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The American Journal of Managed Care January 2019
The Gamification of Healthcare: Emergence of the Digital Practitioner?
Eli G. Phillips Jr, PharmD, JD; Chadi Nabhan, MD, MBA; and Bruce A. Feinberg, DO
From the Editorial Board: Rajesh Balkrishnan, PhD
Rajesh Balkrishnan, PhD
The Health Information Technology Special Issue: New Real-World Evidence and Practical Lessons
Mary E. Reed, DrPH
Inpatient Electronic Health Record Maintenance From 2010 to 2015
Vincent X. Liu, MD, MS; Nimah Haq, MPH; Ignatius C. Chan, MD; and Brian Hoberman, MD, MBA
Impact of Primary and Specialty Care Integration via Asynchronous Communication
Eric D. Newman, MD; Paul F. Simonelli, MD, PhD; Shelly M. Vezendy, BS; Chelsea M. Cedeno, BS; and Daniel D. Maeng, PhD
Mind the Gap: The Potential of Alternative Health Information Exchange
Jordan Everson, PhD; and Dori A. Cross, PhD
Currently Reading
Patient and Clinician Experiences With Telehealth for Patient Follow-up Care
Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA; Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD
Organizational Influences on Healthcare System Adoption and Use of Advanced Health Information Technology Capabilities
Paul T. Norton, MPH, MBA; Hector P. Rodriguez, PhD, MPH; Stephen M. Shortell, PhD, MPH, MBA; and Valerie A. Lewis, PhD, MA
Alternative Payment Models and Hospital Engagement in Health Information Exchange
Sunny C. Lin, MS; John M. Hollingsworth, MD, MS; and Julia Adler-Milstein, PhD
Drivers of Health Information Exchange Use During Postacute Care Transitions
Dori A. Cross, PhD; Jeffrey S. McCullough, PhD; and Julia Adler-Milstein, PhD

Patient and Clinician Experiences With Telehealth for Patient Follow-up Care

Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA; Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD
Telemedicine visits may be used with established patients for follow-up care without a loss of patient satisfaction with communication with providers and with enhanced convenience and reduced travel time; a majority may be willing to pay standard co-pays or more for this convenience. Clinicians see value in this new mode of care to enhance connections with patients.

Objectives: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology.

Study Design: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system.

Methods: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys.

Results: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in “the overall quality of the visit.” VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment.

Conclusions: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.

Am J Manag Care. 2019;25(1):40-44
Takeaway Points

Telemedicine visits have been used to provide healthcare access to more remote populations. In a busy health system, telehealth visits were incorporated for established patients to allow patient–clinician interaction in a new, more convenient mode. In the first full year of patient visits in this new mode, we found that:
  • Patients rated these visits highly and the majority would recommend them to family and friends.
  • Using standard measures of patient experience, most patients and clinicians perceived no loss of communication in virtual video visits compared with office visits, although clinicians were somewhat more likely to see loss of personal connection as a problem.
  • Patients perceived considerable added convenience, saved travel time, and expressed willingness to pay co-payments for this visit option.
  • Virtual visits are an important and useful option in clinical care.
Telemedicine visits have been used in the United States to enhance access to healthcare, most notably for people who live in remote and underserved areas.1,2 The increasing availability of personal technology (89% have internet access, 77% are online daily3) offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access for patients when transportation challenges, schedules, or physical disability make office visits difficult in any geography.4 Although face-to-face interactions may be preferred in some circumstances by patients or clinicians, the convenience of accessing healthcare consultations from the home or office may save lost time at home or work, travel time, and missed and rescheduled appointments.5-9 Understanding the perceived relative value of different modes of healthcare services may help to shape the use of virtual or remote healthcare technologies.10,11

Effective population health management is a balancing act that requires consideration of patient needs and preferences for more flexible and timely access to consultation, accountability to payers by managing high costs, and understanding how to leverage new technologies.12,13 System learning that demonstrates the value of different types of “visits” for the system and the patient is essential.14

We initiated the Massachusetts General Hospital (MGH) TeleHealth program in 2012, offering a range of telemedicine services in 15 clinical departments. This paper describes experiences with virtual video visits (VVVs): 2-way audiovisual synchronous videoconferencing between the MGH clinician and patient. The research reported here focuses on the patient and clinician experience of a VVV in a full year of operation to understand its value and comparative experience with VVVs and office visits.


Study Setting and Telemedicine

Clinicians in 5 specialties (psychiatry, neurology, cardiology, oncology, and primary care) were trained in how to provide a VVV throughout the first year and on a rolling basis. Oncology and primary care VVVs were not implemented until late in the data collection period. Clinicians offered VVVs as an option to established patients based on their professional assessment of the suitability of the mode of visit for the individual patient’s situation (eg, patient could communicate effectively in this mode, physical examination was not critical at the visit). Clinicians were compensated by MGH for conducting these VVVs because they were not covered by payers in Massachusetts. In advance of the VVV, participating patients received education, instruction, and phone-based technology support and testing for installation of the visit software. Patients were not charged insurance co-payments for the visit.

Survey Methods

The data reported here come from surveys of patients and clinicians in the MGH TeleHealth program. This study was reviewed and approved by the Partners Health Care Office of Human Research. The surveys we employed were developed by the MGH Center for TeleHealth leadership and Mongan Institute Health Policy Center research team, including experts in survey and health services research, telemedicine, clinical medicine, and health management. We included selected patient experience measures developed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS)15 and augmented with items developed for this mode of visit. Surveys were pretested with patients and refined. Key domains included technology and communication quality, visit quality and experience, patient time and costs, and willingness to pay for a VVV.

Of 426 eligible patients, 254 (60%) completed surveys using a secure web tool. Eligible patients had at least 1 VVV during the accrual period and at least 1 office visit in the 6-month period prior. Initial recruitment was by email request within 1 week of the VVV. Patients whose email addresses were not functional were contacted by postal mail or telephone. Persistent nonresponders to the survey were offered a $10 incentive after 4 weeks of attempts without reaching the patient. Patients younger than 18 years were not directly contacted; rather, surveys were sent to their parents.

Of 74 eligible clinicians (physicians, nurse practitioners, psychologists) who provided at least 1 VVV to program patients during the study period, 61 (82%) completed surveys online, with recruitment by email. An gift certificate valued at $50 was offered to each physician as an honorarium for participation.

The results reported here are descriptive; subgroup comparisons within patient and clinician populations use χ2 or t test comparisons as indicated, and analyses comparing patient and clinician responses utilize 2-sample t tests of the difference in proportions. All analyses were conducted using SPSS version 23 (IBM Corp; Armonk, New York).

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