Posted: 3/21/2018
Patients benefit from expedited service thanks to telemed technology
Effective use of technology is important to deliver healthcare. By leveraging technology, you can bring down lack of access and cost of healthcare. — Narayana Murthy (founder, InfoSys)
Technology is cool, but you've got to use it as opposed to letting it use you. — Prince (musician)
In healthcare organizations around the country, patients’ waits for specialty referral visits can be months long. It’s a bottleneck that providers are trying to unplug with the help of technology.
At Parkland Health & Hospital System, the Gastroenterology (GI) specialty clinic receives more than 400 referrals every month from physicians in the system’s Community Oriented Primary Care centers (COPCs). In 2016, the wait list was six months or longer for patients to be seen by a GI specialist. Thanks to an innovative e-Consult program, Parkland has found a way to eliminate unnecessary clinic appointments to ensure patients seen in clinic are those who will most benefit from face-to-face visits.
“The situation was frustrating for everyone – patients, referring primary care physicians and GI specialists,” said Christian Mayorga, MD, Clinical Chief of Digestive and Liver Diseases and Senior Medical Director, Medical Specialty Services at Parkland and Assistant Professor of Internal Medicine at UT Southwestern Medical Center.
“We were struggling to see patients in a timely fashion and knew we needed to expand access and cut wait times. But with limited resources, the question was how?” he said.
“As the safety-net public hospital for a major urban area, our challenge is the high demand for services,” said Joe Chang, MD, Parkland’s Associate Medical Director and Senior Vice President, Population Health. “Despite efficiencies we put in place, the sheer volume of patients can be overwhelming. Telemedicine offers a viable solution when there aren’t enough doctors available to meet demand.”
Across the U.S., telemedicine is providing a cost-effective means to expand access to medical care using technology to connect patients and physicians remotely. One form of telemedicine involves the asynchronous, or “store and forward,” transfer of images to another site for consultation, also known as “e-Consults.”
“e-Consults allow doctors to send and interpret health information, not in real time, but at a different time from the initial patient visit,” Dr. Chang explained. “It allows a primary care physician to get a quick consult with a specialist via secure email about a question or concern rather than requiring the patient to have a face-to-face visit with the specialist at a later time.”
Dr. Mayorga said that many patients seen in the GI clinic did not require an in-person visit, while other patients who did need a face-to-face assessment had to wait too long for appropriate care.
“Often the reason for referral is very simple and requires only a review of data in the patient’s medical chart,” he said. “For example, a primary care doctor may want to verify whether it’s safe to start a patient with fatty liver disease on a cholesterol-lowering drug. Rather than making the patient wait three to four months for a GI clinic appointment, a specialist could answer the question almost immediately with a simple ‘yes’ or ‘no’ response via an e-Consult.”
Inspired by the success of a telederm initiative that whittled waits for Parkland dermatology clinic visits from nine months to a zero wait time, Parkland leaders in 2016 decided to develop a similar program for GI patients.
“As clinic director, I’ve always been fascinated by the use of technology to improve patient care,” Dr. Mayorga said. “We were excited by the possibilities but also nervous about potential pitfalls of using technology to expand access.”
Dr. Mayorga and his team identified broad categories of patients whose reason for referral could be answered satisfactorily by an e-Consult. They then asked all stakeholders – residents, fellows, GI specialists and COPC primary care providers, ‘Do you think this question can be appropriately assessed via e-Consult?’ They were surprised to find that in more than 90 percent of the cases, staff felt comfortable with an e-Consult.
The GI team collaborated with Parkland’s IT experts to build a new user-friendly e-Consult platform into the existing Parkland electronic health record that required no additional training for physicians. Referring providers can choose how they want their questions answered, requesting either an electronic or face-to-face consultation. Launched at just one COPC clinic, the e-Consult service was quickly rolled out system-wide to all 12 outpatient health centers. The proportion of e-Consult to in-person consults grew rapidly, from just 8 percent during the initial month in August 2016 to 45 percent within six months.
Guaranteeing a turnaround-time of three business days for e-Consults, the GI specialists were able to reduce the wait list for in-clinic consultations, expediting treatment for patients most in need of one-on-one specialty care.
“By all measures of success, the goals of the new GI e-Consult service at Parkland are being met,” Dr. Mayorga said. “The program has enabled us to provide faster answers for patients about their care, free up clinic slots for patients needing in-person visits and improve provider satisfaction.”
For more information about Parkland, please visit www.parklandhospital.com