While resting in her Cheney home, Robin Allen turned to her smartphone for a face-to-face video chat with a nurse practitioner to discuss a recent infection. Within a 10-minute virtual exam, Allen received a diagnosis of pink eye.
She didn’t feel well enough to go to a clinic, and a friend had told her about Providence Health Care’s Express Care Virtual. The $39 session connects patients over a device or computer using internet access to a health care provider for basic medical issues, from skin rashes to allergies.
“In December, I was plagued with pink eye,” Allen says. “So I texted my friend, ‘I need to know what this is.’ I didn’t want to leave the house; it was too painful. I had had pink eye before. My kids have had it. We were caring for a friend’s son who had it, and that’s where I got it.”
With her friend’s advice, Allen downloaded the Express Care Virtual app, paid an insurance co-pay, and waited only briefly.
“I was in the waiting queue, like, one minute, and I got through to the nurse practitioner,” Allen says. “She was very professional, tactful, kind. The whole thing was super convenient. I was literally in my pajamas and laying on my floor. She asked me to hold my phone up to my eye. She confirmed it was pink eye.”
Allen adds, “She asked me some general health questions. Within minutes, she called in the prescription, and my husband was able to pick it up. From start to finish, it was 10 minutes or under. It was literally like a face-to-face encounter without the additional germs at a clinic.”
MultiCare, a regional health care provider acquiring Rockwood Clinic this year, is offering a similar Spokane-area service through its $49 Doctor On Demand video-chat exam with a physician, and a $25 text-based option called MultiCare eCare.
Presently, Rockwood’s $39 VirtualHealthNow is another regional choice for primary-care services over a smartphone, tablet, or computer using internet. Long-term planning for that program is under review as part of Rockwood’s transition to MultiCare later this year, says spokesman Kevin Maloney.
Patients using virtual-care models typically are seeking treatments for such ailments as allergies, sore throats, coughs, colds, flu, urinary tract infections, pink eye, ear infections, and common skin rashes. If diagnosis is reached, providers can write a prescription electronically for patients to pick up at a pharmacy.
A person isn’t charged for a virtual session if a provider determines during the encounter that the patient’s condition requires an in-person visit at a facility or emergency room, providers here say.
Dr. Sunita Mishra, a Renton-based medical director of innovation for Providence, says the Express Care Virtual model launched two years ago around the state of Washington and has attracted more than 2,000 visits overall. Patients in Spokane have had access to Express Care Virtual for about a year.
“For everyone who has used it, when asking how they like it with a survey, the satisfaction scores are quite high,” Mishra says. “What made us think about all these strategies around express care is we oftentimes aren’t available for patients when they need us. We wanted to provide better access so they can reach us, in different ways, when and where they need it.”
Overall, the intent of these newer virtual-care models is to give patients that flexibility and faster access for some common urgent care needs, says Emily Yu, MultiCare’s Tacoma-based virtual health program manager. Yu says Doctor On Demand launched in April 2015, and MultiCare eCare started in January 2016.
“With Doctor On Demand, surprisingly we can treat 80 percent of issues that people typically go to urgent care to be seen for,” Yu says. “Instead of waiting a week or two weeks for a physician, you can get treatment in the same day. These are very low-cost services for patients.”
During a video-chat session, providers will do a visual exam and perhaps seek audio cues, such as asking someone to cough. The professionals will ask screening questions and typically seek patient assistance with visual aspects of an exam, such as requesting someone to hold a smartphone’s camera more closely toward a skin rash.
Yu says another example would be a parent assisting with a child’s exam. “For an ear infection, they actually will ask if someone is available, and usually it’s for a kid, so you’ll have the mom point the camera toward the ears to see if any redness is there.”
MultiCare’s Doctor On Demand model, as the name implies, provides access solely to physicians. The service is available to any patient in Spokane and within the state.
Patients access the option through the Google Chrome browser by going to the website www.multicaredoctorondemand.com, or by downloading an app for iPhone or Android, Yu says. Available around the clock, Doctor On Demand transactions are mostly handled as a retail payment with a credit card. Insurance coverage is variable, so patients are encouraged to check.
A provider such as a nurse practitioner handles MultiCare’s eCare cases, which don’t include video or a phone conversation. Yu says some patients might prefer eCare for its lesser cost, or they might lack privacy for video visits.
“I’d like to think of it as texting rather than Skyping,” Yu says. “There is a branching-logic algorithm that asks a series of questions.”
Examples of questions include describing symptoms and when they started. Depending on answers given, the system might ask additional questions. All the information goes into clinical notes provided to a clinician, who will review it and make a diagnosis and treatment plan, as well as issuing a prescription if needed.
Patients can access a free text box to type additional notes they want the clinician to know. If patients have a question afterward or need to change a prescription, there is a customer-support number.
“We have a guaranteed response time with diagnosis and treatment plan within an hour, but we’re averaging 20 minutes,” Yu adds.
Jennifer Semen-za, a Spokane-based Providence spokeswoman, also describes overall virtual-based medicine as gaining popularity with patients in Spokane because of convenience. Some insurance plans allow a patient to pay a lesser co-pay amount, but Providence’s online session doesn’t exceed $39, Semenza adds.
Providence’s Express Care Virtual is available seven days a week from 8 a.m. to midnight. Patients can access it from a link on the Providence website or by downloading a mobile app via a smartphone or tablet.
Thanh Nguyen, an Express Care Virtual nurse practitioner, explains that during a video-chat exam, she’ll ask early about symptoms. With pink eye as an example, she’ll find out if there’s been a change in vision and about eye pain. “I’d ask patient to come close to camera to show the eye, and I’d demonstrate bringing a finger under an eye.”
She adds, “I’d see the conjunctivitis and that the patient is displaying symptoms. I’m asking them to look up at the ceiling, look down, and side to side.”
Mishra says when patients first go online, they enter some information that is transmitted to the virtual care provider.
“You’re told you’ll be connected to a provider in a few minutes, typically less than five minutes,” she says. “Then, the provider comes on and you’d talk to the provider just as you would to them in a doctor’s office. The providers are trained in doing website manner, as we call it, and how to ask the patients to assist in the physical exam.”
The virtual-care option can be more convenient for conditions that can’t wait, such as a toddler’s ear infection. Mishra adds, “It’s sometimes hard to get into the doctor during office hours. If you’re not feeling well, or you have a little one not feeling well, it can be cumbersome to get to a doctor.”
Anecdotally, Providence officials are hearing success stories of more patients using virtual exams, adds Spokane-based Dr. Kirk Rowbotham, medical group chief executive for Providence Eastern Washington and Western Montana.
As a parallel on-demand service, he says Spokane’s first Express Care Clinic opened Jan. 2 in the South Hill’s Lincoln Heights area to offer another quick-access model. At patients’ convenience, they schedule an appointment online or as a walk-in. The clinic is designed for patients to be seen at their allotted time and out the door in about 20 minutes.
“The Express Care Clinic and Express Care Virtual care have been very well received,” Rowbotham says, adding that Providence officials hope to open at least two more Spokane-area Express Care clinics this year.
Both Rowbotham and Mishra say Providence uses a single medical record system for its patients, so if someone is allergic to medicine, that information is shared among clinics, hospitals, and Express Care. Its virtual care providers are mostly nurse practitioners and physician assistants who have training in primary care or urgent care.
Future virtual-care models likely will involve emerging technologies, some just becoming more available on smartphones and other devices, perhaps using them to take a temperature, listen to a heartbeat, or check oxygen saturation.
MultiCare’s Yu also expects upcoming phases of virtual care to spread into specialist services. “We’re piloting in the Tacoma area that after you have a surgery, you have your surgery follow-up over video,” Yu adds.
Another future use of virtual care might add mobile technology data such as from consumers’ MyFitnessPal, MapMyRun, or Fitbit apps to benefit patient care, she says.
“Currently, none of that information is shared with your physician,” Yu says.
But a challenge is collecting health-related consumer data efficiently. The U.S. Food and Drug Administration is starting to regulate some consumer devices with a path to sharing data with medical providers. Yu adds, “Yes, the data is available, but, No. 1, is it high-quality? No. 2, is it actionable data, clearly indicating a problem versus streams and streams of data?”
For patients who are using the current virtual technology, Allen is among consumers helping spread the word about it. A Providence provider called Allen back a week after the visit to make sure her treatment went well.
“I put it on Facebook,” she said. “I’ve had dozens of comments and people have asked me how to get the app. I will use it again.”
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