Stormont Vail Health and Cotton O’Neil patients wanting to avoid a trip out in cold, snowy weather when they’re sick can now take their minor illnesses to their physicians online, called an e-visit, through the MyChart system.
Stormont began exploring the option of adding e-visits, which means patients can fill out a questionnaire online about their medical condition and then get a response from the medical provider — about a year ago, said Judy Corzine, chief information officer. They first tested the use on their employees.
“It’s a way for patient to not need to go into the office if they have a simple medical condition like diarrhea, rashes, sore throat or urinary problems,” she said. “They log into MyChart, request an e-visit, answer a bunch of questions about their medical condition.”
The patients then pay a $45 charge for the e-visit, which can be less than what patients pay as a co-pay on their insurance for visiting an urgent care center or the emergency room, Corzine said. Those fees vary depending on the patient’s health insurance. Most health insurance plans don’t cover e-visits.
After the patient submits the e-visit request, the provider reviews the information and either calls the patient or responds through MyChart.
“If they think you need to come into a provider, the MyChart (e-visit) won’t be charged,” Corzine said.
Stormont employees responded well to e-visits.
“Employees who used it really liked it. It’s really a convenience component, and the providers are very upfront regarding whether it’s something they do need to be seen for or something they can answer over the phone,” Corzine said.
The program has a goal of a one-hour response time after a patient submits a request, she said. Staff have been dedicated to tracking the e-visit requests, and they page providers to let them know they have a patient to see online.
The potential of online communications to change the way providers see patients has been at the forefront of discussions in recent years. Telemedicine offers opportunities for rural communities that sometimes struggle to find providers to get medical care to patients without forcing residents to travel long distances.
But the expansion of ways to communicate also brings challenges. For instance, the Centers for Medicare and Medicaid Services recently clarified its position on the use of text messaging in providing health care, to make sure providers use secured networks and to maintain patient confidentiality.
Corzine said there are basically three ways to approach texting communications with patients. An SMS text, like those done on a cellphone, might have copies maintained on each phone and on the cellular carrier’s system, which creates risk to confidentiality. Such texting is only used for things like appointment reminders, which don’t contain health information.
The second way is on a secure platform, which is what Stormont uses so that clinical staff can text with providers in the organization.
The third way is through MyChart, which offers a level of security so patients and providers can communicate with one another.
CMS clarified that clinical information can be texted between providers, but orders cannot be texted. That means if a physician wants to order a lab or a medication, they can’t request that order be placed through text messages, Corzine said.
“You have to come up with a strategy for what you want to do where,” she said. “Patient communication focus is MyChart. The physician to clinician is via secure text messaging. Patient general information like an appointment (reminder) is general text messaging. You just have to have a strategy to make sure you’re protecting the information with the right tool.”
Insurance companies have worked to keep up with the multiple avenues available, not only for patient communications, but also to support new ways of seeing patients, such as telemedicine or e-visits.
Mary Beth Chambers, manager of communications for Blue Cross Blue Shield of Kansas, said e-visits typically are not covered under insurance.
“A lot of provider offices are doing the e-visits,” she said. “There are some things that providers do which are providing good customer service for their patients. That’s not something that we reimburse them for because they had an email conversation with one of our members.”
However, there are other patient-provider communications using technology that are covered.
“We recognize that things are changing in how some people want to get their health care,” Chambers said. “For some people, you can’t get to the doctor when the office hours are open. Something comes up that’s after hours and you don’t want to go to the ER and the urgent cares are closed, so you want to have other options.”
Telehealth, which refers to a two-way communication usually with both audio and video between providers and patients, has been included in all BCBS of Kansas health plans this year, she said. That benefit is provided through a specific vendor, American Well.
They launched the offering of telehealth services last year through a couple of their largest groups, including state of Kansas employees, Chambers said. This year, it is an included benefit on all individual plans, added either Jan. 1, 2018, or it will be added on anniversary dates of group insurances in the next months.
Although adding telehealth was necessary to stay competitive — competitors have been offering telehealth in recent years — Chambers said use by BCBS insured groups has been low. Of the groups utilizing it the first year, fewer than 100 people used the telehealth services.
“I do think it is something that probably over time will grow,” she said. “I would suspect that it’s somewhat generational. For those generations that are comfortable with getting all of their information on a tablet or a smartphone, versus those that want to talk to somebody.”
The use of technology to expand health care offerings will continue to evolve.
“Ultimately, giving consumers a choice of how they can get care leads to consumer satisfaction,” Chambers said.