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Published Online: 30 January 2015

Online Medical Care: The Current State of “eVisits” in Acute Primary Care Delivery

Publication: Telemedicine and e-Health
Volume 21, Issue Number 2

Abstract

Background: Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or “eVisits,” allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. Materials and Methods: A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. Results: Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. Conclusions: Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction.

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References

1.
Jung C, Padman R, Shevchik G, Paone S. Who are portal users vs. early e-Visit adopters? A preliminary analysis. AMIA Annu Symp Proc 2011:1070–1079.
2.
Whitten P, Buis L, Love B. Physician-patient e-visit programs: Implementation and appropriateness. Dis Manage Health Outcomes 2007;15:207–214.
3.
The impending collapse of primary care medicine and its implications for the state of the nation's health care: A report from the American College of Physicians. Washington, DC: American College of Physicians, 2006.
4.
Adamson SC, Bachman JW. Pilot study of providing online care in a primary care setting. Mayo Clin Proc 2010;85:704–710.
5.
Albert SM, Shevchik GJ, Paone S, Martich GD. Internet-based medical visit and diagnosis for common medical problems: Experience of first user cohort. Telemed J E Health 2011;17:304–308.
6.
Cusack CM, Pan E, Hook JM, Vincent A, Kaelber DC, Middleton B. The value proposition in the widespread use of telehealth. J Telemed Telecare 2008;14:167–168.
7.
Dixon RF. Enhancing primary care through online communication. Health Aff (Millwood) 2010;29:1364–139.
8.
Dixon RF, Stahl JE. A randomized trial of virtual visits in a general medicine practice. J Telemed Telecare 2009;15:115–117.
9.
Fleming DA, Edison KE, Pak H. Telehealth ethics. Telemed J E Health 2009;15:797–803.
10.
Katz SJ, Moyer CA, Cox DT, Stern DT. Effect of a triage-based E-mail system on clinic resource use and patient and physician satisfaction in primary care: A randomized controlled trial. J Gen Intern Med 2003;18:736–744.
11.
Leong SL, Gingrich D, Lewis PR, Mauger DT, George JH. Enhancing doctor-patient communication using email: A pilot study. J Am Board Fam Pract 2005;18:180–188.
12.
Liederman EM, Lee JC, Baquero VH, Seites PG. The impact of patient-physician web messaging on provider productivity. J Healthc Inf Manag 2005;19:81–86.
13.
Liederman EM, Lee JC, Baquero VH, Seites PG. Patient‐physician Web messaging. J Gen Intern Med 2005;20:52–57.
14.
Mandl KD, Kohane IS, Brandt AM. Electronic patient-physician communication: Problems and promise. Ann Intern Med 1998;129:495–500.
15.
Myers MR. Telemedicine: An emerging health care technology. Health Care Manager 2003;22:219–223.
16.
Nijland N, van Gemert-Pijnen JE, Boer H, Steehouder MF, Seydel ER. Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation. Int J Med Inform 2009;78:688–703.
17.
Padman R, Shevchik G, Paone S, Dolezal C, Cervenak J. eVisit: A pilot study of a new kind of healthcare delivery. Stud Health Technol Inform 2010;160:262–266.
18.
Spielberg AR. On call and online: Sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA 1998;280:1353–1359.
19.
Tang PC, Black W, Young CY. Proposed criteria for reimbursing eVisits: Content analysis of secure patient messages in a personal health record system. AMIA Annu Symp Proc 2006:764–8.
20.
Virji A, Yarnall KS, Krause KM, et al. Use of email in a family practice setting: Opportunities and challenges in patient- and physician-initiated communication. BMC Med 2006;4:18.
21.
Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: Is there enough time for prevention? Am J Public Health 2003;93:635–641.
22.
Walters B, Barnard D, Paris S. “Patient portals” and “e-visits.” J Ambul Care Manage 2006;29:222–224.
23.
Saifu HN, Asch SM, Goetz MB, et al. Evaluation of human immunodeficiency virus and hepatitis C telemedicine clinics. Am J Managed Care 2012;18:207–12.
24.
Charpentier G, Benhamou PY, Dardari D, et al. The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: A 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Diabetes Care 2011;34:533–539.
25.
Fonda SJ, Kedziora RJ, Vigersky RA, Bursell SE. Evolution of a web-based, prototype personal health application for diabetes self-management. J Biomed Inform 2010;43(5 Suppl):S17–S21.
26.
Harris LT, Tufano J, Le T, et al. Designing mobile support for glycemic control in patients with diabetes. J Biomed Inform 2010;43(5 Suppl):S37–S40.
27.
Siriwardena LSAN, Wickramasinghe WAS, Perera KLD, Marasinghe RB, Katulanda P, Hewapathirana R. A review of telemedicine interventions in diabetes care. J Telemed Telecare 2012;18:164–168.
28.
Wang J, Wang Y, Wei C, et al. Smartphone interventions for long-term health management of chronic diseases: An integrative review. Telemed J E Health 2014;20:570–583.
29.
Liberati A, Altman DG, Tetzlaff CM, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 2009;339:b2700.
30.
Carrell D, Ralston JD. Variation in adoption rates of a patient web portal with a shared medical record by age, gender, and morbidity level. AMIA Annu Symp Proc 2006:871.
31.
Mehrotra A, Paone S, Martich GD, Albert SM, Shevchik GJ. Characteristics of patients who seek care via eVisits instead of office visits. Telemed J E Health 2013;19:515–1519.
32.
Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc 2006;13:91–95.
33.
Hsu J, Huang J, Kinsman J, et al. Use of e-Health services between 1999 and 2002: A growing digital divide. J Am Med Inform Assoc 2005;12:164–171.
34.
Artnak KE, McGraw RM, Stanley VF. Health care accessibility for chronic illness management and end‐of‐life care: A view from rural America. J Law Med Ethics 2011;39:140–155.
35.
Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3:209–214.
36.
Reid PP, Compton WD, Grossman JH, Fanjiang G, eds. Building a better delivery system: A new engineering/health care partnership. Washington, DC: National Academies Press, 2005.
37.
Baker L, Rideout J, Gertler P, Raube K. Effect of an Internet-based system for doctor-patient communication on health care spending. J Am Med Inform Assoc 2005;12:530–536.
38.
Rohrer JE, Angstman KB, Adamson SC, Bernard ME, Bachman JW, Morgan ME. Impact of online primary care visits on standard costs: A pilot study. Popul Health Manage 2010;13:59–63.
39.
Houston TK, Sands DZ, Jenckes MW, Ford DE. Experiences of patients who were early adopters of electronic communication with their physician: Satisfaction, benefits, and concerns. Am J Managed Care 2004;10:601–608.
40.
Moyer CA, Katz SJ. Online patient-provider communication: How will it fit. Electron J Communication 2007;17. Available at http://www.cios.org/EJCPUBLIC/017/3/01732.html (last accessed May 14, 2014).
41.
North F, Crane SJ, Chaudhry R, et al. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health 2014;20:191–198.
42.
Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013;32:1361–1367.
43.
Butler J, Dalan D, McCourt B, Norris J, Stewart R. Online health care: A classic clash of technology, people, and processes in transforming health care through information: Case studies. New York: Springer Science+Business Media, 2010.
44.
Fox S, Rainie L. The online health care revolution: How the Web helps Americans take better care of themselves. Washington, DC: The Pew Internet & American Life Project, 2000.
45.
Lin CT, Wittevrongel L, Moore L, Beaty BL, Ross SE. An Internet-based patient-provider communication system: Randomized controlled trial. J Med Internet Res 2005;7:e47.
46.
Chan CV, Kaufman DR. A framework for characterizing ehealth literacy demands and barriers. J Med Internet Res 2011;13:e94.
47.
Byrne JM, Elliott S, Firek A. Initial experience with patient-clinician secure messaging at a VA medical center. J Am Med Inform Assoc 2009;16:267–270.
48.
White CB, Moyer CA, Stern DT, Katz SJ. A content analysis of e-mail communication between patients and their providers: Patients get the message. J Am Med Inform Assoc 2004;11:260–267.
49.
Boukus ER, Grossman JM, O'Malley AS. Physicians slow to e-mail routinely with patients. Washington, DC: Center for Studying Health System Change, 2010.
50.
Thornbury WC. Mobile eVisits: Disruptive distribution to bend the healthcare cost curve. Presented at the Healthcare Information Management Systems Society (HiMSS) Meeting, New Orleans, LA, 2013.
51.
Williams J. The value of mobile apps in health care. Healthcare Financial Management. June 1, 2012. Available at hfma.org (last accessed May 14, 2014).
52.
Greenspun H, Coughlin S. mHealth in an mWorld: How mobile technology is transforming health care. Washington, DC: Deloitte Center for Health Solutions, 2012.
53.
Dixon RF, Rao L. Asynchronous virtual visits for the follow-up of chronic conditions. Telemed J E Health 2014;20:669–672.
54.
Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: Implications for the importance of primary care in 'case' management. Ann Fam Med 2005;1:8–14.
55.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457–502.
56.
Bavafa H, Hitt L, Terwiesch C. Patient portals in primary care: Impacts on patient health and physician productivity. Philadelphia: University of Pennsylvania, 2013.
57.
Thornbury WC. mHealth & 2nd generation telemedicine: Making the medical home mobile to provide care for world populations. Chicago, IL: Knowledge Resources, 2013.
58.
Chan CV, Matthews LA, Kaufman DR. A taxonomy characterizing complexity of consumer eHealth literacy. AMIA Annual Symposium Proceedings, 2009. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815448/ (last accessed May 14, 2014).

Information & Authors

Information

Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 21Issue Number 2February 2015
Pages: 90 - 96
PubMed: 25474083

History

Published in print: February 2015
Published online: 30 January 2015
Published ahead of print: 4 December 2014
Accepted: 21 May 2014
Revision received: 15 May 2014
Received: 29 January 2014

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Authors

Affiliations

Ryan Hickson
College of Pharmacy, University of Kentucky, Lexington, Kentucky.
Jeffery Talbert
Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, Kentucky.
William C. Thornbury
College of Medicine, University of Kentucky, Lexington, Kentucky.
Nathan R. Perin
Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, Kentucky.
Amie J. Goodin
Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, Kentucky.
Martin School of Public Policy and Administration, University of Kentucky, Lexington, Kentucky.

Notes

Address correspondence to:Amie J. Goodin, MPPUniversity of Kentucky789 South Limestone Street, BPC 237Lexington, KY 40536-0596E-mail: [email protected]

Disclosure Statement

W.C.T. is the founder and owner of an eVisit technology called “Me-Visit.” R.H., J.T., N.R.P., and A.J.G. declare no competing financial interests exist.

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