eVisit Online Consultations: Ready for Prime Time

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eVisit Online ConsultationsReady for Prime Time?
Minnesota MGMA Conference eVisit Breakout August
2, 2007
Paul C. Seel MD
Medical Director, Sophrona Solutions
Marc-François Bradley
President, Sophrona Solutions
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What is an eVisit?
Two-way physician-patient communication of
clinical information conducted over a patient
portal

• Gives patients 24/7/365 Convenience
• Reduces practice phone calls
• Compensates physicians for non-office patient
  communication

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Structured vs. Unstructured Communication
Structured eVisit
VS
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Elements of a Structured eVisit

• Chief complaint
• History of the present illness
• Past medical history
• Surgical history
• Social history
• Family history
• Allergies
• Alcohol, tobacco and caffeine
• Pharmacy information

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Why Do eVisits?

• Quality
• Improved documentation of phone calls
• Increased touch points for chronic disease
  patients
• Improved access to care
• Cost
• A low cost way to provide low intensity,
  non-urgent service
• Reduced costs for data entrythe patients do it
• Level staff work load
• Reduced phone traffic
• Revenue Opportunities
• Provides reimbursement for phone calls
• Allows a shift to higher intensity services

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Ingredients for Innovation

• Market
• Patients want it
• Payers have begun to embrace it
• Physicians will adopt if it benefits some
  combination of efficiency, quality and
  reimbursement
• Product
• Internet based platforms for asynchronous
  communication
• Logic driven interviews to generate structured
  histories
• Salience
• Is there sufficient clinical application?
• Can it create efficiencies?
• Does it make business sense?

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Patients Want the Convenience of This Type of
Access to Their Physicians

• In a HarrisInteractive survey, 74 of patients
  desire the ability to communicate with their
  physicians via some sort of e-mail only 8 of
  patients report such access. 1
• University of Minnesota MHA students found
  similar desires (77.9) in the Twin Cities
  patients along with evidence of the patients
  being web savvy (74 on-line banking). 2
• 13.5 said they had no interest in any on-line
  communication. 2

1http//www.harrisinteractive.com/news/newsletters
/wsjhealthnews/WSJOnline_HI_Health-CarePoll2006vol
5_iss16.pdf 2 U of MN MHA students 104 randomly
selected Strategic Positioning Analysis 2007
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The Retail Clinics..patients are seeking
convenient access for simple health care problems

• 80 of retail clinic users judged the clinics
  satisfactory on quality, cost and convenience
  criterion.
• 64 of the general population was concerned a
  serious condition might be missed, down from 71
  in 2005.
• Other concerns such as staff training were also
  decreasing.

HarrisInteractive Health Care Survey March 2007
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By The NCHSs Numbers 1

• Office Visits
• 910 million total outpatient physician visits/yr
• 92.4 visits/primary care MD/week
• 48.3 of all visits were in follow-up for a
  condition previously seen by the physician
• Phone Calls
• 26 phone calls/primary care MD/week

1 National Center for Healthcare
Statistics http//www.cdc.gov/nchs/data/ad/ad374.p
df
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Urinary Tract Infections

• 17 million UTIs in patients lt 65 yrs of age 1
• 164,000 physicians involved in active IM, FP and
  Ob/Gyn practice 2
• 100 episodes /yr in patientslt 65 yrs of age/
  physician
• Evidence based medicine supports the treatment of
  uncomplicated UTIs without a face-to-face
  encounter

1 Data pooled from UpToDate incidence stats 2
http//www.cdc.gov/nchs/data/ad/ad374.pdf
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Ambulatory Care Points of Pain

• I spend hours a day on the phone rendering
  uncompensated care
• I have no time to see the patients I need to,
  let alone new patients
• My overhead is killing me
• Why in the world are my patients going to the
  retails clinics

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What does it cost to provide a Service?
Profitability Analysis of a Phone Call
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Profitability Analysis
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Comparison eVisits vs. Phone Medicine?

• Financial
• Net loss with a phone call -
  39.33
• Net profit from an
• eVisit 3.75
• Overall difference 43.08

• Non-Financial
• Improved documentation
• Save time and avoid phone tag
• Asynchronous advantages

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eVisit Pilot Survey After 250 eVisits by 16
Physicians

• Physician Satisfaction
• (10 out of 16 respondents)
• 100 Adequate info to make a clinical judgment
• 90 Easy to use and will continue to use
• 50 Saves time

• Patient Satisfaction (132 out of 250
  respondents)
• 97 Satisfied with the clinical response and
  medical content
• 87 Easy to use and 100 would use again
• 91 Saves time

• Clinical Appropriateness
• -- Patient use and clinical response audit
  found use to be
• appropriate in each case upon review of the
  records.

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Patient Portal Technology

• ASP (application service provider) architecture
  is common.
• Typically no additional hardware needed.
• Usually licensed as a service and not sold.

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Patient Portal Technology

• Ease of use
• Seamless connection from website
• Single patient login
• Simple for office staff
• Secure HIPAA compliant
• Broad set of communication functions
• Pre-Registration, Bill Payment, Appointment
  Scheduling

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What does an eVisit look like?

• Quick Demonstration

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Pitfalls Critical Success Factors

• Pitfalls
• Over reliance on the software to provide the
  solution
• Inappropriate clinical application
• Inattention as critical mass volume of eVisits
  develops
• Lack of recognition for physician work component

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Pitfalls Critical Success Factors

• Critical Success Factors
• Insurance reimbursement (35 in MN)
• Patient population
• Internet savvy patient population that prizes
  personal time and convenience
• For patients on high-deductible plans eVisits
  are the lower cost option
• Structured eVisit.
• Easy access to charts.

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Pitfalls Critical Success Factors

• Critical Success Factors
• Clinic Readiness Assessment
• Do doctors really understand how expensive phone
  calls are for them?
• Triage Flow Planning
• Patient Adoption Marketing Plan
• Internal policies
• Level of service, physician responsibility, and
  assuring coverage.

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eVisit FAQs
HarrisInteractive, September 2006
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Thank You
Copy of todays presentation
www.sophrona.com/resources.htm