Fla. Hospital Begins Telemedicine Program

Fla. Hospital Begins Telemedicine Program

News Jan 12, 2018

Jan. 12—The waiting room is buzzing with patients—some wearing disposable face masks—with hopes of seeing a doctor in a reasonable time frame for a pesky respiratory problem, rash, urinary tract infection, and the like.

Staying home, avoiding germs in a waiting room, and receiving medical attention for minor issues on your own terms is now possible in Southwest Florida.

The NCH Healthcare System in Collier County launched a "virtual visit" program last month, enabling patients to have a telemedicine visit any time of day or night with a medical professional for non-emergency issues.

The program is open to anyone—whether local residents or visitors, insured or uninsured—by going online, filling out a form and using a video platform, like Facetime, to connect with a doctor at the NCH Physician Group. The upfront, out-of-pocket fee for a telemedicine visit is $45.

Telemedicine as a means to deliver medical care has been around for decades, with the military taking the lead to treat deployed soldiers, and university hospitals followed suit to provide video consults to rural doctors and clinics.

Telemedicine is increasingly going mainstream, where survey after survey show community hospitals and group practices considering it a part of operations, or that it will be in the near future.

Forty-six percent of healthcare providers in a 2014 survey by Healthcare Information and Management Systems Society report using multiple telemedicine systems, with two-way video conferencing as the most popular followed by diagnostic image-sharing systems. About 25 percent of the 400 survey respondents said they were using telemedicine for remote patient care.

An updated survey in April showed a steady uptick in telemedicine usage in both inpatient and outpatient settings. Roughly 35 percent of respondents reported using telemedicine for patient-focused purposes. In addition, nearly 20 percent of concierge physicians who offer fee-based, kid-glove care to member patients use video conferencing, the survey found.

The virtual visit program between remote patients and NCH doctors began in December with a soft launch. The plan is to work out kinks before rolling it as a service to businesses in the community for their workforces, and internally to NCH employees and dependents, Allison Zablo, assistant director of the NCH Physician Group, said. The group has 210 physicians who are employed by the hospital system.

The program uses Facetime or another video platform that patients have in their homes, she said. In the first three weeks after the program began, 26 people logged on to the NCH website for a virtual visit, she said. The website is https://nchvirtualcare.anytime.org/home.

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"I think that's about what we expected," she said about the initial volume. About 8 of the virtual visits came in after hours.

A call comes in and a doctor with NCH's physician group who are taking part in the program and on schedule will be notified, she said. A text will go to a doctor's cell phone if necessary. Eight to 10 doctors on any given day are on the virtual visit schedule.

Dr. James Teet, a family physician and one of the virtual visit physicians, was exposed to telemedicine before coming to NCH.

Training is provided to physicians through Carena, a Seattle-based telemedicine company that NCH has contracted with to coordinate the program, he said.

If one of the local doctors does not respond to a patient's request for a virtual visit after 10 minutes, the call will be picked up by Carena to handle, Teet said.

"The chief complaints are cough, sinusitis, urinary tract infections and rashes," he said "That encompasses a lot of the complaints."

For a rash, it is possible for the patient to move their webcam at home so he can see the rash; same goes for looking down a patient's throat, he said.

Patients can be prescribed medicine, like antibiotics, cough medicine and nasal sprays, yet pain pills or other controlled substances will not be prescribed, Teet said.

If the medical condition cannot be treated through the virtual visit, the patient will be referred to an NCH provider, and the $45 virtual fee will be credited toward the office charge, Zablo said. However, the $45 virtual fee cannot be submitted to insurance plans toward a deductible.

"There's no insurance involved," she said.

Teet sees virtual visits as advantageous for patients. The service is overdue for patients to have greater control over their health, as opposed to insurance plans controlling their options.

"A lot of things in medicine is not patient driven," he said. "This is patient driven."

It's also a good option for uninsured patients, or for insured patients who see the $45 out-of-pocket fee a small price to pay instead of taking time off from work to sit in a waiting room.

"I think it's not only exciting and interesting and new, it makes medical care more accessible," Teet said. "It expands medical care to people who can't access it. Patients create the demand. They are truly at the center of it."

For years, NCH has used telemedicine technology for remote interpretation of radiology scans, for networking with specialists at Mayo Clinic, for robotic-based stroke monitoring and other applications.

The hospital system has been named to the American Hospital Association's "most wired" annual list for the past six years for embracing telehealth services and other technology.

The publicly-operated Lee Health System in Lee County uses telehealth services with palliative care patients after patients are discharged, to monitor patients at home with chronic obstructive pulmonary disease, for behavioral health consults with patients at home, for home health visits and for post-operative patients at home, according to Lee Health spokeswoman Cheryl Garn.

A variety of telemedicine services are used with admitted patients for remote consults with specialists in the areas of stroke care, genetics, between neurosurgeons, and with rehabilitation patients in skilled nursing.

Plans are in the works to expand services between patients and primary-care physicians for less acute services, Kris Fay, chief administrative officer for the Lee Physician Group, said. Lee Physician has 572 primary care physicians and specialists affiliated with the hospital system.

"Telehealth will play an even bigger role in our healthcare delivery system in the future," she said. "We have it in our strategic plan for 2018 to expand our telemedicine offerings through Lee Physician Group to a wider range of patients who may have minor concerns that could be seen via telehealth, rather than an office visit."

NCH looked at how other hospitals have contracted for telemedicine services and reviewed programs offered at hospitals in Miami and Tampa, Zach Bostock, chief administrative officer of the NCH physician group, said.

"The services were very similar with the one difference being who was providing the care," he said in an email. "We felt strongly that we should use our physicians whenever possible while other health systems have completely outsourced this service."

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