Pilot Study of Providing Online Care in a Primary Care Setting

doi:10.4065/mcp.2010.0145

Mayo Clinic Proceedings

Volume 85, Issue 8, August 2010, Pages 704-710

https://doi.org/10.4065/mcp.2010.0145 Get rights and content

OBJECTIVE

To study the use of e-visits in a primary care setting.

PATIENTS AND METHODS

A pilot study of using the Internet for online care (“e-visits”) was conducted in the Department of Family Medicine at Mayo Clinic in Rochester, MN. Patients in the department preregistered for the service, and then were able to use the online portal for consultations with their primary care physician. Use of the online portal was monitored and data were collected from November 1, 2007, through October 31, 2009.

RESULTS

During the 2-year period, 4282 patients were registered for the service. Patients made 2531 online visits, and billings were made for 1159 patients. E-visits were submitted primarily by women during working hours and involved 294 different conditions. Of the 2531 e-visits, 62 (2%) included uploaded photographs, and 411 (16%) replaced nonbillable telephone protocols with billable encounters. The e-visits made office visits unnecessary in 1012 cases (40%); in 324 cases (13%), the patient was asked to schedule an appointment for a face-to-face encounter.

CONCLUSION

Although limited in scope, to our knowledge this is the largest study of online visits in primary care using a structured history, allowing the patient to enter any problem, and billing the patient when appropriate. The extent of conditions possible for treatment by online care was far-ranging and was managed with a minimum of message exchanges by using structured histories. Processes previously given as a free service or by nurse triage and subject to malpractice (protocols) were now documented and billed.

Section snippets

PATIENTS AND METHODS

The pilot study was conducted from November 2007 through October 2009 in the Department of Family Medicine at Mayo Clinic, Rochester, MN. The Department of Family Medicine averages 56 clinicians practicing in 4 clinics in and around Rochester. The study aimed to learn about the potential for online visits in preparation for construction of an online patient portal to be used for the entire institution. Numerous restrictions were placed on the pilot. The project did not receive publicity and was

RESULTS

During the 2-year study period, 4282 patients were registered for the service, which led to 2531 online consultations and billings for 1159 patients (52%) (Figure 2). During the last 11 months of the study, expansion of registrations and e-visits was discouraged because of the expected release of a new Mayo Clinic portal. There was no billing for the first 4 months of the pilot, during which 299 visits occurred. After 6 months, a 1-month pause occurred in adding registrations (April 2008) to

DISCUSSION

The current study was a regulated pilot of online visits in a primary care setting. Most users were working-aged women who completed e-visits for themselves, their dependents, and their older parents during office hours. The clinicians were not overburdened by repeated visits during the study period or by overwhelming numbers of patients needing assistance.

Patient concerns were wide-ranging, with the top 20 diagnoses making up only 55% of the conditions. Other conditions varied from a request

CONCLUSION

The current pilot study of e-visits in a primary care practice showed the feasibility of online visits to educate, treat, and bill patients. The extent of conditions possible for treatment by online care was far-ranging and was managed with a minimum of message exchanges by using structured histories. Processes previously given as a free service or from nurse triage and subject to malpractice (protocols) were now documented and billed. Patients showed that they could upload digital images and

REFERENCES (35)

JD Ralston et al.
Patient web services integrated with a shared medical record: patient use and satisfaction. [published correction appears in J Am Med Inform Assoc. 2008;15(2):265]
J Am Med Inform Assoc
(2007)
L Baker et al.
Effect of an Internet-based system for doctor-patient communication on health care spending
J Am Med Inform Assoc
(2005)
BB Green et al.
Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework
Contemp Clin Trials
(2008)
JW Bachman
The patient-computer interview: a neglected tool that can aid the clinician
Mayo Clin Proc
(2003)
The TransfMed patient-centered model. TransformMED Web site
B Walters et al.
“Patient portals” and “e-visits”
J Ambul Care Manage
(2006)
PC Tang et al.
The missing link: bridging the patient-provider health information gap
Health Aff (Millwood)
(2005)
CT Lin et al.
An internet-based patient-provider communication system: randomized controlled trial
J Med Internet Res
(2005)
EM Liederman et al.
Patient-physician web messaging: the impact on message volume and satisfaction
J Gen Intern Med
(2005)
EM Liederman et al.
Web messaging: a new tool for patient-physician communication
J Am Med Inform Assoc
(2003)

P Rosen et al.

Patient-physician e-mail: an opportunity to transform pediatric health care delivery

Pediatrics

(2007)

H Christensen et al.

Delivering interventions for depression by using the internet: randomised controlled trial

BMJ

(2004)

L Robertson et al.

Using the Internet to enhance the treatment of depression

Australas Psychiatry

(2006)

R Hess et al.

Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment

Telemed J E Health

(2007)

K Nakajima et al.

Low-cost, email-based system for self blood pressure monitoring at home

J Telemed Telecare

(2006)

KE Mark et al.

Internet and email use among STD clinic patients

Sex Transm Dis

(2008)

JR Thomas et al.

Electronic communication with patients for breastfeeding support

J Hum Lact

(2007)

Cited by (77)

Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments Through Telemedicine
2020, Academic Pediatrics
Increasingly, children with common and lower-acuity conditions are being transferred from general emergency departments (EDs) to pediatric centers for subspecialty care. While transferring children with high-risk conditions has benefit, transferring children with common conditions may expose them to redundant care and added costs. Emergency Care Connect (ECC) is a novel telemedicine program that uses videoconferencing to connect general ED and urgent care providers to pediatric emergency medicine physicians with the goal of keeping children in their communities for definitive care, when safe and feasible. ECC objectives are to: 1) facilitate transfer decision-making for children receiving care in general ED and urgent care sites and 2) increase access to pediatric providers for real-time management, regardless of disposition. In its first 20 months, ECC partnered with 4 general EDs and 1 urgent care location, which together made 1327 contacts with our pediatric center, of which 202 (15%) became ECC consultations for 200 unique patients. Of those consultations, 71% patients remained locally for treatment and 25% experienced a care plan change. Overall, ECC was rated highly by surveyed families and providers. Barriers to implementation, such as lack of familiarity with telemedicine and fears of changes in workflow, were overcome with strong institutional support and frequent, sustained stakeholder engagement. With greater adoption of this model, ECC and programs like it have the potential to allow more children to be treated in their communities, minimize preventable transfers, and reserve beds in children's hospitals for those with potentially higher risk and more medically complex conditions.
Advancing the Science of E-Visits in Primary Care
2019, Mayo Clinic Proceedings
Diagnostic Accuracy in Primary Care E-Visits: Evaluation of a Large Integrated Health Care Delivery System's Experience
2019, Mayo Clinic Proceedings
To compare diagnostic accuracy between primary care E-Visit and face-to-face (F2F) encounters for low-acuity illnesses.
This cross-sectional retrospective analysis of electronic health records in a large not-for-profit integrated delivery system included patients covered by the health care system's employee health plan with an established affiliated physician-patient relationship and an F2F encounter in the past 12 months who had an E-Visit (n=490) or an F2F (n=2201) primary care encounter for a low-acuity illness from July 1, 2015, through December 22, 2016. Patients with a related follow-up visit within 10 days resulting in a revised diagnosis, as determined by 2 physician reviewers, were compared (1) including only the first encounter for each patient and (2) including all encounters more than 10 days apart for included patients.
In both analyses, a follow-up visit occurred within 10 days more than 40% of the time in both groups. However, follow-up visits related to the initial diagnosis occurred only 9% to 12% of the time. Only 2.1% to 2.4% of initial diagnoses were identified by both physician reviewers as revised, whereas 3.8% to 5.5% were so identified by at least 1 reviewer. The only significant difference observed between the E-Visit and F2F groups was in the rate of related follow-up visits when only each patient's first encounter was considered, which was higher for E-Visits (12% vs 9%; P=.04).
Diagnostic accuracy for low-acuity illnesses in this population was equivalent between E-Visit and F2F encounters.
Asynchronous Telemedicine: A Systematic Literature Review
2023, Telemedicine Reports
The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice
2023, BMC Health Services Research
McIsaac score for group A streptococcal infection: Comparison of electronic visits versus face-to-face visits
2023, Journal of Telemedicine and Telecare

View all citing articles on Scopus

This article is freely available on publication, because the authors have chosen the immediate access option.

An earlier version of this article appeared Online First.

View full text

ORIGINAL ARTICLEPilot Study of Providing Online Care in a Primary Care Setting

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSION

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

J Am Med Inform Assoc

J Am Med Inform Assoc

Contemp Clin Trials

Mayo Clin Proc

The TransfMed patient-centered model. TransformMED Web site

“Patient portals” and “e-visits”

J Ambul Care Manage

The missing link: bridging the patient-provider health information gap

Health Aff (Millwood)

An internet-based patient-provider communication system: randomized controlled trial

J Med Internet Res

Patient-physician web messaging: the impact on message volume and satisfaction

J Gen Intern Med

Web messaging: a new tool for patient-physician communication

J Am Med Inform Assoc

Patient-physician e-mail: an opportunity to transform pediatric health care delivery

Pediatrics

Delivering interventions for depression by using the internet: randomised controlled trial

BMJ

Using the Internet to enhance the treatment of depression

Australas Psychiatry

Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment

Telemed J E Health

Low-cost, email-based system for self blood pressure monitoring at home

J Telemed Telecare

Internet and email use among STD clinic patients

Sex Transm Dis

Electronic communication with patients for breastfeeding support

J Hum Lact

ORIGINAL ARTICLE
Pilot Study of Providing Online Care in a Primary Care Setting