and set up same-day time slots so that specialty appointment can be hosted in-office, decreasing commute time for the patient.

 


References

  1. Wurm, Elisabeth MT, et al. “Telemedicine and teledermatology: Past, present and future.” JDDG: Journal Der Deutschen Dermatologischen Gesellschaft 6.2 (2008): 106-112.
  2. Hersh, William R., et al. “Diagnosis, access and outcomes: Update of a systematic review of telemedicine services.” Journal of telemedicine and telecare 12.2_suppl (2006): 3-31.
  3. Puskin, Dena S. “Opportunities and challenges to telemedicine in rural America.” Journal of Medical Systems 19.1 (1995): 59-67.
  4. Hilty, Donald M., et al. “The effectiveness of telemental health: a 2013 review.” Telemedicine and e-Health 19.6 (2013): 444-454.