In a bid to provide quick, convenient access to care for common, easy-to-diagnose ailments, UW Medicine—the University of Washington’s healthcare organization—began an online virtual clinic in January using telemedicine services from Seattle-based Carena.
People in Washington can schedule a face-to-face visit with a doctor or nurse anytime of the day or night for help with minor illnesses and injuries, from acne to flu to warts. It costs $40 a visit, conducted via Web cam on a computer, smartphone or tablet usually within a half an hour of scheduling. The healthcare providers can write prescriptions for some medications.
The UW Medicine Virtual Clinic is aimed at introducing new patients to the healthcare organization—a sprawling collection of hospitals, neighborhood clinics, the UW School of Medicine, and more—while also providing quality, convenient, lower-cost care, says Dr. John Scott, medical director of telehealth at University of Washington.
It’s designed for acute issues rather than ongoing care, and is not meant to replace a patient’s primary care physician—but it could be a way to connect with one.
“So many people now have health insurance, and they may not have a primary care doctor,” Scott says. “It’s another way for us to help them find a primary care doctor and start working on some of those preventative health care things.”
In its first month of operations, the virtual clinic has seen more than 150 unique patients, Scott says.
Despite decades of experience with telemedicine, UW Medicine chose a private company for this effort.
Scott heard about a similar service Carena provides to Tacoma, WA-based CHI Franciscan Health shortly before he became the medical director of UW Telehealth in fall of 2013.
He says he was impressed by Carena’s focus on quality of care through the use of virtual clinic practice guidelines based on research and adapted from national standards; programs to track and reduce antibiotic prescription rates; and follow-up with patients after five days.
Carena is also focused on collaborating with local health systems, handing off care to a patient’s primary doctor, or, if the patient doesn’t have one, helping him or her find one. Scott was also eager to have UW Medicine work with a local company.
Carena has been around since 2000, raising a $14 million Series C funding round in 2012 led by Catholic Health Initiatives (CHI) to fund expansion. Later that year, it launched CareSimple, offering the general public the virtual clinic services it provides to big health plans and employers. Its competitors include Boston-based American Well; MDLIVE, based in Sunrise, FL; and Teladoc in Dallas, TX.
The UW Medicine Virtual Clinic is actually staffed by Carena doctors and nurses for the time being. Toward the end of the year, UW Medicine physicians will get training from Carena on how to do virtual consultations and will take over the service in 2016, Scott says. [Disclosure: My spouse is a UW Medicine employee but has no involvement in telemedicine.]
There’s an art in conducting a physical exam without laying hands—or instruments—on the patient, Scott says. Healthcare providers have to coach their patients to be the doctor’s eyes, ears, and hands, he says, feeling for swelling, for example.
But not everything can be diagnosed via the virtual clinic. About 30 percent of the time, Scott says, the virtual clinician will direct the patient to the emergency department or urgent care clinic. Even that has value because the patient gets peace of mind in knowing it’s appropriate to go in, and the virtual clinic doctor can alert their bricks-and-mortar counterparts. “At least it’s streamlined,” he says.
New diagnostic tools such as the Steth IO smartphone stethoscope from Seattle-based StratoScientific or the Oto HOME otoscope from San Francisco-based CellScope could help with better telemedicine diagnosis. Other wearable devices and technologies such as the Health app from Apple also hold promise, Scott says.
The University of Washington has some 40 years of experience with telemedicine, helping it provide care and training across a five-state area comprised of Washington, Wyoming, Alaska, Montana, and Idaho. Scott says in the 1970s, UW doctors used NASA satellites to communicate in remote areas of Alaska, for example. More recently, programs such as Project ECHO (Extension for Community Healthcare Outcomes) have linked doctors around the region to discuss best practices for treating specific diseases such as Hepatitis C, HIV, and multiple sclerosis, as well as conditions like chronic pain. The UW also has strong initiatives in telepsychiatry and teledermatology, Scott says.
He says cheaper, more accessible technology is one thing pushing telemedicine in general toward a “tipping point.”
“A lot of that is driven by the average person having a smartphone,” Scott says.
Patients are enthusiastic about telemedicine for its convenience. Employers, too, are encouraging employees to use virtual clinic services to quickly get a diagnosis—Is it the flu? Should I go home to avoid infecting coworkers?—without leaving work.
Another big driver is payment reform. As reimbursement models shift from pay-for-service to pay-for-performance, healthcare organizations are increasingly focused on things like reducing hospital readmissions for heart disease patients.
An earlier UW pilot project provided 30 heart failure patients with a device that measured their blood pressure, pulse, cardiac electrical activity, and weight. The data was transmitted back to healthcare providers via a 3G mobile network. “We could see all the patients who are out of range on those metrics,” Scott says.
If a patient showed signs of heart failure, doctors could suggest changes in medication or other interventions. “We did a 90-day pilot with these 30 patients who were in and out of the hospital a lot before this, and then we only had one patient come in to the hospital, and it was because they choked on a hot dog. It wasn’t because of heart failure,” he says. “Other hospital systems have used this on a much larger scale for their heart failure patients, and it has shown dramatic reductions in hospitalizations and also [improvements in] survival.”
Healthcare providers are forming accountable care organizations (ACOs), in which providers team up to improve care quality and reduce costs of treating Medicare patients, yielding savings that the organization would share. UW Medicine launched its Accountable Care Network last year, applying a similar concept for private employers and signing up Boeing as an initial customer.
Scott says the UW is looking at how a virtual clinic can be used in an ACO setting. “That’s where things can really get exciting,” he says. “How do you coordinate care better? How do you have better, more convenient access?”
The UW Medicine Virtual Clinic is currently unavailable to Medicare patients thanks to what Scott calls outdated rules set at the federal level. Meanwhile, a bill pending in the Washington Legislature would recognize telemedicine for coverage by Medicaid and commercial insurance plans in the state.