Rise of the Online Doctor Visit

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

Shevchik: In September 2010, we rolled it out to 277 doctors, covering 12,000 patients. And that’s where it’s out to now. We went from having months where we might get 25 to 30 e-visits a month, to five or six visits a day. Our busiest day has involved 17 e-visits a day. We offer the service seven days a week, from 8 a.m. to 8 p.m.—the reason for those hours are that the pharmacy should be open to service those patients. But for patients, you can do this 24 hours a day; you feel bad in the middle of the night, you can fill out the questionnaire, and go back to bed.

HCI: How big will this eventually get?

Shevchik: It’s not so much the physicians who make it grow so much as the patients. So if you move to Pittsburgh, and you pick Dr. X, and that doctor has five people on HealthTrak; and he has a capacity limit. But he may have 1,000 or 2,000 people on HealthTrak. So 300 doctors may have 12,000 patients today, but may have 25,000 patients, as HealthTrak continues to roll out more and more.

HCI: What lessons have been learned so far?

Shevchik: From an IT standpoint, it’s this: that you can have the best of something, but patients need access to it. What’s more, patients are “splitters,” whereas doctors are “lumpers.” Patients think in terms of very specific conditions, such as, “I have a sinus infection, or I have the flu.” Doctors think more broadly.

HCI: In other words, patients don’t think clinically, correct?

Shevchik: That’s right. Also, being a good diagnostician, you can come up with a good diagnosis. You don’t have to come up with all sorts of crazy explanations. And in fact, 80 or 90 percent of the time, patients actually know what they have now.

HCI: Have the physicians enjoyed being a part of this?

Shevchik: When we started out, it was probably 20 percent ‘yes,’ 20 percent ‘no way,’ and all the rest in the middle, saying, ‘wow, this is really different.’ Some just couldn’t get comfortable without being able to ask another question or do whatever. But as it went on, I would challenge them, comparing their notes from a face-to-face visit with an e-visit; and I’d ask them, what did you learn from the face-to-face visit that you didn’t from the e-visit? And 95 percent of the time, they said, “nothing.” So most have really embraced this; and no one is saying it doesn’t work.

And on weekends, I cover for all 277 physicians myself, for the e-visits. The most I’ll get is 10 or 12 messages a day. But what is really interesting is that I’ll say, “Hi, I’m Dr. Shevchik, and I’m covering for Dr. X,” and they’re delighted.

HCI: Do you have any advice for our readers for those who might follow in your footsteps?

Shevchik: First, find a product that allows for a patient portal. What has changed was healthcare reform; healthcare reform said, ‘you’d better start paying attention to computers.’ And a lot of organizations had electronic health records, but didn’t have a way to attach a patient portal to their EHR. And patients are now starting to accept responsibility for their own chronic illnesses, and the first thing they want is a closer interaction with their doctor.

What’s more, I’ve learned about asynchronicity: patients send in messages any time of day or night, but they’re impressed if you can get back to them in a few hours. It’s different from a telephone call; we’re not putting you on hold for 10 minutes on the phone, which would be pretty frustrating. The other element is discrete data—the computer can read the different individual data elements. Let’s pick a simple example: a patient’s hemoglobin a1c. If it’s under 7, that’s good. And if it can read your a1c, and it’s high, it can read that data element, and you can build in a best-practice alert for a high a1c reading. That’s just one example.