E-visits get checkup of their own

More than 90 percent of people surveyed about e-visits at MUSC Health said they had a positive experience with the $25 online appointments. That’s among the findings of a report out today in the journal Health Affairs. 

It’s a checkup for a young system that lets people answer an online questionnaire, and in most cases, get a diagnosis. E-visits are only available for a limited list of common, non-emergency conditions, ranging from sinus infections to skin rashes. At MUSC Health, they’re usually handled by doctors, nurse practitioners and physician assistants in the emergency department.

MUSC Health launched e-visits three years ago. The system has evolved to include anyone who has a condition on the list of options, even if they have never seen an MUSC Health doctor before. There’s no insurance involved, just the $25 flat fee.

Key findings about MUSC Health e-visits:

• Women are the early adopters. They made up more than 80 percent of the e-visit users in the two-and-a-half-year period covered by the report. “We don’t know why,” said Marty Player, M.D.He’s one of the researchers behind the study and an associate professor in the College of Medicine at the Medical University of South Carolina. “More visits in primary care are by women in general.”

• E-visit users tend to be young. More than 55 percent were in the 18 to 44-year-old age group. 

• Sinus problems top the list of complaints. Almost 40 percent of e-visits involved this common ailment.

• Not all e-visits led to a diagnosis. “The patient filled out the questionnaire and the provider said for some reason, ‘I can’t do the visit. We can’t complete it,’” Player said. “Most of those, 90 percent, were because of the acuity or complexity of the problem.” In those cases, the patient was asked to see a doctor in person.

• Some e-visit users needed a follow up appointment. “About four-and-a-half percent had an office visit,” Player said. “Half a percent had a repeat e-visit.”

• Most e-visit users would have gone to see a doctor if they hadn’t been able to do the online appointment. “E-visits take about seven minutes to do from the time the doctor opens the questionnaire to the time a response goes to the patient,” Player said. “You usually get an answer within an hour. You can do them from work or home, so you don’t miss work and you don’t have the travel time involved in an in-person doctor’s appointment.”

The research was part of the plan from the beginning. As an academic medical center, MUSC leaders wanted scientific scrutiny to test the value of e-visits. The study looked at 1,565 e-visits that took place between December 2015 and July 2017. During that period, e-visit users had to already be MUSC Health patients. That’s no longer the case.

Player said doctors have learned from snags in the system. “One patient got treated for three different things: sinus problems, the flu and something else. Their primary care practitioner was unhappy with that. They thought, ‘Well, you basically gave them everything.’ That was a good point.”

They’re also looking at whether e-visits lead to overprescribing of antibiotics. “As you can imagine, for sinus issues, it’s pretty high,” Player said. “But I don’t think it’s any higher than if you came to the office. I don’t think that by doing telemedicine we’re doing more.”

Player is also involved in a new study comparing e-visit results to in-person visits. When a patient comes to see a doctor, he or she fills out an e-visit questionnaire that goes to an e-visit doctor. Then the patient also sees a doctor in person. Player and his team will see if the diagnoses sync up.

Meanwhile, e-visit options are about to have another growth spurt. “The expansion will probably be more into what are sometimes chronic e-visits or virtual check-ins. We just started one with smoking cessation. We’re also looking at things like hypertension and diabetes,” Player said.