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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- The TransfMed patient-centered model. TransformMED Web site.(Accessed May 12, 2010.)
- “Patient portals” and “e-visits”.J Ambul Care Manage. 2006; 29: 222-224
- 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; 14: 798-806
- The missing link: bridging the patient-provider health information gap.Health Aff (Millwood). 2005; 24: 1290-1295
- An internet-based patient-provider communication system: randomized controlled trial.J Med Internet Res. 2005; 7: e47
- Patient-physician web messaging: the impact on message volume and satisfaction.J Gen Intern Med. 2005; 20: 52-57
- Web messaging: a new tool for patient-physician communication.J Am Med Inform Assoc. 2003; 10: 260-270
- Patient-physician e-mail: an opportunity to transform pediatric health care delivery.Pediatrics. 2007; 120: 701-706
- Effect of an Internet-based system for doctor-patient communication on health care spending.J Am Med Inform Assoc. 2005; 12: 530-536
- Delivering interventions for depression by using the internet: randomised controlled trial.BMJ. 2004; 328: 265
- Using the Internet to enhance the treatment of depression.Australas Psychiatry. 2006; 14: 413-417
- Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment.Telemed J E Health. 2007; 13: 509-517
- Low-cost, email-based system for self blood pressure monitoring at home.J Telemed Telecare. 2006; 12: 203-207
- Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework.Contemp Clin Trials. 2008; 29: 376-395
- Internet and email use among STD clinic patients.Sex Transm Dis. 2008; 35: 960-965
- Electronic communication with patients for breastfeeding support.J Hum Lact. 2007; 23: 275-279
- The use of internet-based technology to tailor well-child care encounters.Pediatrics. 2009; 124: e37-e43
- Safety-net providers bring patients online: lessons from early adopters. California HealthCare Foundation Web site.(Accessed May 12, 2010.)
- Guidelines for physician-patient electronic communications. American Medical Association Web site.(Accessed May 12, 2010.)
- Portals in primary care: an evaluation of patient readiness and willingness to pay for online services.J Med Internet Res. 2006; 8: e26
- Physician-patient e-visit programs: implementation and appropriateness.Dis Manag Health Outcomes. 2007; 15: 207-214
- Online patient-provider communication: how will it fit?.Electronic J communication. 2007; 17 (Accessed May 12, 2010.): 1-14
- Proposed criteria for reimbursing eVisits: content analysis of secure patient messages in a personal health record system.AMIA Annu Symp Proc. 2006; : 764-768
- E-visits have potential to cut rising medical costs. American City Business Journals Web site. Portland Business Journal.(Accessed May 12, 2010.)
- Online physician communication. Physician's News Digest Web site.(Accessed may 12, 2010.)
- Willingness-to-pay stated preferences for telemedicine versus inperson visits in patients with a history of psoriasis or melanoma.Telemed J E Health. 2006; 12: 639-643
- The doctor is in (your inbox): E-visits can be an efficient way to practice, but they have been slow to catch on. Minnesota Medicine Web site.(Accessed May 12, 2010.)
- Toward automating the medical history.Mayo Clin Proc. 1968; 43: 1-25
- A computer-based medical-history system.N Engl J Med. 1966; 274: 194-198
- A history of computerized medical interviews.MD Comput. 1984; 1 (68.): 52-59
- The patient-computer interview: a neglected tool that can aid the clinician.Mayo Clin Proc. 2003; 78: 67-78
- Your EHR + Medfusion patient portal = best solution for meaningful use. Medfusion Web site. Medfusion, Inc, 2010 (Accessed May 12, 2010.)
- Patient interview software. Primetime Medical Software, Columbia, SC2010 (Accessed May 12, 2010.)
- Kaiser Permanete honored as leader in health information technology [press release] Oakland, CA. Kaiser Permanente.(Accessed May 12, 2010.)
- Impact of online primary care visits on standard costs.Popul Health Manag. 2010; 13: 59-63
Article Info
Footnotes
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.
Identification
Copyright
© 2010 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Patient-Computer Dialogue: A Hope for the FutureMayo Clinic ProceedingsVol. 85Issue 8
- PreviewDialogue between physician and patient continues to be the mainstay of clinical medicine. During the clinical visit, the physician endeavors to establish rapport, develop bonds of mutual respect and trust, obtain information relevant to the patient's medical problems and general health, and communicate information for the patient's immediate and long-range use. In turn, the patient can communicate personal preferences to the physician, and the two can work together to develop an approach to treatment that is consistent with both the patient's wishes and the dictates of medical science.
- Full-Text
- Preview