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Making the eVisit Work

April 27, 2012
by Jennifer Prestigiacomo
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How UPMC got patients, physicians, and payers onboard

Since April 2009, the University of Pittsburgh Medical Center (UPMC) health system has facilitated more than 4,000 electronic visits (eVisits), and even more importantly, has engaged four different payers to reimburse for this electronic service.

This eVisit program earned the 20-hospital UPMC health system in western Pennsylvania a finalist award in the Healthcare Informatics IT Innovator Awards that was presented at this year’s Healthcare Information and Management Systems Society (HIMSS) Conference in Las Vegas.

Since August 2008 through this March, UPMC has racked up 4,060 eVisits, and the program has seen roughly a 400 percent increase in growth since mid-2010. The health system topped 100 eVisits per month first in October 2010 and then 200 eVisits in December 2010. The eVisit program is tightly integrated with UPMC’s patient portal and personal health record (PHR), dubbed HealthTrak (a product from the Verona, Wis.-based Epic Corp., which is UPMC’s electronic health record vendor).

“Once you have that solid foundation,” says G. Daniel Martich, M.D., CMIO, UPMC, “I think you can more effectively build an eVisit and personal health record program on top of that because without that linkage, the value to the patient and certainly the workflow on the physician side, goes away.”

Martich projects the program could see at least a 25 percent growth rate in eVisits over the coming year, barring any significant changes in CMS or other reimbursement policies. There are currently 88 practices in 277 locations using HealthTrak that have registered close to 100,000 patients. Currently, a total of 397 primary care physicians can participate in eVisits.

How it Works
UPMCs’ eVisit platform allows non-emergent patients to seek treatment for 25 primary care topics like back pain, bronchitis, burn, cold symptoms, anxiety, depression, and other problems, and the cost is the same as an office visit. (There are no specialist eVisits at this time.) The top problems that patients have requested eVisits for have been sinusitis (26.7 percent) and urinary symptoms (11 percent). Martich has said that his team has tried to be thoughtful around what additional topics to add. Recently, an eVisit for birth control was added, which was created by an internist interested in allowing easier access for underserved populations.

After logging on to their HealthTrak account, patients can select an eVisit and complete a tailored questionnaire to provide the physician with medically relevant data in structured form. The questionnaires are consistent from patient to patient, compared to in-person visits or telephone conversations where the questions asked can vary from encounter to encounter. This consistency leads to a more consistent care and, over time, provides a source of data for analyzing care. After submission of the questionnaire, patients receive responses from their physician, typically within four hours and sometimes within minutes; and physicians are staffed to respond to eVisits through extended daytime hours, with many physicians responding outside of regular hours as well.

“What we’ve found is that once we tell patients that there is this e-Visit concept,” says Martich, “we’ve been very successful both in growth of the number of patients on the portal, but really the side effect has been that patients are using the e-Visits more and more.”

The eVisits functionality was initially developed using code from UPMC’s EHR vendor. Custom web page designs and software builds have been repeatedly implemented in the years that followed. The Internet transactions are carried out using Microsoft Active Server Pages (ASPs) (from the Redmond, Wash.-based Microsoft), and the security is provided using Microsoft’s Internet Authentication Service (IAS). The database for all data was built using InterSystems Cache (InterSystems Corporation, Cambridge, Mass.).

Fitting into the Fee-for-Service Model
The most important innovation of the eVisit program was the development of a framework for fee-for service based eVisits, which was critical for physician adoption, says Martich. It was and remains challenging to get traditionally conservative insurance plans onboard to pay for an email conversation between a doctor and a patient, he says.

Before negotiating with payers, a pilot of the eVisit program was implemented. Data from this pilot program and the logic of using CPT code 99444 for telehealth were presented to several local insurance payers and soon multiple payers came onboard in April 2009.