Constrained by consumers who don’t always want to schedule a video visit or go to the doctor or the emergency room, healthcare systems are finding new value in asynchronous, or store-and-forward, telehealth.
Not every telehealth encounter has to include video, or even be a real-time conversation. Many healthcare organizations find that an asynchronous platform – also known as store-and-forward – works better for certain services.
“It can be a very simple and effective format for what we want to do,” says Brett Oliver, MDdirector of medical information for Baptiste Health, an eight-hospital, 400-site health system based in Louisville, Kentucky, serving parts of Illinois, Indiana and Tennessee. “And that’s what our patients really want.”
Unlike synchronous telehealth, which is essentially a real-time, two-way audio-video stream between patient and care provider, asynchronous telehealth does not involve real-time communication and, more often than not, does not include video. Consumers enter information into an online platform at their own pace and convenience, usually through a questionnaire, and a healthcare provider accesses that data on the other end, then responds with a diagnosis and a treatment plan. This can be done over the phone or computer and include images and even video, but the key factor is that the patient and provider can access the platform whenever and wherever they choose.
Asynchronous telehealth has proven popular in direct-to-consumer programs and for services that do not rely on immediacy or direct communication. It is often used for acute care issues for someone who might visit the doctor’s office, urgent care clinic, or emergency room, but are not critical enough to merit practical care, such as infections, rashes, colds and viruses. In fact, many healthcare systems faced with crowded emergency rooms have used asynchronous telehealth platforms to reduce emergency room traffic and provide patients with an easier way to seek care at home.
Go beyond the pandemic
At Baptist Health, Oliver said the health system relied on its asynchronous eVisit platform during the pandemic, when ER traffic was heavy, hospitals struggled with capacity and staffing issues. work, and it was imperative to separate infected patients from uninfected patients and staff. .
“It was a real revelation for us,” he says.
Brett Oliver, MD, director of medical information for Baptist Health. Photo courtesy of Baptist Health.
With the pandemic subsiding, the health system has seen continued interest in the platform, indicating that asynchronous telehealth has a place in Baptist Health’s list of services, alongside in-person and video visits.
“Our patients want that,” says Oliver. “And if we don’t have it, they’ll go somewhere else.”
Baptist Health is not unique. Asynchronous telehealth had seen some success before COVID-19, especially in populated areas where the non-urgent walk-in care market was intense. But many health systems were hesitant to adopt a service that didn’t include video, and federal and state regulations were much more restrictive and, in some cases, banned the use of the technology altogether. The pandemic has changed that, as state and federal regulators have relaxed the rules to increase coverage and access to telehealth and health systems ready to try it.
Oliver says Baptist Health had created a centralized hub for nurse practitioners to manage asynchronous telehealth visits, building the platform from an old retail clinic program that hadn’t worked. They built the program on their Epic EHR infrastructure, partnership with telemedicine provider Bright.md.
Before the pandemic, he says, the asynchronous service was little used, but COVID-19 changed the public’s perception of how they wanted to access health care. Primary care has always been a bit of a challenge for Baptist Health and its patients, many of whom live in rural areas, but a platform that has allowed them to connect with a care provider at their convenience, rather than driving somewhere or find the time to sit down at a computer for a video tour, hit the bull’s eye.
Oliver says many people are more comfortable talking about their health in this format, rather than through a video or even in person. They are less self-aware and usually focus on getting quick and easy treatment for a persistent health condition that is not serious enough to warrant a traditional medical visit. A post-visit patient survey found that one in four or five patients would have visited the emergency room if they had not been able to use an eVisit, he says.
“A lot of people didn’t know about asynchrony,” he says, noting that they’re dealing with around 100 cases a week, down from a peak of 300 at the height of the pandemic. “Now they don’t want to be without it. They think it’s personalized care even though there’s no video.”
The process is quite simple. Consumers complete a questionnaire, which takes approximately 12-15 minutes, which is reviewed by an NP and forwarded to a clinician. The clinician reviews the information in the EHR and then submits a diagnosis and care plan, if applicable. The health system promises a response within two hours, but usually gets back in touch within 15 minutes.
Oliver says the meeting can be expedited at any time to include a video visit or a referral for the patient to see a doctor. Questionnaire questions are also being refined to make it easier for NPs to refer cases to the right clinician, and the health system is setting aside time to update and add questions to allow them to address more health issues.
According to Oliver, almost 90% of patients seen and treated through the platform do not seek further care within 30 days, meaning they receive the care they need. The healthcare system also reports a patient satisfaction rate of well over 90%.
It will be important to track and collect this information, he says, convince payers that asynchronous telehealth should be a covered service. Like so many other health systems, Baptist Health is not reimbursed for these services and instead charges users a flat fee, which can hinder uptake by populations of Medicare and Medicaid.
Securing vendor support
Another key benefit of this platform is that it improves vendor efficiency. But it took time for suppliers to realize this.
“It was definitely a learning curve for us,” Oliver says of the effort to get vendor buy-in. “A lot of them had never used this before, so their first thought was, ‘Are you taking anything from me? They’re used to seeing patients because that’s how they get paid. »
But just as it is more convenient for patients, this platform also fits seamlessly into the clinician’s workflow. They can sit down, review all the data at their fingertips, research all nagging questions, and send the patient a diagnosis and care plan in less time than it would take to schedule and complete a video or a in-person appointment, and they can move the meet up to a video visit or in-person treatment if needed.
“About 95% of diagnoses can be made right after reviewing patient information,” says Oliver. This tells him that the healthcare system not only sees the right patients on this platform, but that it chooses the right conditions to treat on this platform, and does not refer patients there who end up needing it. more complex or advanced treatments.
Along with adding more health issues that can be covered in an asynchronous visit, Oliver sees more room for expansion on the platform. He would like to include chronic care management to allow patients and their care providers to stay connected between scheduled appointments, as well as wellness visits and follow-ups after inpatient services. In this sense, the platform could be used as a remote patient monitoring program.
“It allows us to have more touch points with our patients,” he says. “We need to think about and be able to use different modes of care delivery.”
Eric Wicklund is the innovation and technology editor for HealthLeaders.