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

Presenters

Timothy A. Miller MD FAAFP Physician Champion

Jill Karkiewicz Physician EMR Director

Jamie Corzine RN BSN MSHI Physician EMR Coordinator

Video Clip of Commercial

Agenda

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

Who are we?

DMH Medical Group - 100 plus multi-specialty physicians

Located in Central Illinois Centricity since 2001

Single Chart Model

Kryptiq Patient Portal since 2006

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

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

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

What Mayo Found…From the Patient Perspective

1. Patients have the necessary skills to submit E-visits.

2. Convenient3. Eliminates multiple phone calls

between provider and patient

What Mayo Found…From the Provider Perspective

1. Organized patient information2. Standardization3. Protocol utilization by RNs4. Paid for thinking5. Concise transcribed note

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

Next Steps @ DMH

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

* 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

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

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

Website www.dmhevisits.com

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

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

Terms of Use

FAQs

Project Implementation

Marketing and Communication Commercial Advertisements

Office Materials, Newspapers, Billboards, Social Media

Patient stories Patient Educational

Handouts

Project Implementation

Billing/Accounting Develop and implement payment process

for physician practices Develop and implement billing process for

Central Billing Office Train staff

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

How To GuidesTable 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 ..……………

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

Demonstration of Software

Where we are at today ~

Goal for the 1st six months was 100 E-visits 120 E-visits (Jan. 2012 through June 2012) Top 10 Symptoms E-visit Symptoms

Sinus, Sore throat, Bronchitis, UTI, Cold, Cough, Pink eye, Earache, Diarrhea, Allergy symptoms

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

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)

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

Questions

Patient Portal Home Page

Dr. Miller’s Patient PortalHome Page

Logged in as a patient

Select your physician

Disclaimer

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 9-1-1 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 $35.00. 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 $35.00. Method of payment include MasterCard, Visa, andDiscover.

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.

Payment Screen

Oops!

Receipt

Preferred Pharmacy

Medication and Allergies

Contact Information

Reason for visit

Questions

Questions

Questions

Questions

Questions

Questions

Questions

Your E-visit is complete

Patient Narrative within Portal

Patient Narrative within Portal

Patient Narrative within Portal

Finished

Patient Narrative on Provider’s Desktop as Transcription

Patient Narrative on Provider’s Desktop as Transcription

Second Document in Patient Chart as evisit

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 email to be sent back to the patient

Patient Notification

Receive a secure link in their email to log into the Secure Message Center

Retrieve the email sent from their provider with their instructions