Given the high cost of a typical emergency room visit, it’s a significant fact that most of ED visits are for minor medical conditions that can be diagnosed and treated virtually. That happens to be the business niche of one provider of telemedicine services, Stat Doctors, headquartered in Scottsdale, Ariz. The company, which has been existence since 2009, uses the telemedicine services of board-certified emergency physicians. It has been expanding its technology platform that now includes mobile apps as well as a home-grown electronic medical record.
Andrew Wagner, M.D., Stat Doctors chief medical officer as well as a practicing physician for the service, thinks telemedicine is quickly establishing itself as a credible alternative to traditional patient care. He stresses that its services are not meant to replace the ED or the patient’s primary care physician office, (and in fact works with providers in those care settings when patient has a true medical emergency or chronic condition). Instead, its focus is on treating minor medical conditions—sinusitis, allergies, rashes or sports injuries—that do not generally require a visit to the ED or urgent care center.
Wagner says two factors set the company’s services apart from traditional “bricks-and-mortar” care settings. One is the physician perspective: Stat Doctors partners with a single large medical group, Emergency Medicine Physicians, Canton, Ohio, with a network of about 800 emergency medicine physicians who serve 15 states. Working with a single medical group makes coordinating an easier task, he says, adding that the physicians have helped the telemedicine company to streamline the service.
The second is technology. About a year and a half ago, Stat Doctors started down the path of developing and implementing mobile technology. “Not every computer has a webcam on it, but the majority of smartphones and tablets do have them,” he says, adding that from a physician’s perspective, video is an excellent tool for connecting with the patient and providing care. “We said, everybody has smartphones, and they all have webcams. We want to do the majority of our visits via live video, because we think it’s a better experience,” he says.
Wagner says that all of the functionality that exists on the web-based application developed for the computer has been replicated on the mobile app. In addition to the smartphone apps, the company has developed a mobile app for the iPad that has the same functionality as the smartphone app. It is now looking at extending the app for Android tablets, he says.Wagner notes that in April, the Federation of State Medical Boards (FSMB) issued advisory policy guidelines on telemedicine. Among its key points are: that standards of care that protect patients during in?person medical interactions apply equally to medical care delivered electronically; providers using telemedicine should establish a credible “patient?physician relationship” and ensure that their patients are properly evaluated and treated; and that providers should adhere to well?established principles guiding privacy and security of records, informed consent, safe prescribing and other key areas of medical practice.
Speaking of the FSMB statement, he says, “It’s up to the individual states if they are going to adopt this, but it is clear that they support this type of practice of medicine,” he says. “We feel like we are ahead of the game in that; and it turned out to be a really good decision. Everybody loves their smartphones; it’s just easier and more convenient.”
Wagner says that medical school teaches that 90 percent of diagnoses come from just listening to a patient. Communicating with a doctor via smartphone is not unlike a patient describing his symptoms to his or her primary care doctor, he says. He adds that if there is one thing emergency medicine doctors can hang their hat on it’s the ability to make quick diagnoses. He says that sets the telemedicine services of his organization apart from urgent care centers that use mid-level practitioners. The emergency medicine physicians working under contract still practice clinically and do telemedicine on the side. Some may have scaled back their regular practice or opted for a more flexible schedule, depending on their life circumstances.
Among the company’s clients are self-insured employers that have a vested interest in delivering the right level of care to patients, as well as insurance companies, for the same reason. It also contracts with hospitals, getting them involved with an employer plan. Wagner thinks there is an opportunity for integrating the traditional care delivery model of the hospital into the telemedicine care delivery model. “Right now telemedicine is a standalone entity, but as things get more sophisticated and hospitals come under more pressure and patients demand it, we are going to see a large integration between brick and mortar and telemedicine,” he says.
Patients are connected to an emergency medicine doctor in minutes. Following a consultation, a prescription is sent electronically to the patient’s local pharmacy if required. Patients get a follow-up call three days after the consultation to make sure they got their medications, if they scheduled an appointment with their primary care doctor, and if they have additional questions, Wagner says. He says the follow-up call is important to providing quality care. “Telemedicine is an upcoming field, but we want to make sure we are treating patients appropriately, so we get a second bit of the apple,” he says.
Wagner says the telemedicine model should not replace the family doctor. He says it’s important for the patient to have a close relationship with the family doctor, whose practice is the patient’s medical home for care. “We are not here to manage diabetes of chronic hypertension; we are here for acute unscheduled illnesses,” he says. Records of the e-visit are kept electronically, and are sent to the patient’s primary care physician in keeping with health Insurance Portability and Accountability Act (HIPAA) and privacy rules. If the emergency care doctor thinks it is warranted, he or she will refer a patient to the ED, and request a call back from the hospital if there is any reason for concern.
New patients go through a registration process that documents their medical history. Wagner says Stat Doctors has developed its Web-based EMR internally with input from its practicing physicians. It has just completed version of the EMR for the Web as well as for the iPad.
“We have had five years of experience treating patients, and we are starting to understand how to get the right information to the doctor at the right time,” he says. “We are trying to replicate that historic relationship your grandparents had with their doctor.” In the virtual world, that means knowing the patient’s medical history, but also getting to know the patient on a more personal level. He says the new EMR app will start to achieve that.
Wagner says all of the company’s apps have been developed in-house, where its technology team sat down with doctors and took in their questions and concerns. “We think we are the first telemedicine company to come out with a mobile app specific to physician documentation. I don’t think there is anybody out there that has this level of sophistication when it comes to medical record documentation and informatics in terms of pulling in the correct information on the patient beyond basic medical information,” he says.
Asked about his view of where telemedicine is headed a few years from now, he said the company is starting to look at treating a broader range of patients to treat more moderate conditions such as chronic obstructive pulmonary disease exacerbation, and to virtualize care on a larger scale. Treating moderate conditions will require integration of peripheral dev ices. For example, the company has developed a “kiosk” model to integrate peripheral devices to integrate peripheral devices, such as an otoscope. “None of these devices will be available to the patient in their home, but we’ve integrated peripheral devices to give our doctors the typical tools they would use when they are practicing in the brick and mortar world. We are virtualizing the doctor,” Wagner says.
Wagner says telemedicine offers a value that is in line with the goals of healthcare reform. “If you can one basic problem, how to get the patients the right level of care at the right time, that would be an extraordinary feat, and we are starting to do that,” he says.