E-Visits
Definition
E-Visits broadly defined are electronic exchanges between a medical provider and their patients for delivery of health-care. This has taken many forms during it's evolution from secure e-mail or messaging between provider and patient to electronic communications via a secure portal from a provider's website. Typically the standard of e-Visit encompasses a patient submitting a medical concern and the provider securely relaying medical advice and or care via prescribing medication/therapy online.
This form of online care has been shown to be desired by patients but has not been widely adopted by health-care providers for several reasons. Part of the reasons stem from lack of consistent reimbursement from payers for these services, lack of effective secure means of communication that integrates with the provider's EHR systems, and some concern that providers have with potentially being overwhelmed with patient online consultations.
Payment
Current charges for e-Visits range with some practices charging 25 dollars up to 50 dollars per e-visit. Some large organizations that operate under a capitation model may provide the access to providers for e-Visits for a set fee to the patient per year. With most of these e-Visits encompassing what would be a level 3 office visit many practices find it cost effective to manage their patient's care via the online pathway instead of the added cost of bringing the patient into the office. The current E&M coding for e-Visits is a single code when insurance is billed for the service and is not stratified into levels like the E&M office visit codes. Where insurance does not cover e-Visits, providers who provide e-Visit services typically have a secure transaction directly billing the patient's credit card for the service.
Portals
The interface for providing online care is key to being successful with this means of communication. As ambulatory EHR's become more sophisticated, incorporating a stronger web presence is mandatory to maintain patient loyalty and satisfaction in interacting with their provider. As more of our daily activities transition online such as banking, social media, and shopping our expectations increasingly include receiving health-care online. Using a portal that communicates and accesses the patient's health record is key to providing care as the provider then has access to their health history, allergies, past treatments and current medications.
Performance
Studies looking at e-Visits and their viability in an ambulatory primary care setting have been limited. The recent pilot at the Mayo health system highlights its effectiveness in reducing costs and improving patient satisfaction with their care. Part of the effectiveness in e-Visits stems from how information is gathered from the patient. Simple messaging unstructured from the patient to the provider often requires multiple communications between the two and is limited in gathering consistent, pertinent clinical information useful for the provider to deliver effective care. By utilizing a question engine that has branching logic to "assesses" the patient based on their "chief complaint," the provider receives as communication a structured patient history of their concern that the provider can then act on to deliver the appropriate care. This branching question engine interface is currently available from Instant Medical History software provider. It has been utilized in many portal applications. E-Visits also can provide effective care for managing chronic conditions such as diabetes, depression and hypertension. Utilizing EBM scales built-in to the questions that patient's interact, e-Visits can be tracked within the EHR over time and assist the clinician in providing more consistent and effective care that ultimately is more convenient for the patient. As our population of patients grows and to meet the increasing demand for subsequent clinical care effective use of e-Visits will be an integral tool for providers in their daily practice routine.
References
1. Bachman JW. The patient-computer interview: a neglected tool that can aid the clinician. Mayo Clin Proc. 2003;78(1):67-78.
2. Instant Medical History. Patient interview software. Columbia, SC: Primetime Medical Software; 2010. http://www.medicalhistory.com/home/index.asp.
3. Tang PC, Black W, Young CY. Proposed criteria for reimbursing eVisits: content analysis of secure patient messages in a personal health record system. AMIA Annu Symp Proc. 2006;764-768.
4. Adamson, S. C., & Bachman, J. W. (2010). Pilot Study of Providing Online Care in a Primary Care Setting. Mayo Clinic Proceedings, 85(8), 704 -710. doi:10.4065/mcp.2010.0145
--Tlockwood 23:22, 20 November 2010 (CST)
Submitted by Travis Lockwood MD
