The promise of telemedicine and of widespread use of Internet messaging and data sharing with patients seems tantalizingly close. Internet, video and mobile technologies have already changed industries from retail to finance to travel. The technologies have the potential to transform healthcare, yet they haven’t had a significant impact yet. What would it be like if they did?
That was the theme of a talk last week by Robert Pearl, M.D., executive director and CEO of the Permanente Medical Group in Northern California, at a Health Affairs Issue Briefing meeting. In his talk and in a paper in Health Affairs, Pearl gave a glimpse into that future by talking about how the 8,000 physicians and 3.4 million members of Kaiser Permanente Northern California (KPNC) have increasingly come to rely on Internet, mobile and video technologies. For instance, the number of virtual “visits” grew from 4.1 million in 2008 to an estimated 10.5 million in 2013, he said. KPNC predicts that by 2016 virtual visits —including secure e-mail, telephone, and video encounters— will exceed in-person visits in its Northern California system.
Pearl noted that KPNC members routinely make appointments, order medication refills, and access medical information online. A mother can send a secure message with a photo of her child’s rash and then have a 3 a.m. video visit with a pediatrician at no extra cost. KPNC physicians respond to millions of secure e-mails each year and 48 specialty departments offer video consultations, he said.
Pearl said that member surveys indicate that the online tools are very popular with members. In his Health Affairs article, he wrote that 87 percent of respondents to a 2013 internal survey of KPNC members who had registered to use the secure features of kp.org reported that their secure e-mail encounters with physicians did a very good or excellent job of meeting their needs. In addition, since 2008 the number of secure messages sent by patients has increased by almost 20 percent per year, on average.
As of September 2013 approximately 73 percent of KPNC patients had registered on the website, and as of December 2013 more than 42,000 patients had logged onto KP Preventive Care, a mobile application that allows users to review the status of preventive health care screenings, communicate with their physician, or schedule tests such as mammograms.
Another potential benefit, he added, is physician satisfaction. In an annual survey of career-track physicians, more than 90 percent of respondents said that the availability of online tools has allowed them to provide higher-quality care for their patients. Additionally, the availability of sophisticated technology has proved to be attractive to the medical school graduates the Permanente Medical Group recruits.
Yet, as Pearl concluded, despite their very positive experience, it is likely that the technologies will be adopted more slowly than patients or policymakers would like. “Our positive experience did not happen by chance,” he said. Kaiser has invested significantly in EHR development so that data can be available at every point of contact with patients.
And because Kaiser’s physicians are all employees, its leadership has the authority to require that clinicians use the tools. Using the technologies in a meaningful way requires considerable workflow changes and resource re-allocation, as well as physician leaders who are comfortable with technology.
Perhaps most significantly, KPNC works on a prepaid model, so it doesn’t face the perverse incentives that still exist elsewhere in the system. (In the fee-for-service world, there is no consensus among payers on criteria or reimbursement rates for virtual visits.)
Yet Pearl sees signs of progress. In his Health Affairs paper, he notes that “once regulatory and accrediting agencies such as Medicare and commercial health plans assign value to care delivered virtually that is comparable to the value assigned to care delivered in the office, the advantages to organizations that invest in technologically enabled care will increase dramatically.”