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Rise of the Online Doctor Visit

March 22, 2011
by Mark Hagland
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UPMC’s groundbreaking e-visit program is a “win-win” for patients, physicians

Sometimes, all a patient who’s already seen a doctor needs is a quick follow-up communication with his or her doctor, or a brief consultation on a healthcare problem. In that regard, leaders of patient care organizations nationwide are beginning to facilitate online communications between physicians and their patients for common, non-urgent medical matters and ailments.

One organization that is doing so is the 20-hospital, integrated University of Pittsburgh Medical Center (UPMC) health system in western Pennsylvania. Through the recently established e-visit program called HealthTrak, in which a patient engages with her or his provider online, eligible patients can have questions answered, conditions analyzed, and prescriptions written, without leaving home. The key to UPMC’s program is a secure patient website that makes use of a robust patient portal.

Grant Shevchik, M.D., a family physician and geriatrician whose suburban medical practice in Murrysville, Partners in Health, is a part of UPMC, is the medical director of HealthTrak, the program that has brought online visits to UPMC patients. Shevchik began developing the concept for the HealthTrak project in 2008, and brought a number of other physicians into the development work in 2009. Then later in 2009, UPMC Health Plan, the integrated system’s affiliated health plan, agreed to reimburse physicians for e-visits under the program, becoming the first health insurer in western Pennsylvania to reimburse for e-visits.

The program continued to roll out, and, at the time of publication of this article, 77 practices with 989 physicians, who care for 53,000 registered users, are active in the program. Of the physicians, 57 percent are primary care. Within the program, patients can get securely delivered medical advice, review their medical history and lab results, renew prescriptions, track blood glucose and blood pressure, request appointments, and ask billing questions, among other tasks.

Shevchik spoke recently with HCI Editor-in-Chief Mark Hagland about the program. Below are excerpts from that interview.

Healthcare Informatics: Please tell us a little bit about the origin of this program.

Grant Shevchik, M.D.: This started with an MBA course that I was taking in which you were supposed to come up with an idea for a new project in medicine. My idea was to come up with an e-visit for relatively minor, common issues, like urinary tract infections, sinus infections, and so on. And the idea was that there would be a questionnaire that would be filled out online, and the questionnaire would be embedded in the EMR. Fortunately, there is actually a CPT code for a non-face-to-face visit, under Medicare, code #99444, for an online medical examination.

So we got some physicians together in the summer of 2008, and began a project with the physicians at UPMC, and with people from Epic [the Verona, Wis.-based Epic Systems Corporation, the UPMC health system’s core outpatient EMR vendor]. Epicare is our outpatient electronic medical record; and within Epicare, there is MyChart, the patient portal, which we’ve branded as HealthTrak. We’ve done a number of customizations with the core system.

The key to how the whole thing works is the patient portal, where you can see your problem list, medication list, past history, and so forth. What’s more, we’ve built into the portal the clinical decision support needed to address over 20 areas, from sinus infections to pneumonia to vaginal yeast infections to erectile dysfunction, etc. So the patient goes into the portal, articulates their symptoms, and the branching logic in the system guides them forward through a detailed questionnaire. And the results of that questionnaire trigger the online visit with the physician.

HCI: What medical specialties are involved?

Shevchik: Currently, internal medicine and family practice. We have a physician in neurology working on some things, and one in cardiology, looking at something, but it’s mainly primary care.

HCI: What has the growth in volume or use been so far?