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31 Jan 2017

When flu cases rise, physicians start making more (virtual) house calls

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Telemedicine is the new wave in patient-provider relationships. It has taken on a large share of the ongoing flu epidemic. Jupiterimages Thinkstock images



JANUARY 27, 2017 11:00 AM

Reposted by Physician Licensing Service


The ongoing influenza epidemic has strained emergency rooms, urgent care clinics and physician offices as patients seek relief.


One area that is providing relief on both sides of the stethoscope is telemedicine.


Telemedicine puts patients in touch with providers via telephone and webcam.


“It certainly is a way to relieve some of that pressure on doctors offices, urgent care and ER,” said Dr. Robert Bernstein, vice president of clinical affairs for Carena, a Seattle-based virtual urgent care clinic.


“We see all the urgent care issues from rashes to bladder infections,” Bernstein said. “A lot of coughs and colds.”


Carena contracts with clients around the country and several in the region including, Virginia Mason Medical CenterUniversity of Washington Medicine and CHI Franciscan in Tacoma.


Carena has 25 providers including family medicine physicians and nurse practitioners on staff.


Some clients such as CHI Franciscan add in their own physicians as part of its Franciscan Virtual Urgent Care. The service costs $35.


MultiCare Health System offers Doctor on Demand. That service provides patients immediate access to a board-certified physician for a range of medical issues. The cost of each video doctor visit is $49.


MultiCare also has eCare. That online service provides online diagnosis and treatment service for common health conditions. Patients are connected to clinicians via email or text for a $25 fee.


At CHI Franciscan, a patient begins the telemedicine process by calling in or registering through the internet.


Emergency departments can also refer patients. There’s even a mobile app.


CHI Franciscan’s website begins with a series of questions to screen anyone who should instead be calling 911.


“Welcome,” the website continues. “We’re sorry you’re not feeling well.”


Once a patient requests a visit, they will get a call back within 20 minutes, Bernstein said. Though times have lagged a bit during the epidemic, callbacks are still averaging 10 minutes.


Many patients contact the system looking for a medicine to treat their flu symptoms, Bernstein said.


First, “We really have to ask the question, ‘Is this flu or is it something else?’ ” he said.


Physicians look for red flags indicating a more serious condition.


If a patient seems dehydrated, has respiratory involvement, has a complication such as pneumonia or is in a high-risk category, then they will be referred to an in-person visit.


If it turns out the patient needs in-person care, they are not charged for the virtual visit, said Dr. Jessica Kennedy-Schlicher, CHI’s virtual urgent care director.


“It’s really a win-win for the patient and the physician, who wants to provide that access and that convenience but wants to see that patient in the most appropriate location,” Kennedy-Schlicher said.


When that patient is referred to an in-person visit, CHI Franciscan will alert the clinic or emergency department and provide them with appropriate patient records.


Bernstein said conversations between patient and provider can often be more engaged when conducted via telephone or webcam. Patients feel more comfortable at home and less intimidated by the medical surrounding.


“They often feel more connected to the provider than in person,” he said.


But, the physicians acknowledged, there are disadvantages.


Physicians can’t use stethoscopes, thermometers and other diagnostic equipment on a virtual patient.


A webcam might show skin color, but not as accurately as an in-person visit would.


Kennedy-Schlicher said doctors can work around those issues.


“Your intuition as a physician gets pretty good over the years,” she said. “If you feel like there’s a piece of information you need, you bring them in. You would err on the side of having more information.”


Telemedicine promises to get more efficient as more tools come online in the coming years.


Patients with chronic diseases, for instance, could have portable diagnostic equipment at home, which could be accessed by physicians.


Maybe those robots that now sterilize hospital rooms might one day make house calls.
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