E-visit ~ Convenient Online Doctor Visits for Treating Minor Illnesses

Transcription

1 E-visit ~ Convenient Online Doctor Visits for Treating Minor Illnesses

2 Presenters Timothy A. Miller MD FAAFP Physician Champion Jill Karkiewicz Physician EMR Director Jamie Corzine RN BSN MSHI Physician EMR Coordinator

3 Video Clip of Commercial

4 Agenda Who are we? What Peaked Our Interest? Implementation Demonstration of software Lessons Learned Next Steps Q & A

5 Who are we? DMH Medical Group plus multi-specialty physicians Located in Central Illinois Centricity since 2001 Single Chart Model Kryptiq Patient Portal since 2006

6 What Peaked Our Interest? DMH Medical Group Patient Center Medical Home Important goal of the PCMH project and Meaningful Use is the use of technology to engage patient families Attended a Practice Improvement meeting in Kansas City, MO in 2009 Attended an E-visit presentation, by Dr. Bachman from Mayo Clinic

7 Highlights from Dr. Bachman s Presentation Benefit Increase patient access to physicians Mayo Pilot 2 year pilot study utilizing 56 family practice physicians Utilized Instant Medical History software Over 4000 patient registered 2500 visits completed 1159 visits were billed Age range 4 days to 86 years

8 Highlights from Dr. Bachman s Presentation Cost for visit = $35.00 Most frequent chosen symptoms Sinusitis, Depression, Back pain, Cough, Anxiety, Hypertension, Abdominal pain, Headache, and Urinary Tract Infection Response to patient occurred within 24 hours

9 What Mayo Found From the Patient Perspective 1. Patients have the necessary skills to submit E-visits. 2. Convenient 3. Eliminates multiple phone calls between provider and patient

10 What Mayo Found From the Provider Perspective 1. Organized patient information 2. Standardization 3. Protocol utilization by RNs 4. Paid for thinking 5. Concise transcribed note

11 Dr. Bachman Presentation Take-Aways Improved and low cost access for our patients Promote use of Kryptiq Patient Portal Pursue use of Instant Medical History Software Pre-surgical Questionnaire Start Your Visit Physician practices Increase productivity Get paid for thinking Increased efficiencies for physicians Improved documentation of patient information

12 Next DMH Project Approval from Administration Identification of team members Created project plan/timeline Move forward with project

13 * Core Team Members CMIO* VP of Quality M.D.* Primary Care Physicians* Executive Director & Director of DMH Medical Group* Ambulatory EMR Director* Information Systems Webmaster, Network Analyst, and Interface Engineer Accounting/Billing Marketing EMR Team

14 Scope of Project To provide online doctor visits as a convenient option for the treatment of minor ailments Project Group included: 29 Providers 20 Physicians 9 Mid-levels

15 Project Implementation Created subcommittees from within project team members Technical Sub-Committee Patient Portal Instant Medical History Software Website design Fee Collection Software Utilized hospital s on-line bill payment vendor

16 Website

17 Project Implementation Policy, Procedure Sub-Committee Clinical Approach Open access or limited set of symptoms Website content Develop Terms of Use Develop Frequently Asked Questions Policy and Procedures Develop Policy for Physician Response Times Set fee for an E-visit = $35.00 Develop policy for on-going review of appropriateness of visit

18 List of Symptoms Allergy symptoms Bladder Infection Bronchitis Cold Cold Sore Cough Diarrhea Dizziness Earache Hives Nausea Pink Eye Poison Ivy Rash Sinus symptoms Sore throat Vomiting Yeast Infection

19 Terms of Use

20 FAQs

21 Project Implementation Marketing and Communication Commercial Advertisements Office Materials, Newspapers, Billboards, Social Media Patient stories Patient Educational Handouts

22 Project Implementation Billing/Accounting Develop and implement payment process for physician practices Develop and implement billing process for Central Billing Office Train staff

23 Project Implementation Physician & Office Staff Training Responding to e-visits Utilizing Centricity and Patient Portal to complete e-visit process Billing process Methods used: Training guides User Group meetings Staff meetings One on One Provider training

24 How To Guides Table of Contents What is an e-visit?... Who can do an e-visit?... Age Requirements... What is the cost of doing an e-visit? Initial List of Symptoms How will patients learn about e-visits?. Process after Patient Submits an e-visit?... Responding to an e-visit... Provider s Process for Documenting e-visits Process for entering e-visit charges e-visit Desktop Checklist Patient Portal Instruction Sheet for Patients..

25 Project Timeline 8 months to development and implement project Soft Go-live began 10/16/2011 Physicians began introducing E-visits to their patients during office visits On-going training with physicians and staff Marketing to community began 12/1/2011

26 Demonstration of Software

27 Where we are at today ~ Goal for the 1 st six months was 100 E-visits 120 E-visits (Jan through June 2012) Top 10 Symptoms E-visit Symptoms Sinus, Sore throat, Bronchitis, UTI, Cold, Cough, Pink eye, Earache, Diarrhea, Allergy symptoms

28 Where we are at today~ Working through physician barriers to adoption Resistant to change from current process Phone call - no charge to patient versus charging patient for an E-visit Monitoring desktop during off hours Responding within specified guidelines Liability concerns

29 Where we are at today ~ Working through patient barriers to adoption Patient misuse of e-visit Using E-visit software for symptom that isn t specified Using incorrect patient account for submission of E-visit Patient changes mind halfway through E- visit and doesn t complete e-visit Prefer to utilize urgent care vs. E-visit (insurance coverage)

30 Where are we going?? Initial message when patient starts a visit Text messages Notify physicians when they have an e-visit they need to respond to Provide a receipt of payment for patient Ability to bill insurance companies directly Ability to upload photographs Expansion of symptoms

31 Questions

32 Patient Portal Home Page

33 Dr. Miller s Patient Portal Home Page

34 Logged in as a patient

35 Select your physician

36 Disclaimer

37 Terms of Use Please read entire document before accepting terms of use. The DMH Medical Group is making visits with your provider easier with e-visits, a convenient way of being treated by your provider online instead of coming to the office. Here are a few important points to remember 1. If you are experiencing a medical emergency, call or go to the nearest emergency room immediately. 2. e-visits are only for non-emergent medical visits. Examples of a non-urgent visit include allergy symptoms, sinus symptoms, nausea, vomiting, diarrhea, bronchitis, cough, cold, sore throat, rash, hives, poison ivy, urinary tract infection, dizziness, yeast infections, pink eye, cold sore, and ear ache. 3. Patients must be greater than 18 years of age or an emancipated minor in order submit an e-visit. If the patient is less than 18 years of age a parent or legal guardian will need to submit the e-visit on their behalf. 4. The charge for an e-visit is $ MasterCard, Visa and Discover are accepted. Payable prior to starting the e-visit. 5. e-visits are available to all established patients, and are designed for use with non-urgent health issues. They are not intended to replace office visits. 6. After reviewing your information, your provider may need to see you in the office visit. If it is necessary for you to come to the office, then the $35.00 payment will be applied to your insurance co-pay/deductible or refunded if appropriate. 7. e-visits are designed to be convenient visits for you and your provider between regular check-ups. These visits do not replace recommended visits. Your provider will still want to see you in the office for check-ups. 8. The e-visit software uses secure computer technology. Do not share your password with anyone unless you want them to have access to your health information. 9. If you aren t a patient of a DMH Medical Group provider and would like to become one, please contact a provider to set up an appointment. Patient Financial Responsibility and Agreement 1. I am aware that e-visits are an on-line evaluation and treatment option and maybe an alternative to an office visit. I understand and acknowledge that. 2. I understand that if I am doing an e-visit with my DMH Medical Group provider the following apply: a. An e-visit will only be done on patients 6 months and older. b. A doctor will respond to you within: i. 6 hours if the visit is received before 4:00 pm during regular business hours. after 4:00 p.m. then your visit will be responded to by 10:00 am the next business day. ii. If you submit a visit on holiday or weekend it will responded to within 24 hours. 3. I understand that if I am doing an e-visit thru Convenient Care thru DMH e-visits the following apply: An e-visit will only be done on patients 2 years of age and older. A doctor will respond to you within: 4 hours if the visit is received before 8:00 pm during regular business hours. If the visit is received after 8:00 p.m. then your visit will be responded to by 9:00 am the next business day. If you submit a visit on holiday or weekend it will responded to within 24 hours. 4. Payment for an e-visit is $ Method of payment include MasterCard, Visa, and Discover. 5. Charges relating to pharmacy, labs, x-rays or other tests will be billed separately. Once you begin the visit, please be mindful of pharmacy hours when selecting where to pick-up prescriptions.

38 Payment Screen

39 Oops!

40 Receipt

41 Preferred Pharmacy

42 Medication and Allergies

43 Contact Information

44 Reason for visit

45 Questions

46 Questions

47 Questions

48 Questions

49 Questions

50 Questions

51 Questions

52 Your E-visit is complete

53 Patient Narrative within Portal

54 Patient Narrative within Portal

55 Patient Narrative within Portal

56 Finished

57 Patient Narrative on Provider s Desktop as Transcription

58 Patient Narrative on Provider s Desktop as Transcription

59 Second Document in Patient Chart as evisit

60 Provider Completion Steps Signs the Transcription document Utilizes Full Featured Append Includes 3 encounter forms CPOE A&P-CCC evisit Status Custom built SM-Basic Signs the evisit update which triggers an to be sent back to the patient

61 Patient Notification Receive a secure link in their to log into the Secure Message Center Retrieve the sent from their provider with their instructions