The two-minute vir­tual doc­tor visit

Modern Healthcare - - INNOVATIONS - By Shelby Liv­ingston

Vir­tual care has ce­mented it­self as a main­stay of the Amer­i­can health­care sys­tem.

More pa­tients want re­mote ac­cess to care. More physi­cians want to pro­vide con­ve­nience. And most ma­jor in­sur­ers are now pay­ing for it.

The tech­nol­ogy is re­spond­ing. High-qual­ity smart­phone cam­eras, faster in­ter­net con­nec­tions and con­nected med­i­cal de­vices let providers repli­cate an in-of­fice pri­mary-care visit at a much lower cost. But while video vis­its help busy pa­tients or those in ru­ral ar­eas, they do lit­tle to ad­dress the na­tion’s grow­ing prob­lem with physi­cian burnout, said Dr. Ray Costantini, founder of Port­land, Ore.-based vir­tual care startup

Costantini, who be­came “a lit­tle dis­en­chanted with tele­health” dur­ing his time head­ing up dig­i­tal health ser­vices at Ren­ton, Wash.-based Prov­i­dence Health & Ser­vices, said that tele­health of­ten takes more time than an of­fice visit. And time is some­thing busy physi­cians do not have to spare. So in 2014, Costantini cre­ated’s SmartExam plat­form to make each vir­tual visit two min­utes long. To com­pare, physi­cians spend about 13-16 min­utes with a pa­tient in an in-of­fice pri­mary-care set­ting, ac­cord­ing to a 2016 Med­scape physi­cian com­pen­sa­tion re­port.

SmartExam works like this: Pa­tients log into the plat­form and an­swer a series of ques­tions about their symp­toms and health his­tory. They can up­load im­ages of a rash or take a guided phys­i­cal exam. Pa­tients then fill out their phar­macy and billing in­for­ma­tion. The process takes about eight to 12 min­utes.

Then, SmartExam com­bines the pa­tient’s re­sponses with in­for­ma­tion pulled from their med­i­cal record to come up with a likely di­ag­no­sis. It sends all of the data in a chart-ready note to the physi­cian who can then se­lect the ap­pro­pri­ate di­ag­no­sis and treat­ment plan— or en­ter a new one—and send a pre­scrip­tion to the pa­tient’s se­lected phar­macy, if needed. All the in­for­ma­tion is added to the pa­tients’ med­i­cal record. It all takes just two min­utes.

The prom­ise of pa­tient con­ve­nience with­out the ex­tra bur­den has won a grow­ing fan club among hos­pi­tals and med­i­cal groups

“All that tele­health does is it re­moves the ge­o­graphic bar­rier to care, but it doesn’t solve that un­der­ly­ing sup­ply and de­mand is­sue.” DR. RAY COSTANTINI

in­clud­ing Greenville (S.C.) Health Sys­tem, Rush Univer­sity Med­i­cal Cen­ter in Chicago, and Ad­ven­tist Health Med­i­cal Group in Port­land, Ore. Costantini de­clined to say how many health sys­tems works with, though it is cur­rently avail­able to more than 7 mil­lion pa­tients.

That number is sure to grow. The startup, which raised $3.5 mil­lion in fund­ing in 2015, was named one of Gart­ner’s “cool ven­dors” for health IT in 2016. It’s the cho­sen plat­form for the co­hort of eight ma­jor health sys­tems eval­u­at­ing tele­health un­der the lead­er­ship of con­sul­tancy Avia in Chicago.

Ad­ven­tist Health Med­i­cal Group, which op­er­ates 34 clin­ics through­out Port­land’s metro area, will make SmartExam avail­able to es­tab­lished pa­tients at sev­eral clin­ics start­ing in April, and roll it out to all pa­tients by the end of the year. It will en­cour­age those with sim­ple con­di­tions to seek care through the plat­form, al­low­ing clin­ics to free up in-per­son ap­point­ments for pa­tients with more dire con­di­tions.

SmartExam can di­ag­nose more than 350 con­di­tions—such as ear pain, sea­sonal al­ler­gies, rashes, coughs and colds—that make up between 30% and 60% of the care de­liv­ered in pri­mary-care of­fices, Costantini said.

These are low-acu­ity con­di­tions that are “man­aged all the time over the phone, though providers are dis­in­clined to do that be­cause there’s no re­im­burse­ment,” said Dr. Ralph Prows, Ad­ven­tist’s chief med­i­cal of­fi­cer. Re­im­burse­ment for SmartExam, which is billed as an e-visit, is about $40 to $65 per visit, Costantini said. It’s a win-win, be­cause providers get paid and pa­tients pay just $20 for treat­ment, he said.

In April, Rush Univer­sity Med­i­cal Cen­ter will of­fer SmartExam to pri­mary-care pa­tients. “We wanted to give peo­ple op­tions that re­ally work for them,” said Dr. An­thony Perry, a physi­cian and vice pres­i­dent of pop­u­la­tion health and am­bu­la­tory care at Rush.

Costantini is re­luc­tant to char­ac­ter­ize SmartExam as solely ad­dress­ing low-acu­ity care. He says the startup is build­ing mod­ules to di­ag­nose more con­di­tions.

This story first ap­peared in Mod­ern Health­care’s Trans­for­ma­tion Hub, ModernHealth­­for­ma­tion

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