The new house call

Telemedicine expands to include virtual doctor visits at home, work

BY KAYLA PRASEK

Five years ago, visiting with a doctor from home via video may have seemed unimaginable. Today, thanks to ever-expanding technology, Sanford Health and Avera Health patients can do just that, and soon Altru Health System and Essentia Health patients will be able to do the same.

This service is just another on a continually growing list of telemedicine services each of the region’s major health care systems provides to its patients. While each is slightly different, the concept is the same: log in via desktop or laptop computer, tablet or smartphone from home or work and visit with a physician. It saves time and money, particularly for routine illnesses.

Virtual Visits

Sanford Health, headquartered in Sioux Falls, S.D., started video visits one year ago for South Dakota and Minnesota patients and recently expanded the service to North Dakota. However, the health care provider started e-visits four years ago.

An e-visit is a questionnaire, available in the patient portal, which asks specific questions about symptoms. A provider then looks at it and the patient’s records, and will reply back with medical advice and may prescribe medication; the patient may also be asked to make an appointment in person. “If you’re someone who gets, for example, the typical sinus infection every year, this is a great option for you,” says Dr. Allison Suttle, chief medical officer. “The provider can compare your symptoms with your medical chart and can prescribe medicine if necessary.” E-visits are only available to patients in South Dakota and Minnesota.

Suttle says video visits are ideal for patients who become sick after hours or on weekends or who live in rural communities. “You might have pink eye or influenza, and instead of going to acute care, you can go into the patient portal and request a video visit and can be talking with a physician within an hour,” Suttle says. The physician will ask the same questions as he or she would if the patient had come into the clinic. “Our focus is on providing the same quality of care as you would receive in person,” Suttle says.

Patients across the Sioux Falls, S.D.-based Avera Health system have access to AveraNow, an app- and web-based video visit service rolled out in June. No appointment is necessary, and certain Avera providers are currently only providing services via AveraNow to treat a set list of common health problems “that we feel comfortable diagnosing without examining the patient,” says Dr. Jason Knutson, a family medicine physician at Avera Medical Group McGreevy 69th & Western in Sioux Falls. Knutson called it “convenient” and “perfect for flu season.”

Grand Forks, N.D.-based Altru Health System has a planned release for e-visits in 2016, which will be followed by adding video visits. “We really wanted to get the foundation on the patient portal more built up, so we have more functionality available,” says Mark Waind, chief information officer. “This is the next logical step.” At Altru, patients in non-emergency situations would fill out a questionnaire which would then be evaluated by a physician. Video visits would be a scheduled visit.

Essentia Health, whose west region is based in Fargo, N.D., is working on some type of home video visits for its patients, says Maureen Idekar, director of telehealth. “We are looking at that type of service and and have some capacity that we are developing. Consumers expect that access,” Idekar says.

Sanford added e-visits and video visits as a response to the area’s need for access, Suttle says. “There’s a physician shortage, especially in rural areas, and we don’t want to delay our patients from receiving quality care. Our patients told us they wanted easy access, and this is a way for patients to be seen while they’re still at work.”

Avera started working on adding video visits about five years ago, Knutson says. “Everything is online, and we wanted to offer a service that would be a little bit more and be on the cutting edge. We wanted to offer another avenue for patients to have health care.”

In the year Sanford has offered video visits, it has been “hugely successful,” Suttle says. “The patients who do use it love it. They feel they’re getting the same quality of care, and our providers feel their patients are getting service sooner.”

Because Avera just added its service, Knutson acknowledged it takes awhile to catch on so the organization expected it to be slow initially. However, “we’re doing better than we thought we would. We’re exceeding the goals we set, so we’re expecting it to get busier as the service catches on,” Knutson says.

Having the ability to provide video visits “revolutionizes health care,” Knutson says. “It changes health care dramatically. South Dakota is a very rural state, so this opens the door for our patients. They could have a visit with us from anywhere in the country.”

Other Uses

Video visits are actually just an extension of telemedicine, a service Sanford, Avera, Altru and Essentia all provide. Telemedicine allows patients, usually in rural communities, to go to their home clinics and have appointments with specialists in other locations. It can also be used for physicians from small clinics and hospitals to speak with physicians in a major hospital about the next step of care for a critical patient.

Sanford started its telehealth programs in 2011, after “we knew we could utilize this technology to provide access to our rural locations, while keeping those patients local but giving them access to our specialists,” says Susan Berry, enterprise director of telemedicine services at Sanford.

Sanford’s formal telehealth program, One Connect, gives emergency room providers access to physicians at the major Sanford hospitals to assist in critical situations. The program also provides virtual inpatient consultations with specialists, remote monitoring of ICU patients, telepharmacy to verify medications before administering and teleradiology to read CT and MRI scans. On the clinic level, 40 specialists offer virtual consultations for clinics that don’t have specialists come in for outreach programs. Sanford’s mobile medical trucks in the Bakken are also outfitted with telehealth services for any assistance those providers may need.

Altru started introducing telemedicine services in 2008 and slowly expanded its service line, Waind says. Altru is mainly providing specialty services to its rural facilities, and has 72 providers who have connected to more than 40 sites. Waind says Altru expects to conduct more than 3,000 telehealth visits this year, up from 2,600 in 2014. “We’re expanding each year based on the demand in our region,” Waind says. “We’ve used the services when our providers can’t go to their outreach clinics or when the patients can’t come into us because of weather. It’s the perfect application for rural settings like North Dakota.”

When Altru added its telehealth services, it was because the organization knew there was a need for it, particularly for rural patients. “We try to develop our services for our patients,” Waind says. “As technology improves, this seemed like a natural service. It provides convenience and can eliminate the need for transporting patients.”

Essentia added telehealth services in 2011, but has seen the services grow substantially this year, already adding eight programs in the past year with plans of adding three more. Essentia provides hospital-based services, including tele-emergency room, which connects rural hospitals to the ER in Fargo. “If it’s a complex problem, it’s nice for those physicians to have more support from experts,” Idekar says. Essentia also provides diabetic care, medical weight loss, medical therapy management, psychiatry, vascular wound care, oncology and cardiology services via telehealth. “The specialist could be at any of our major hospitals while the patient only has to go to their home clinic,” Idekar says.

Essentia felt a sense of urgency to be able to provide specialty care to its rural clinics, which is where telehealth came in. “It’s pretty common at the rural sites to not have those services,” Idekar says. “Our patients are able to avoid traveling when they’re very ill, and we’re able to take these scarce resources and stretch them to improve access.”

At the same time, “we’re able to maintain the same quality and services that are provided in the clinic because all of the infrastructure is the same,” Idekar says. “It’s just a more convenient route.”

Looking Forward

As for the future, Suttle says health care is rapidly changing, and technology changes are a major part of it. “There’s a very good chance that 70 percent of primary care visits could be virtual in the near future. Preventative care is going to become the norm, rather than the old way of waiting for patients to be sick. It’s an opportunity to reach out to patients in new ways,” Suttle says.

While there are currently limitations on how far an e-visit or video visit can go, Suttle says new technology is coming which could allow patients to take their own vital signs or detailed photos of their ears and throats.

“Health care is changing, but everything is becoming more about instant access,” Waind says. “Health care isn’t any different. Eventually all non-urgent care will be handled via a virtual visit.”

Idekar says these types of services are going to keep the population healthier. “People will be able to get treatment faster, which will help cut down on costs so they can focus on wellness and prevention.”

Kayla Prasek Staff Writer Prairie Business 701-780-1187, kprasek@prairiebizmag.com