The Doctor Will See You Now: Leveraging Telehealth to Better Connect Providers with their Patients
Many people don’t mind seeing their doctor; it’s the getting there that causes problems. Between travel, traffic, trying to find parking, and waiting to be seen in a busy clinic, it’s no wonder people put off scheduling appointments. Getting to the doctor can be even more difficult for patients with limited mobility, no transportation, or those who just can’t take time off work. People are busy and taking care of their health can be anywhere from an inconvenience to an immense burden. To combat this common problem, clinicians across the Partners HealthCare network are trying to leverage technology like video, secure messaging, telephone, and smartphone apps (which are grouped under the umbrella term “telehealth”) to more easily check-in with their patients. This not only gives our patients greater access to their physicians, it gives them the gift of time.
“There is a large amount of symptom and medication management, shared decision making, and care coordination that providers can deliver remotely without making their patients take time off work or sit in traffic,” says Adam Licurse, MD, a primary care physician at Brigham Health and the Medical Director for the Telehealth Programs at both the Center for Population Health and Brigham and Women’s Hospital.
One of the technologies used to connect physicians and their patients is eVisits. These visits, which can be initiated by either the doctor or the patient depending on the situation, are secure questionnaire-based messages sent over the Partners Patient Gateway, our online patient portal. The Center for Population Health is working with primary care and specialty sites using our electronic health record system, Epic to offer different kinds of eVisits.
A patient can initiate an eVisit for mild, acute conditions like sinus problems, red eye, and diarrhea, among others. An eVisit allows patients to email specific questions and symptoms to their primary care provider or care team. Within one business day, their clinician will email them back with a diagnosis and treatment plan. In 2017, patients initiated 1,671 eVisits through primary care clinics at Brigham Health, Massachusetts General Hospital, and Newton-Wellesley Hospital. Following an eVisit physicians have the ability to order labs and prescribe medication. If they believe the patient needs a higher degree of medical attention, they can schedule an in-person appointment.
eVisits initiated by the provider are usually used for routine follow-up care for chronic conditions. For example, if a patient has gestational diabetes, her primary care doctor or endocrinologist can check-in with her to closely monitor her symptoms and prevent complications. Instead of coming back into the office every week or every other week, the physician can schedule an eVisit that the patient can complete over Partners Patient Gateway. In 2017, clinicians at Mass General and North Shore Health System completed 9,841 provider-initiated visits.
Michelle* has used the eVisits tool to regularly check in with her psychiatrist at Massachusetts General Hospital. For about three months, her doctor recommended scheduling an hour-long weekly check-in for evaluation and monitoring. She explains that the eVisits took out the stress out of having to travel to her appointment and saved her the expense of parking. “At first I was hesitant to use eVisits because I did not want to lose the familiarity and comfort with a face-to-face visit with my provider,” she says. “But I realized that connecting with my provider through this forum felt like I was in the same room with them. I didn’t lose any of the benefits that I expected to from not going into the office for a face-to-face meeting.”
Provider initiated eVisits consist of a survey which asks a lot of the same questions a physician would ask in the office. If a patient’s answers look normal, then the patient is good to go. If there are any red flags after reviewing the patient’s answers, the doctor can call them right away to schedule an in-person follow-up.
Neelima Singh, MD, an Endocrinologist at North Shore Health System, is an enthusiastic user of Partners eVisits. They allow her to connect with patients on a more-timely schedule and frees up her office time to see more critical patients in-person. She explains that patients often don’t have time to come back as quickly as she wants them to, they can forget to call with their blood sugars, or Dr. Singh doesn’t have an opening on her end. But these quick check-ins can have an enormous impact on her patients’ health. “I have been checking-in with a patient about his diabetes over the eVisits platform. Three months ago his A1C was 13 percent and since then we have been talking every 3-4 weeks,” she says. “I saw him today and his A1C level was at 7.5 percent. That’s amazing—in three months to go from a 13 to 7.5.”
Another way patients can connect with their doctors is through Virtual Visits. These are live, secure, video-chat connections using patients’ computers or phones that allow face-to-face interactions between a doctor and their provider. These video visits are scheduled and documented, which often replace traditional office visits. Several of our primary care systems, including Brigham Health, Mass General, Emerson Hospital, and Pentucket Medical, routinely deliver care through the Virtual Visits platform. Across Partners, providers completed nearly 6,000 Virtual Visits in 2017. The telehealth team is also working to expand the scope of Virtual Visits beyond ambulatory care to target different populations across the care continuum that are at higher risk of costly care events.
A long-term goal is to link Virtual Visits with various remote monitoring technologies like blood pressure cuffs or weight scales using a tool pioneered by the Partners Connected Health team. The technology, called the Connected Health Integration Pathway (CHIP), acts like large highway that links our electronic health records to our patient portal, and allows a wide variety of internet enabled devices to input patient data, feeding real-time results into the thruway.
To connect patients to CHIP, doctors will need to send an invite to their patients through Patient Gateway and then prescribe the appropriate high-tech monitoring devices for home use. Instead of manually inputting measurements like weight or blood pressure, the devices will automatically connect to CHIP and beam the information into patients’ electronic records. There is also no limit on the number of devices that can be connected, which means patients could monitor multiple aspects of their health simultaneously—such as glucose levels, weight, and blood pressure. This will allow doctors to closely monitor patients with complex conditions such as diabetes or chronic heart failure.
As the team looks towards the future, they are starting to envision how telehealth can be integrated into all aspects of care. “We are looking for opportunities from outpatient, inpatient, to post-acute care to offer telehealth programs,” says Dr. Licurse. “We envision a future that for most providers, delivering care to most patients, there will be routine elements of virtual health offered across the care spectrum.” As these virtual communication technologies advance, and as more patients gain access to new technologies, telehealth is poised to become a high-value, ubiquitous tool for Partner’s providers.