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Pilot Study of Providing Online Care in a Primary Care Setting


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


      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.


      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.


      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.
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      Linked Article

      • Patient-Computer Dialogue: A Hope for the Future
        Mayo Clinic ProceedingsVol. 85Issue 8
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          Dialogue 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.
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