Posted: 8/9/2017
Improves access, offers greater satisfaction for patients and physicians
For years “telemedicine” has been a favorite buzzword in the healthcare industry, promising to someday revolutionize many patient-doctor interactions. But with mounting pressures to control costs, improve quality outcomes and expand access to care, providers like Parkland Health & Hospital System say the future of telemedicine is now.
“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.”
Parkland has been a U.S. leader in adopting telemedicine. “We’ve been offering better access to care through ‘virtual visits’ for decades,” Dr. Chang stated. “We just used a different name. Now it’s called ‘telemedicine.’”
Parkland’s first large-scale foray into telemedicine began four years ago with a pilot tele-dermatology program. At the time, patients were waiting up to nine months to get a dermatology appointment when referred by a Parkland primary care physician (PCP), a delay that was frustrating to patients and physicians alike.
But delayed care isn’t the only issue facing patients referred to Parkland specialists. Transportation from outlying areas of sprawling Dallas County into the main hospital campus where specialty clinics are located is a daunting problem for many. Patients may lose a full day of work in order to run the gauntlet of bus or train rides to their appointment. And there’s the issue of lost wages and childcare costs associated with time off work to visit the doctor, as well.
“All that changed when we launched the tele-derm program,” Dr. Chang said.
Now, a PCP at one of Parkland’s Community Oriented Primary Care health centers (COPCs) sends high-definition photos of any suspicious skin condition to the dermatologist using the secure electronic health record. The dermatologist responds electronically with a diagnosis and treatment recommendation within 24 to 48 hours. Only patients needing a follow-up in-person visit with a dermatologist are scheduled.
“Today, there’s no wait time for dermatology appointments,” Dr. Chang said. “It’s great for patients and for their primary care physicians. They get a quick assessment and diagnosis of the problem. Specialists like it because they are able to focus on patients with more serious conditions requiring their expertise. Everyone is happy because we’ve eliminated a huge bottle-neck in the continuum of care.”
Other specialties that have recently added telemedicine services at Parkland include urology, ophthalmology, gastroenterology and behavioral health, with plans to roll out telemedicine for diabetes and neurology patients in the future. “Every specialty is interested,” Dr. Chang said.
Growing telemedicine programs is a key focus of Parkland’s 2020 strategic plan, which calls for the system to “improve access and reduce delays in care through expanding group visits, telephone visits, telemedicine visits or other options to connect patients with providers.”
With more than 1 million outpatient visits per year, Parkland leaders see telemedicine as a potential life saver – literally. Parkland provided more than 41,000 telemedicine virtual visits in COPC and specialty clinics over the last year.
Parkland rolled out gastroenterology e-consults in early 2017. At that time, only 5 percent of GI consults were handled electronically; approximately 75 percent of referrals never were actually seen by a specialist. As of June 2017, 40 percent of GI consults for more than 600 patient visits were handled electronically, greatly improving access to care and the patient experience in the past six months.
An important fringe benefit of these efforts, Parkland has discovered, is greater satisfaction for all physicians – both primary care and specialists. In 2016 Parkland launched a “train the trainer” program designed to create a group of PCP mini-specialists at every Parkland COPC. Based on a program developed at the University of New Mexico called ECHO, urology specialists meet one afternoon each month with designated PCPs via teleconference to conduct a virtual “grand rounds” session on topics like urinary tract infections, bladder or kidney cancer or incontinence. Urology specialists also offer a monthly physician group session when PCPs can consult directly with the specialist on any urology question, empowering them to improve their skills to evaluate common urology problems during the outpatient primary care visit.
“In the past 18 months, we’ve built a group of urology ‘mini-experts’ throughout our COPC system,” Dr. Chang said. “It’s been a tremendous success and has reduced the wait time for urology referrals dramatically. Other specialties are asking to join in, as well.”
To learn more about services at Parkland hospital, visit www.parklandhospital.com