Medical University of South Carolina Helped Patients with Free Virtual Visits During Hurricane Florence

Medical University of South Carolina logo

At Zipnosis, we talk a lot about clinical efficiency, quality, and reducing unnecessary visits to the ER for simple conditions. And these are all valuable outcomes of launching a virtual care platform. What is incredibly meaningful, however, is hearing how our customers deploy virtual care to help people in communities where there are particularly challenging situations. This is exemplified by one of our newer customers, Medical University of South Carolina (MUSC). When hurricane Florence was recessed out in the Atlantic, MUSC made the swift decision to offer South Carolina residents free virtual visits during the storm.

Free online visits in the aftermath of natural disasters aren’t a new thing – for big companies. Many of the major consumer-facing telemedicine service providers have offered free visits following some of the big hurricanes that left people stranded and unable to reach their doctors. But I believe MUSC’s fast actions signal a new phase in how virtual care can be used for disaster relief.

During the storm, patients who needed assistance with common conditions had access to care from their trusted, local providers. And providers could easily care for patients with common conditions in a fraction of the time, leaving them free to care for more complex or urgent cases face to face. MUSC even used their newly-deployed phone service to help current patients receive medication refills. And, because the virtual care platform is integrated with the EMR, patients’ records remain complete.

During the course of the storm, approximately 80% of MUSC’s more than 150 virtual visit patients throughout South Carolina used promo codes to receive free online care. These patients had health concerns ranging from upper respiratory infections and bronchitis, to bladder infections, to asthma inhaler refills.

According to Dr. Ed O’Bryan, Chief Medical Officer, Business Health at MUSC, “Conditions like bladder infections or bronchitis don’t wait because there’s a hurricane. Patients who weren’t able to come in due to flooding – or even evacuation to other parts of South Carolina – could get treatment easily.”

This deployment of MUSC’s virtual care platform highlights why many of us at Zipnosis come to work everyday. As our CMO, Dr. Lisa Ide says, “We are about more care for more people.” I’m proud to support and work with an organization like MUSC that is so clearly dedicated to supporting their community.

About the Author

Catherine Murphy, Zipnosis VP Account Management

Catherine Murphy

Catherine serves as Chief Success Officer at Zipnosis. A 20-year industry veteran, she combines deep experience in IT project management, account management, and business development, including work with United Health Group and Surescripts. She leads the Customer Success team, with an aim of helping each health system customer achieve the best possible results from their partnership with Zipnosis.

 

Winter is Coming: Prepare for Cold and Flu with Virtual Care

For most people, the end of summer is characterized by back to school ads, discounted swimwear and the promise of crisp autumn air. In healthcare, it’s more than stacks of new notebooks – it’s time to plan for managing cold and flu season.

Cold and flu season can strike anywhereEach year, health systems and providers brace themselves for an onslaught of stuffy noses, hacking coughs and spiking fevers. And this year, as staffing plans are made and vaccine doses ordered, the question on everyone’s minds will be, “What do we do if we see a repeat of last year?”

If you work in healthcare (and unless you were, say, living off the grid in the Alaskan tundra last winter) a repeat of the 2017-2018 flu season likely strikes fear—or at least concern—into your heart. While not as terrifying as the white walkers in Game of Thrones, the onset of cold and flu season requires similar preparation to withstand a viral invasion. So, how can health systems deal with the visit volumes, the potential for infection to spread in waiting rooms, and overwhelmed clinic staff?

Virtual Care Can Help

Having a virtual care service in place can help mitigate some of the challenges that are part and parcel with cold and flu season. It’s not the only answer, certainly, but virtual care adds real value where it counts.

Support Vaccination

“An ounce of prevention is worth a pound of cure,” as the saying goes. It’s no secret that the best way to reduce influenza cases is vaccination, and health systems often have well-developed strategies for promoting annual influenza vaccination. A virtual care service can add value by creating an additional channel for patient communication.

Providers can remind patients to get their flu shots during video visits. Health systems can include a note about getting vaccinated in patient education materials. And, Zipnosis customers can use their virtual care platform to incorporate flu shot reminders into their virtual visit (a feature successfully deployed during last summer’s measles outbreak in Minnesota).

Manage Provider Time

Here’s where virtual care really shines. A store-and-forward / asynchronous virtual care model enables providers to diagnose and treat patients in a fraction of the time as an in-person visit, as noted by our VP of Customer Success, Catherine Murphy, a couple weeks ago.

In a look at data from six customers over the course of last flu season (October 1, 2017 to March 31, 2018), the average provider work time per asynchronous virtual visit was just shy of 2 minutes and maintained high quality standards. During that time, these six customers completed close to 12,000 visits, amounting to less than 340 provider hours. For comparison, 12,000 in-person visits at 15 minutes each would total about 3,000 hours. On average, virtual care saved each of these health systems 440 hours of provider time. That’s nothing to sneeze at.

Mitigate Waiting Room Infection

One of the biggest challenges about cold and flu is that they are just so darn infectious. A study in Infection Control and Hospital Epidemiology found greater than 3% increase in influenza-like illnesses in children and family members within 2 weeks of annual wellness visits.

Hospitals, health systems and clinics have a variety of tactics to help stem waiting room infection – from handing out face masks to regular sterilization procedures. Virtual care can be added to the list. By offering a remote option for treating highly infectious conditions like influenza, patients don’t have to come into their doctor’s office for treatment. Plus, patients with common conditions like urinary tract infections or pinkeye can also get treated at home, lessening the chance they contract an influenza-like illness at the doctor’s office or urgent care.

Take the 2018 On-Demand Virtual Care Benchmark Survey

Now’s the Time

This isn’t Game of Thrones, and we aren’t facing an influx ofwhite walkers, but winter is coming. Getting a virtual care service launched now will go a long way to help health systems manage the impact of cold and flu season on their providers and patients. Starting now will mean your virtual care service is up and running when it counts. Pair that with some smart marketing tactics, and you’ve got winning combination to combat the coming cold and flu season. 

 

The Flip Side of ROI: Virtual Care and Cost Containment

The other day, I saw the Advisory Board released new research indicating that healthcare executives’ primary priority is cost containment, even over revenue growth. This focus shouldn’t surprise anyone remotely familiar with U.S. healthcare. Increasingly, health systems are being asked to do more with less – more patients, less staff; more innovation, less budget.

Working closely with our customers, I see first-hand the budgetary constraints and financial scrutiny that are an everyday part of operations. That’s why our team has worked hard to provide health systems with a clear understanding of the financial implications of an on-demand virtual care service, starting with revenue.

Why Revenue Still Matters

The Advisory Board’s study didn’t say healthcare executives were uninterested in revenue, just that often takes a back seat to cost containment. When it comes to effectively managing the bottom line, a two-pronged approach addressing both revenue and cost containment is vital.

As mission-driven organizations, non-profit health systems need to think about revenue. Grants and donations can only cover so much of a health system’s operating budget. In order to effectively provide services for their communities, health systems need to have additional sources of revenue.

A quick Google search yields numerous articles, seminars, webinars and other resources for health systems looking to maximize payer contracts. With the growing trend toward value-based care, effective contracting is critical to healthcare organizations bringing in revenue. Many of our customers use their virtual care services to support and enhance local payer contracts.

Virtual Care’s Revenue Impact

Traditionally, virtual care has been viewed as a patient satisfier (and sometimes market requirement) first and revenue generator second. The trouble is that revenue is seen primarily as visit fees, which often can’t cover the cost of care delivery much less software licensing. In reality, virtual care’s ability to generate revenue and return on investment for health systems lies in its utility as a patient acquisition channel. I won’t go into the nuts and bolts today, because it’s been done extensively in previous blog posts (here and here), as well as in case studies (here and here).

Cost Containment with Virtual Care

Cost containment is the flip side of the ROI coin

While revenue is important, health system executives are right to make cost containment a priority. Last year, expense growth outpaced revenue growth by 1.2%. And, just as health systems can’t achieve their missions without revenue, they can’t effectively operate in a deficit.

I really view cost containment and revenue growth as two sides of the same coin. And, while Zipnosis has been vocally focused on revenue, we have also been focused on the flip side. So, how does virtual care support health systems’ cost control initiatives? Two ways:

Expense Reduction for Risk-Based Populations

Health systems are also big employers, and employee compensation is one of the biggest expenses they face. To help control compensation costs, health systems are often self-insured. This creates a somewhat ironic situation where healthcare costs are actually a major health system expense.

Virtual care offers health systems a low-cost access point for convenient care delivery. When focused on risk-based populations like self-insured employees, this can translate to a major cost savings. A recent study by Humana found video visit costs paid out at approximately ⅓ the cost of in-person care while producing comparable follow-up rates and lower incidence of antibiotic prescriptions.

Looking at data from across the country, we calculate the mean cost of in-person care at $320 per visit (note: we’ve seen this as high as $500-$600). Conversely, our customers see the cost of delivering care via the virtual care platform at approximately $5. That’s an average per-visit savings of $315. On an individual visit level that may not look like much, but imagine the savings possible across an entire self-insured population. Even with activation between 5% and 10%, significant cost savings is possiTake the 2018 On-Demand Virtual Care Benchmark Surveyble – enough to cover software costs and free up budget to support important programs.

Enhancing Clinical Efficiency

I alluded to this somewhat in the previous section. Virtual care, in particular asynchronous modalities, can produce significant clinical efficiencies. On average, providers spend 15 minutes per in-person visit and are saddled with the administrative overhead of documentation later in their day, often after hours. With Zipnosis’s asynchronous modality, the visit time is a fraction of an in-person visit and there is no documentation.   

That efficiency is part of why virtual care can be an effective low-cost access point, but it also can help drive significant cost savings, since health system providers are able to grow their patient panels while avoiding the costs of adding staff, outsourcing, or the health system adding brick-and-mortar locations.

About the Author

Catherine Murphy, Zipnosis VP Account Management

Catherine Murphy

Catherine serves as Chief Success Officer at Zipnosis. A 20-year industry veteran, she combines deep experience in IT project management, account management, and business development, including work with United Health Group and Surescripts. She leads the Customer Success team, with an aim of helping each health system customer achieve the best possible results from their partnership with Zipnosis.

How to Grow Market Share with Virtual Care

This past week, I was at the American Telemedicine Association’s annual conference, and one of the things I heard over and over was the growing need for health systems and providers to offer virtual care. But health systems are often in a difficult position when it comes to technology investments like virtual care. They need, not only to prove it aligns with their mission and organizational objectives, but that it makes financial sense.

Healthcare organizations are increasingly being asked to do more with less—to think as businesses with an aim to expand and grow revenues. In fact, non-profit health systems are often caught between their business needs, the aims of their missions, and of course, delivering high quality care to diverse patient populations. The great news is that virtual care can help bridge that gap, supporting health systems in expanding access to care, both by increasing convenience and lowering costs while aiding in expansion and growth.

The Business Case for Virtual Care

When I say that building a business case is less clear that doesn’t mean it is difficult, more that, because the technology is relatively new and evolving, health systems sometimes find it challenging to pin down how they want virtual care to impact their business. While expanding access and enhancing patient experience are mission-driven goals, they also can create impacts on the bottom line. Other facets of virtual care, like increased clinical efficiency can bring a positive impact to the bottom line, particularly for populations where the health system owns a portion of their risk (e.g., self-insured employees or other owned health plans). But the real winner in building a business case has to do with gaining market share.

Virtual Care Meets Market Share

 

We recently published a study with MultiCare Health System in Washington that demonstrated the patient acquisition potential of offering a virtual care service to the marketplace. Through the study, we found that 34% of virtual care users who had not received care from MultiCare in the 24 months preceding their virtual visit sought in-person care in the 12 months after their virtual care experience – more than 3 times that of a control group.

So, how do you set patient acquisition goals relative to your market? Start by figuring out how much of the market you currently have—your market share.

What’s Your Market Share?Grabbing a piece of the market share pie

To calculate market share, try this for a nice-round-numbers approach. You, or someone at your organization, probably have a relatively good handle on how many patients you treat per year, on average. Divide that by your approximate market size, which you can find this with a quick Google search.

Setting Market Share Goals

The 34% patient conversion rate MultiCare achieved is tied to the closely circumscribed study cohort, imagine what that could look like relative to a major metropolitan market. For example, imagine you have 12% of a market of 3 million – that’s a nice size patient panel of 360,000. But, what could increasing your market share just 1% do? Before you pull out your calculators, I’ll tell you that it would add 26,400 patients to your health system—or 1% of your market potential.

Market Potential

market potential equation

Once you know your current market share, set attainable goals. Start with an aim of increasing your market share .25%. Using our hypothetical scenario above, that translates to 6,600 new patients.

Working with the 34% conversion rate, how many virtual visits would you need to achieve that .25% increase? Once again, I’ll do the math for you. You would need just over 19,000 new patients to come through your virtual care service to gain your 6,600 new patients and .25% market share increase.

That may sound like a lot, but there are budget sensitive strategies to increase growth and virtual visit volume that can help you achieve your market share and patient acquisition goals.

Accelerating Growth

From my perspective, one of the most interesting findings of our study with MultiCare is not the patient conversion rate but the market opportunity. The independent analytics firm who compiled and analyzed the study data found that understanding the demographics of patients who were likely to use virtual care meant that targeting just 20% of the market would yield 82% of the people most likely to use virtual care. That means highly focused, targeted marketing efforts could significantly increase virtual care utilization.

It’s exciting to hear from various health system customers about how they are leveraging virtual care to reach new patients and broaden access to care. Several of our health system partners are unlocking market potential by contracting with local health plans and employers to offer virtual care to their members and employees. Combined with targeted marketing, this approach can help accelerate your health system growth and put you well on your way to achieving your objectives.

About the Author

Catherine Murphy, Zipnosis VP Account Management

Catherine Murphy

Catherine serves as Chief Success Officer at Zipnosis. A 20-year industry veteran, she combines deep experience in IT project management, account management, and business development, including work with United Health Group and Surescripts. She leads the Customer Success team, with an aim of helping each health system customer achieve the best possible results from their partnership with Zipnosis.

What Does Access Really Mean?

Working closely with our customers, I hear over and over that patient access is a key strategy and reason for launching virtual care. Taking a cue from our health system customers, we talk a lot about virtual care’s ability to expand and facilitate access to care. But what does that really mean? Who benefits from the expanded access that virtual care provides?

Meet Kate

One of the things I find really refreshing about working at Zipnosis is that we don’t stop at thinking about what our health system customers need. What I mean here is we’re also thinking about tMiddle Aged Telemedicine Patientheir patients. Who is using their virtual care platform? Why are they using it? What can we do to improve the experience for them?

We actually have well-realized personas covering several known users. The flagship persona is someone we call “Kate.” Kate is in her mid-30s, married with two kids who she chauffeurs  around in a late-model SUV. Kate works full-time and has insurance through her employer. She’s also the persona who drives our standard product demo – if you’ve ever seen the Zipnosis platform in action, it’s probably through the lens of Kate.

Recently, I began to think about Kate because access for her means something different than it does for a lot of the population. It’s really about convenience more than need. Kate could take time away from work, she could drive to see her primary care doctor for care, it’s just inconvenient to do so. But what it we took away Kate’s SUV, her employer-sponsored insurance, even her full-time job?

Meet Katie

Katie looks a lot like Kate on the outside. She’s also in her mid-30s with two kids, but instead of Kate’s SUV, Katie relies on public transportation. Instead of Kate’s employer-sponsored insurance, Katie has a high-deductible health plan that means she pays for most healthcare costs out-of-pocket. Instead of Kate’s full-time job, Katie works two part-time jobs and doesn’t have paid time off. What does healthcare access mean to Katie?

To answer that question, I gave myself an exercise: Put myself in Katie’s shoes and understand the decisions she needs to make when looking at where—and whether—to seek care for a common condition like a UTI. Here’s what I learned:

In-Person Care Options

I looked at 4 in-person care delivery options: A primary care clinic, an urgent care center, a retail clinic, and the emergency room.

Work Schedules

Working two part-time jobs without PTO, Katie needs to find time to go to the doctor. That may mean determining if she can afford to take time off of work, coordinating shift coverage with co-workers, or finding an option that’s open when she’s free. That means the hours of operation and when an appointment would be available are major factors in decision making.

Primary care: 8 am – 6 pm; appointment availability “tomorrow”

Urgent care: 7 am – 7 pm most weekdays

Retail clinic (average): Weekdays, 9 am – 7:30 pm; weekends, 9 am – 4 pm*

Emergency room: 24 hours daily

*Lunch hours: Practitioners take a daily, required lunch break each day. Please note that lunch time are approximate and may vary.

Transportation

Part of managing schedules is figuring out the impact of public transportation. Katie needs to factor in schedules and routes. Then, she needs to determine how much time she’ll need to spend in transit. Using my house as a starting point, I determined that transportation would take anywhere between 15 and 45 minutes each way, most of which required walking about ½ mile in addition to the bus.

Child care

If Katie needs to seek care outside of her typical working hours or when the kids are not in school, she needs to consider what to do with her children. Does she haul them along to the doctor’s office? Does she get a last-minute babysitter – and is that practical from a financial standpoint?

Cost

Finally, with her high-deductible health plan transitioning the full cost of care to Katie, how much will she have to pay out-of-pocket for each of her options? The data shows costs varying widely for services, but the following are pulled from a Blue Cross Blue Shield (MA) fact sheet on typical costs for common services and Consumer Reports:

  • Primary care: $130 – $180
  • Urgent Care: $120
  • Retail Clinic: $55 – $75
  • Emergency Room: $400 – $700

Access with Virtual Care

Imagine the impact a virtual care offering could have on Katie. Access to a virtual care service effectively eliminates the need to balance her competing priorities.

Work Schedules – With virtual visits available via any internet-connected device, Katie doesn’t have to worry about missing work.

Transportation – Katie can access virtual care anywhere, so transportation ceases to be a concern.

Child care – Katie can complete a virtual visit while her kids do their homework at the kitchen table, or while they’re playing at the park.

Cost – Unlike the more costly in-person options, most of our health system customers charge between $20 and $40 for a virtual visit, making it far and away the most affordable option.

With virtual care, Katie can quickly, easily, and affordably receive care for her UTI – without the stress and worry. Virtual care may well be working to bring convenience to the Kates of the world – and that’s no small thing – but our greater impact is in the benefit we bring to the Katies.

About the Author

Justin McLaughlin, Customer Success Executive

In his role as Customer Success Executive, Justin works to help health systems across the country effectively operationalize virtual care. He has extensive experience in implementations, project management, and account management. Justin is passionate about helping his customers, helping them realize the benefits virtual care brings to their organization and patient populations.

Meet Cold & Flu Season Head on with Virtual Care

Summer is slowly ending here in the Northern hemisphere, meaning short, crisp days, bright foliage and bonfires. These signs of the season also presage something less pleasant: cold and flu season.

There’s good news though – launching virtual care now can help you more effectively manage increased volume, curtail waiting room infection, and maximize the opportunity to create patients for life.

Virtual Care and Cold & Flu Volume

Brick and mortar locations, including primary care practices, retail clinics, and urgent cares, bear the brunt of increased volume that comes with cold and flu season. Virtual care can help alleviate that burden by routing patients to a convenient online access point, taking the strain off clinicians and support staff and freeing up appointment slots for higher value, more complex conditions.

Minimize Waiting Room Infection

Health systems go to great lengths to prevent waiting room infection. Nonetheless, when cold and flu season strikes, all bets are off. Offering a virtual care solution where patients can receive diagnosis and treatment recommendations for highly infectious diseases like cold and flu helps keep patients out of the waiting room and reduces the likelihood of waiting room infection.

In an article on Health IT Outcomes last fall, Zipnosis’ Chief Clinical officer Kevin Smith noted, “one of the best ways to be a good healthcare citizen and avoid spreading germs to others in overcrowded waiting rooms at clinics, urgent care centers, and emergency rooms is to take advantage of online virtual visits.”

Create Patients for Life

Cold and flu season is more than a challenge for health systems – it’s an opportunity.  With the uptick in volume that comes along with cold and flu season comes the potential of adding patients to your health system. With more and more patients seeking convenient options and looking for care online, a virtual care service is a fantastic way to attract those patients to your health system. What’s more, a recent white paper from Carrot Health found that approximately 25% of virtual care users converted to health system patients within one year of their virtual visit.

Imagine the impact if even a fraction of your cold and flu visits could be addressed through a virtual care solution. Your clinicians and support staff would be freed up to better serve patients, the decrease in infectious patients in your clinic would lower the likelihood of your staff and patients becoming sick, and you have the opportunity to create lasting relationships with new patients. Win-win-win.

How to Prevent Your Emergency Department from Becoming an Urgent Care

The Challenge:

Across the country, emergency departments (EDs) are experiencing, well, an emergency – specifically, overuse. Patients – for a variety of reasons – are treating emergency rooms like urgent care facilities. A report from the New England Healthcare Institute estimates that this overuse of EDs is responsible for $38 billion in wasteful spending each year. Additionally, a literature review published in the American Journal of Managed Care found that on average 37% of ED visits were judged to be non-urgent. The CDC’s numbers match up, finding that of the 130 million ED visits in 2013, only 8 percent could be classified as “immediate” or “emergent”.

Little girl in the emergency department with a broken arm

Patients treating the emergency room as an urgent care can cause problems for hospitals and health systems. ED use can cause fragmentation, and even with an efficient EHR, can make effective care coordination challenging. What’s more, an ED being used as an urgent care for non-emergencies may increase wait times for all. Using “broken bone” as an example, ProPublica’s ER Wait Watcher shows an average wait time of between 38 and 72 minutes.

Another major concern for health systems related to ED overuse is uncompensated care. Patients treating the ED like an urgent care my receive a rude awakening when they find that their visit cost is only partially covered by insurance or is exponentially higher than a PCP or true urgent care visit. According to an article in the Annals of Emergency Medicine, only 50 percent of ED charges are reimbursed – including reimbursements through Medicare, Medicaid, and private insurance.

With the mean cost of care delivered in the ED over $2,000 per visit (approximately 300% the cost of primary care) according to research published in the Journal of Medical Internet Research, that adds up quickly – for both health systems and patients. A study in the American Journal of Medicine found that medical debt is a contributing or primary factor in more than 40% of personal bankruptcies. This creates a financial strain on health systems, and has the potential to result in ED closures, which in turn compromises access for patients experiencing a true emergency.

Why Patients Choose the ED – Access, Access, Access

There is no doubt that many patients go to the emergency department due to a bona fide emergency. But an article in the Journal of Emergency Nursing found that the reasons for going to the emergency department for non-emergency care were centered around access and inappropriate referrals. Specifically, patients visited the emergency room because they were unable to obtain a PCP appointment, were told by staff (not physicians) to go to the emergency room, or felt that it would take less of their time.

A review in the American Journal of Managed Care found similar reasoning around convenience, access, and cost. But the inability to access quality care elsewhere was the foremost reason for patients visiting the ED for non-urgent conditions. This is a particular challenge for uninsured and underinsured individuals and families, as well as those classified as having a low income, and why the top strategy for reducing ED overuse is broadening access to primary care services, according to the Centers for Medicare and Medicaid Services.

Ultimately, many patients go to the ED because they think it is easier than the alternatives. Younger patients, in particular, view the emergency department as a reasonable alternative to a primary care clinic for receiving care. This is part of the larger trend of consumerism in healthcare, in which patient choice is driving change in how and when care is delivered.

So, What’s the Answer?

Unfortunately, there’s no magic bullet to the challenges of supporting efficient use of an emergency department. The good news is there are things health systems can do to help reduce overuse. And one of those things is launching a virtual care service line and driving patients to the online access point in lieu of the ED.

For patients who are unable to obtain a PCP visit, virtual care offers an alternative access point. Available 24/7, unlike primary care clinics or even urgent care facilities, virtual care gives patients unprecedented access to care. Patients who can’t afford to or are otherwise unable to take time away from work to seek care during normal office hours can use the virtual care service to get the care they need. And, when using a virtual care platform that incorporates  evidence-based algorithms and best practice-driven protocols patients are only directed to the urgent care or emergency department visits when clinically appropriate.

Improve Patient Access with Zipnosis Virtual CareWhat’s more, patients seeking convenience in addressing non-urgent needs will likely find virtual care more appealing than the emergency department. They no longer have to leave their home, drive to the hospital, and sit in the waiting room. And virtual visits take a fraction of the time a primary care visit or even a trip to the emergency room would take.

The low cost of virtual care can also help steer patients away from the ED. Patients who don’t have insurance, are underinsured, or are taking on a larger portion of risk with a high-deductible health plan may struggle to pay for emergency care, leaving health systems with higher rates of uncompensated care. Patients who cannot cover a several-hundred dollar (or higher) emergency visit (see the shocking ED price tag example above), may be better able to pay the $30 or $40 for a virtual visit, about the cost of a typical copay.

Most importantly, with a virtual care service, health systems are expanding access to care. That means common conditions can be treated quickly before complications develop and the danger to the patient increases. This can be the difference between a simple urinary tract infection and a kidney infection or an upper respiratory infection and pneumonia. That means, getting patients treatment early could help reduce ED visits and improve patient outcomes.

About the Author

Kevin Smith - Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Virtual Care and the Quadruple Aim

It’s no secret the healthcare industry is facing some challenges. Factors like patient access, achieving consistent health outcomes across populations, rising healthcare costs, and growing physician burnout are causing healthcare organizations to strategize around how to make healthcare in the U.S. more effective. These challenges form the foundation of the quadruple aim – a set of goals designed to usher in positive change in the healthcare landscape.

Achieving the Quadruple Aim

Significant improvements in these areas will necessarily be facilitated through the use of technology. Virtual care, sometimes called telemedicine, can help health systems support improvements in each of these key areas.

There are two distinct modes of virtual care: Synchronous, including phone and video, and asynchronous or “store-and-forward” like Zipnosis’ online adaptive interview. An asynchronous solution collects and organizes patient-provided health history and symptom information, enabling providers to access it at a later time. Providers then make a diagnosis and develop a recommended treatment plan, which is sent back to the patient. Asynchronous technology, specifically, is instrumental to achieving the quadruple aim due to its inherent efficiency.

So, how exactly does virtual care impact the quadruple aim? Let’s take a look:

Aim: Improve Patient Access

Access to care is a growing concern in the healthcare industry. With the passage of the Affordable Care Act in 2008, millions of people have insurance coverage. But this isn’t enough. Access is more than insurance; it’s the ability to receive care when and how a patient needs it. And that remains a challenge today.

Merritt Hawkins’ 2017 Survey of Physician Appointment Wait Times found that in the U.S., the average wait time for a new patient appointment is 24.1 days – a 30 percent increase since 2014. This can be explained in part by the growing gap between the number of practicing physicians and the population for which they care. According to the Association of American Medical Colleges, there is a current shortfall of between 14,000 and 25,000 physicians across all disciplines. They further project a shortage of up to 100,000 physicians by the year 2030. Access is a particular challenge in rural areas, where hospitals have been closing at a rate of one per month since 2010.

Virtual care helps address the challenge of patient access by breaking down the geographic barriers between physicians and patients. Using a virtual care service, a patient that lives hours from the nearest clinic or hospital can receive care without having to worry about the drive. A study by the UC Davis School of Medicine found that by receiving care online, patients avoided driving millions of miles. What’s more, a virtual care solution that offers asynchronous care is available on-demand, meaning that patients can access care in a time that works for them, rather than having to schedule an appointment. This care delivery model also helps physicians to unlock marginal capacity, enabling them to safely and effectively diagnose and treat more patients than with in-person or video visits.

Aim: Improve Health Outcomes

Often viewed through the lens of population health, achieving consistent health outcomes has become increasingly challenging in the face of growing care fragmentation. Instead of offering a solution, direct-to-consumer telemedicine companies who deliver care outside the continuum only exacerbate the fragmented care environment. Conversely, virtual care delivered by a health system offers the same patient benefits while facilitating effective coordination of care and supporting consistent patient record documentation.

Achieving consistent health outcomes requires consistency in care delivery. This is another area where virtual care can offer a solution. By developing protocols for care on a foundation of national best practices and incorporating organic clinical decision support in the form of diagnosis and treatment pathways, virtual care can support consistent, guideline-adherent care. And because an asynchronous model captures a large volume of structured data, virtual care can help health systems measure things like guideline adherence and antibiotic stewardship.

Aim: Lower Overall Healthcare Spend

It’s impossible to have a complete conversation about healthcare in the U.S. without discussing the continued growth of healthcare spend. According to the Centers for Medicare and Medicaid Services (CMS), U.S. healthcare spending reached $3.2 trillion in 2015, accounting for approximately 18 percent of the country’s Gross Domestic Product. CMS data shows that between 2010 and 2015, the average annual growth in national health expenditures was 4.3 percent, more than double inflation.

The costs of healthcare are born in varying degrees by insurance companies, employers, health systems and healthcare providers, individuals, and the taxpaying public. One trend in healthcare is the assumption of greater risk by both individuals and health systems, through high deductible health plans and value-based care, respectively.

Virtual care holds the potential to curtail healthcare spending on a broad scale. While research needs to be done to verify the impacts on various parties, early indicators are that virtual care offers both patients and health systems a means of delivering and receiving care at a lower cost than in-person care. Moreover, virtual care has the potential to reduce emergency department usage by siphoning off those seeking convenience for non-emergency care and by treating conditions early that may could become emergencies if not treated.

Virtual care is also expanding outside of the realm of urgent/ambulatory care to support longitudinal needs such as post-operative care or chronic condition management. This means that a future state could see the cost savings from virtual care – to patients, health systems, and payors – grow exponentially.

Aim: Reduce Physician Burnout/Improve Physician Engagement

Simply put, the healthcare industry – in any country, under any circumstances – does not function without healthcare providers. And providers are becoming burned out in record numbers. In fact, this is a top factor contributing to the growing physician shortage mentioned above. One of the key reasons cited for physician burnout is the increased clerical burden physicians are undertaking.

Virtual care, particularly the asynchronous model, significantly reduces clerical burden by aggregating patient-generated symptom information and inputting it directly into the EMR through advanced integration capabilities. As a result, virtual care enables physicians to focus on practicing medicine rather than documentation. Further, routing routine health concerns to the virtual care platform enables physicians to focus on more complex health concerns, putting their energy to the patients who really need their expertise.

Healthcare Going Forward

As we work to improve healthcare for health systems, physicians, and most importantly, patients, it is vital that we look to new technologies like virtual care to help achieve those ends. Virtual care offers clear solutions to help the healthcare industry achieve each element of the quadruple aim. And that bodes well for all of us.

 

About the Author

Dr. William Riley is a Professor in the School for the Science of Health Care Delivery at Arizona State University, where he teaches process engineering, health finance, and health care quality and safety design. He previously served as the Associate Dean for the School of Public Health at the University of Minnesota.

To his present role in academics, Dr. Riley brings 25 years of senior executive experience in health care organizations, including serving as President and CEO of Pacific Medical Center in Seattle, Washington; CEO of Aspen Medical Group in St. Paul, Minnesota; Senior Vice President at Blue Cross Blue Shield of Minnesota in St. Paul; and Senior Vice President of St. Paul-Ramsey Medical Center/Ramsey Clinic.

Dr. Riley’s research areas include quality improvement and patient safety, with several nationwide and international projects currently underway. He is the author of more than 60 articles related to quality management, patient safety and health care management, and has co-authored two books on performance improvement in health care.

A past chair of the Public Health Accreditation Board, Dr. Riley serves on several boards, including the Fairview Physicians Associates (FPA), an affiliate of Fairview Health Systems. He received his PhD from the University of Minnesota School of Public Health.

Virtual Care and Public Health: Helping Manage a Measles Outbreak in Minnesota

You may have heard that our home state of Minnesota is in the grip of a measles outbreak – primarily in the Twin Cities metro area, though there are several cases in outlying counties. As I write this, there are 78 confirmed cases of measles, and the number is growing. I’m not going to get on a soap box about vaccination (though, the vast majority of patients were, unsurprisingly, unvaccinated). Instead, I’ll use this example to illustrate the role of virtual care in a public health crisis like this one.

How Virtual Care Can Help

When managing certain outbreaks of infectious conditions, the value of virtual care is two-fold. First, it provides a unique channel for evaluating potentially contagious patients, taking them out of the waiting room and limiting the opportunity for infections to spread. This is particularly important when a communicable disease is active (think cold and flu season). By directing patients to the virtual visit, rather than into clinics, virtual care can help health systems curtail the spread of illnesses like influenza.

Second, and most important in this recent measles outbreak, it offers a front-line communication channel for health systems to share critical information with their patients and the community.

The early symptoms of measles are very similar to those of an upper respiratory infection – one of the top conditions patients seek treatment for via the Zipnosis platform. We collaborated with one of our Twin Cities clients to find a solution that we could deploy quickly to help manage communication about the outbreak. This is particularly important, since Minnesota medical regulations allow any person to seek virtual care or telemedicine; some states require a person to have an established relationship with a clinic to be eligible for virtual care.

Through collaboration with our health system client, we rapidly developed and deployed an online messaging feature enabling health systems using the Zipnosis platform to share important information about the measles outbreak for patients using the virtual visit system. Accessible and editable by staff within the health system, our Minnesota clients are now using this functionality to provide important patient alerts about the measles outbreak and to educate them about early symptoms, dangers, and the steps they should take if measles is a possibility.

This new feature goes beyond this one outbreak or use. Health systems can now relay information about other things their patients may need to know: updates on allergen and pollen levels, reminders to get a flu shot prior to flu season, or information on seasonal diseases like Lyme disease and other outbreaks.

Public Health and the Potential of Virtual Care

Virtual care is more than a technology – it’s a digital care delivery channel, just as important to supporting health outcomes as a nurse line or clinic. And, as patients continue to adopt virtual care in greater numbers, its value as a channel for communication, education, and care delivery will increase too.

Today, we see nearly limitless possibility for virtual care to support health systems and providers as they work to drive positive health outcomes for their patients and communities. Health systems are just beginning to understand how they can use virtual care to do more than treat common conditions, and we are excited to help them realize this potential. While this particular feature may not be a groundbreaking industry disruptor, it gives our health system clients another option for supporting the health of their communities – and to us, that’s huge.

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Financial Sustainability: How to Add Revenue to Your Health System with a Virtual Care Service

Recently, KPMG released a survey that found the number one barrier to health systems launching virtual care is lack of financial sustainability. Simply put, health systems aren’t seeing how virtual care produces returns. And in an environment where budgets are tight and expenditures are closely monitored, justifying the investment in virtual care technology can be challenging.

There’s just one problem with this barrier—it’s not real. The perception that virtual care doesn’t produce a sustainable financial return is rooted in the old “telemedicine” mode of thinking. In reality, health systems are seeing the financial benefits of offering a virtual care service today. This isn’t just a pipe dream – it’s backed by data.

Finding Financial Sustainability

I’ve had virtual care financial returns on the brain lately, trying to figure out how health systems are missing the ROI virtual care produces – and I think I’ve hit on an answer. The reason such a large misunderstanding around the true value of virtual care persists within the healthcare community is the focus on transactional revenue and outsourced telemedicine networks. I touched on this a recent blog post. Measuring returns by looking exclusively at transactions is an outdated way of viewing virtual care’s impact. It’s consistent with the fee-for-service mentality most health systems are rapidly leaving behind – not with modern, value-based reimbursement and digital care delivery.

Unlike traditional telemedicine, the financial return from virtual care goes beyond the individual transaction, appearing as downstream revenue impacts. This is evident in areas like diminished patient leakage, reduced cost of care delivery, and most importantly, patient acquisition.

The Real Virtual Care Value

Recent research from healthcare analytics company Carrot Health demonstrates exactly how virtual care is increasing the revenues for one Zipnosis health system client. Carrot Health followed a cohort of 974 virtual care users who had not received in-person care in the 24 months prior to their virtual encounter – matching the health system’s definition of a new patient.

In a new white paper, Carrot Health revealed that this large, integrated health system saw 25% of new virtual care users convert to health system patients by using additional, in-person services within 12 months of their online encounter. With an average annualized per-patient revenue of close to $3,000, these conversions translated to more than $700,000 in additional revenue over the study period.

In a recent article I wrote for Becker’s Hospital Review, I noted that this is just the tip of the iceberg. Applied over a longer period, or for a larger population, the revenues increase exponentially. For example, a population of 2,000 new virtual care users at the same conversion rate would produce revenues of $1.5 million. How’s that for financial sustainability?

And, the Market Says…

Have you wondered about the venture money funneled into virtual care and telemedicine software companies over the past few years? The data suggesting patient preference for online care, while interesting and valuable, isn’t enough to sway investors. It’s the ability to see the potential financial impacts virtual care can have on health systems that gets venture firms excited.

When asked about the reasons for investing in Zipnosis, Matt Hermann of Ascension Ventures noted, “In today’s environment, compelling ROI data like Carrot Health has compiled about Zipnosis’ virtual care offering will help health systems parse through the innovation noise and have confidence in making critical business decisions. We think every health system should be deploying multi-modal virtual care solutions like Zipnosis for both short term and long term success.”

And long-term success is really the name of the game. Virtual care is transitioning from being an interesting but unimportant feature to a vital care delivery channel. Health systems are using virtual care to find financial sustainability by adding patients and revenue today. And as this transition builds steam, the returns health systems will see are only going to grow.

About the Author

Zipnosis CEO Jon Pearce

Jon Pearce is co-founder and CEO of Zipnosis. As a healthcare entrepreneur with experience in med-tech start-ups and as a venture analyst, he is focused on leveraging the power of technology to improve the way health systems engage with and treat their patients.

Where’s the Return? How to Find Virtual Care ROI for Health Systems

For early adopters of telemedicine, the excitement of new care delivery technology (e.g., video conferences) was enough to build a business case. These days, online care has gained acceptance by both patients and healthcare organizations – it’s no longer just early adopters being lured by something shiny and new. Health systems are being tasked with meeting patient demand for online care and justifying this investment by showing its impact on their organization.

Traditionally, determining the return on telemedicine investment hasn’t always been clear. As a newer way to deliver care, it’s taken some time to develop and validate ROI models and some telemedicine companies continue to struggle with proving ROI to health systems.

Virtual care, which includes traditional telemedicine tools in addition to its suite of transformative digital health solutions offers an alternative. Leading health systems are building out their digital healthcare programs with virtual care and seeing the organizational and financial benefits.

Beyond the Bottom Line

As with other strategic initiatives, virtual care’s return is not just financial. Patient perception in the marketplace and brand positioning are both impacted by launching a virtual care service line. Health systems that offer virtual care and communicate that offering effectively to the marketplace are more likely to be seen as a leader in patient access and technology. With 46% of consumers in a recent survey stating they would choose a health system that offers virtual care over one that doesn’t, this can have a big impact on position in the marketplace and your bottom line.

Virtual care and telemedicine can also play a big role in supporting long-term organizational strategy and building a foundation for the care delivery of tomorrow. The contribution of virtual care to achieving, say, improved patient access or greater operational efficiency goes well beyond any financial returns. Additionally, launching virtual care in support of long-term, strategic objectives can mean that the true financial impact takes time to materialize – think lifetime value.

How to Find Your Virtual Care ROI

Virtual care ROI has many lenses. The best return on investment approach is the one that fits your goals and organizational strategy. Effective goal setting, identifying the right KPIs to measure performance, and developing a reporting process and cadence are vital steps to understanding and measuring the success of your virtual care program.

Metrics like total visits, number of new patients, clinical guideline adherence, clinician work time and patient satisfaction combine to tell the story of a virtual care service. Is it helping bring new patients to the health system? Is it providing high quality medical care? Is it driving operational efficiencies? Do patients like it? These are some of the true measures of virtual care success.

Finding Financial ROI

Of course, there are the numbers…

Calculating the financial return on investment is more than just subtracting costs from revenues. If you want to see the impact virtual care could have on your bottom line, check out our interactive ROI calculators:

ROI through preventing patient leakage

ROI through cost shift in a value-based environment

And, download our latest eBook, Measuring Virtual Care Success: Your Complete Guide to ROI, for more information on quantifying the impact virtual care could have on your health system.

Why Virtual Care Should be Part of Your Health System’s 2017 Growth Strategy

As 2016 comes to a close, health systems—like most businesses and non-profit organizations—are deep into planning their growth strategy for the new year. Faced with rising consumerism in patient populations, increasing competition from traditional and non-traditional healthcare companies, and the continued transition to value-based reimbursement, leading health systems are looking to virtual care as a means of supporting organizational growth strategies.

Aligning Virtual Care with Health System Growth Strategy

Any way you slice it, adding a virtual care service line is a strategic business decision. Your virtual care strategy should reflect your health system’s big-picture growth strategy. But how, precisely, do the two tie together?

The Virtual Care SWOT

Every health system is different, with unique cultures, competitive environments and goals. However, many health systems face similar challenges and opportunities. When it comes to health system strategic growth planning, virtual care can help make the most of strengths and capitalize on opportunities while shoring up weaknesses and mitigating external threats.

Leverage Strengths

With a virtual care platform in place, health systems can:

    • Offer patients online access to their clinicians by staffing the virtual care service internally
    • Increase patient engagement and satisfaction through convenient access and digital tools that fit into their lives
  • Maintain high levels of clinical quality and capture structured data to support quality initiatives

Capitalize on Opportunities

Launching a virtual care service line can help health systems:

    • Attract and retain new patients – particularly younger generations who have yet to settle into a primary care relationship
    • Build a foundation for continued innovation and partnership with a virtual care provider committed to keeping clients on the leading edge
  • Strengthen or develop new contract relationships with large employers, insurers and/or educational institutions to drive revenue

Address Weaknesses

Virtual care can help health systems work within internal constraints by:

    • Leveraging marginal capacity to treat more patients with current staff
    • Meeting patient demand for convenient care and improve access without adding physical locations
  • Offering virtual care at a free or reduced cost to employees and their dependents to reduce overall healthcare costs

Mitigate Threats

Offering virtual care supports health systems through:

    • Staying in step with – and/or offering a point of differentiation from – competitors’ online service offerings
    • Supporting patient retention by offering a convenient, online access point
  • Creating a lower-cost channel to provide care to patients in value-based reimbursement populations

For more information on how virtual care can support organizational growth strategies, check out our free Best Practices Guide to Virtual Care  – your handbook for successfully launching, operationalizing and growing a virtual care service.

virtual-care-best-practices

Bryan Health Goes Virtual with Zipnosis

In growing numbers, patients are expecting convenient, accessible care from health systems. At Zipnosis, we hear this all the time. This need is compounded in areas where patients may need to drive hours to reach a physical clinic. Seeing these market forces play out in their community, Bryan Telemedicine, the virtual care arm of Bryan Health—a leading health system based in Lincoln, NE—decided to meet this challenge head-on by offering virtual care.

The Search Begins

Like many health systems, Bryan Telemedicine began looking for a virtual care solution to meet the demand for accessible, convenient care. They had a wish list that included being able to leverage current staffing and internal clinical expertise, support continuity of care for their patients, and achieve high levels of clinical guideline adherence. Initially, it seemed they might have to settle for a traditional video only (synchronous) telemedicine solution – then they found a unique approach by Zipnosis that better addresses their requirements.

The Start of a Beautiful Partnership

Bryan Telemedicine was attracted to Zipnosis’ evidence-based protocols and proven clinical quality they deliver. Bryan Telemedicine was also excited by how Zipnosis leverages marginal clinical capacity – a feature that allows them to provide 24/7 virtual care without adding staff. But what about those patients that can’t be treated online? The Zipnosis platform routes these patients to the most appropriate level of care within the Bryan Health system. You see, we’re all about delivering the right care at the right time – whether online or in person.Bryan Health - Zipnosis

One Year Later…

Bryan Telemedicine launched their virtual care service, Bryan Health eVisits, in late summer 2015. Since then, they’ve been pleased to see how virtual care fits seamlessly into their overall continuum of care. They have also seen an increase in new patient acquisition and a reduction in patient leakage to other virtual care solutions and health systems.

Recently, Bryan Telemedicine has expanded their virtual care service through a partnership with Memorial Health Care Systems(MHCS) in Seward, Nebraska. The arrangement takes advantage of the virtual care expertise of Bryan Telemedicine and their Nebraska board certified physicians. Bryan Telemedicine physicians will staff the new service, reviewing patient information and making an appropriate on-line diagnosis.

The Zipnosis team is continually impressed by Bryan Telemedicine’s innovative approach to care delivery. To help tell their story, we worked together to build this case study. Check it out and learn more about Bryan Telemedicine’s journey and the results they’re seeing as a Zipnosis partner.

virtual-care-best-practices

Virtual Care Puts Consistency and Quality Back in Healthcare

Over the past decade or so, the U.S. healthcare system has transitioned from paper-based documentation of patient records to the use of electronic health records (EHRs). One might assume that computerized health records and systems would result in dramatically improving the efficiency and quality of care. The outcome isn’t so cut and dry.

While some efficiencies have been achieved with EHRs, a recent survey showed that fewer physicians believe that use of an EHR has facilitated improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012). What about improvements in the quality of care? We know that overuse of antibiotics is a problem of global proportions, resulting in increased antibiotic-resistant organisms making it more difficult to treat certain infections. Another study demonstrated that patients with viral upper respiratory infections (the common cold) receive inappropriate antibiotic prescriptions 65% of the time. And a third study found antibiotic guideline adherence rates for treating sinus infections were just 43%. This is in spite of the many tools in EHRs that are supposed to assist with improving the quality of care. So how can we improve?

That’s where effective clinical decision support – and the Zipnosis platform – come in.

Clinical Decision Support Boosts Care Quality

There are many ways to improve the quality of care. One approach is akin to a pre-flight checklist. When we fly in an airplane, we trust that the pilot is using a checklist to make sure everything on the plane is working properly before take-off. “Engines, check. Wings attached, check.” We would be less comfortable if our pilot relied only on their experience and intuition and skipped the checklist.

In healthcare, the equivalent of a pre-flight checklist is used less often than you would expect, with busy clinicians sometimes relying solely on their experience and intuition, which is often very good. However, a clinical checklist approach includes tools which clearly spell out best practice guidelines based on the current scientific literature. Health professionals do their best to keep up on the latest studies, but no single human can manage to wade through the estimated 2.5 million scientific articles published each year – in the English language alone. However, one form of clinical decision support includes summarizing relevant clinical guidelines and providing the best practices to clinicians at the time they are making treatment decisions.

To ensure that the clinical decision support (CDS) is effective, it is necessary to be able to measure the rates of clinician guideline adherence to determine if care provided followed the established best-practice standards. Studies have shown that when specific CDS features were used, clinical guideline adherence was significantly improved. Overall, internal analysis of visits through the Zipnosis platform, where CDS is incorporated into the diagnosis and treatment process, have shown a guideline adherence rate of 94%. In my doctoral research, implementing clinical decision support, along with other educational interventions, resulted in an increase in guideline adherence of 3.3% for treatment of sinusitis, from 95.2% to 98.4%.

Clinical Decision Support Meets Virtual Care

At Zipnosis, we help providers improve the quality of care they deliver. Our proprietary protocols are grounded in national best practices, and offer built-in CDS.

The process starts with an adaptive patient interview that systematically captures the appropriate patient symptom history by asking the same questions that would be asked in a face-to-face visit – except the software never forgets a question.

This history is then summarized and presented to the clinician, along with curated diagnosis pathways and treatment options enhanced by CDS in the form of clearly summarized guidelines and best practices. This reduces the variability in diagnosis and treatment, which in turn, results in higher rates of guideline adherent diagnosis and treatment.

Health systems can effectively track guideline adherence through the Zipnosis platform, too. Both the patient history and the diagnosis and treatment plan are stored as structured data, allowing for efficient and accurate quality reporting. At any point, our Statnosis™ real-time analytics platform allows clients to easily report on how well clinical providers adhere to the best practice guidelines.

Achieving Adherence with Zipnosis

Let’s look at a real-world example. Remember the not-so-impressive statistic above – inappropriate antibiotic prescriptions for the common cold 65% of the time? In an analysis of over 1,700 virtual care patient visits for upper respiratory infection symptoms from two large health systems, adherence to best practice guidelines was achieved in over 95% of the cases. At Zipnosis, we take the issue of appropriate antibiotic use very seriously. We saw the need to do better, and we did.

High quality care that is safe, effective and adheres to best practice guidelines can and is being be achieved in the virtual care setting. And the outcomes exceed the quality of care the more traditional face-to-face setting represented in the study above.

Providing quality care is vital – as healthcare practitioners, it’s our job. Ideally, there should be no differentiation in quality standards based on the setting (virtual care versus in-person care). The quality of care is good or it is not and Zipnosis helps health systems meet the highest standards of healthcare today. Quality care – check!

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

 

5 Unexpected Benefits Integration Brings to Your Virtual Care Service

Offering virtual care is a great way to meet market demand and attract new patients. But to get the most out of your virtual care service, integration with your internal IT systems is a must. Benefits of integration, like enhancing the value of your patient portal and ensuring continuity of care, are just the tip of the iceberg. Choosing a virtual care partner who offers advanced integration with your internal IT systems can bring you some surprising advantages.

1.  Enhance patient experience

Patient experience is a major focus in healthcare these days. Health systems are launching virtual care services in an attempt to improve patient experience, but when the virtual care experience is disconnected from other care delivery systems, this goal is hard to attain. Integrating virtual care with your patient portal and EHR, however, can tie a virtual care offering to patient experience objectives.

    • A CCDA integration with your EHR can help make the online adaptive interview more personalized by accessing information from the patient health record, including medication allergies and health history.
  • Offering single sign-on (SSO) from the patient portal to your virtual care service means patients experience a seamless handoff when moving between these systems

2.  Improve patient retention

The healthcare landscape is becoming more competitive, and patients are making healthcare purchasing decisions differently. This combination means that healthcare consumers are increasingly likely to seek care outside of their primary care provider or medical home. Offering virtual care can help attract and retain these patients, and integrating with your patient portal through SSO can foster closer ties with your health system. Integrating with your appointment scheduling system can help prevent patients from seeking care elsewhere by making scheduling follow-up care or other appointments quick and easy.

3.  Seamlessly transition between virtual and in-person care

Systems integration can help marry the virtual visit with in-clinic services. Integrating your virtual care platform with your patient scheduling system, as well as with systems like labs, can help fit virtual care into the overall care continuum. Pairing virtual visits with in-clinic services can also increase the number of conditions your health system can safely treat through your virtual care platform. Start by pairing virtual visits with in-clinic services such as lab testing or imaging, and grow your virtual care service by incorporating follow-up care or referrals. Our ZipTicket® workflow and integration with lab systems brings the virtual visit and in-clinic services together in a process that saves patients time and adds depth to clients’ virtual care services.

4.  Reduce physician time spent on EHR data entry

Let’s face it, your health system has spent good money on your EHR system. But recent studies show it’s eating into patient interactions and physicians’ personal time, and that EHR-related data entry is a major cause of physician burnout. Effective integration, however, can reduce time spent entering data into the EHR. A standard EHR integration with a store-and-forward virtual care platform like Zipnosis can map information from the virtual visit directly to the EMR, eliminating the need for double documentation. Advanced integrations can take things even further. HL7 and other EHR integration options can create patient records in the EHR, eliminating the need to create a new record when the patient comes in for an office visit. And, by pairing EHR integration with certain patient scheduling integrations, your health system can add an adaptive interview to the front end of an office visit. This provides the clinician with a structured clinical note already added to the EHR, giving them more time to interact with the patient and minimizing the amount of data entry necessary per visit.

5.  Get ready for the future

Moving forward, consumer driven data from wearables and the “internet of things” is going to inform health decisions – both from a patient and provider standpoint. The healthcare industry is poised to see numerous benefits from this transition, according to a recent CIO article. However, flexibility and communication are going to be increasingly important to reaping these benefits, particularly as technology moves forward. Effective integration between virtual care and your IT systems can tighten workflows, improve communication and give your health system the foundation to adapt as your patients further embed technology in their lives.

Put integration to work for you

At Zipnosis, we offer advanced integration options to effectively connect your existing systems with our leading-edge virtual care platform. We interoperate effectively with any EHR, and offer advanced options including:

    • HL7 integration, covering use cases for patient registration, transcriptions, billing, results, and more
    • CCDA integration with your EHR provides a more streamlined workflow and personalized adaptive interview
    • Advanced EHR integrations reduce the need for double documentation, since information is securely transferred from one system to another
    • Single sign-on (SSO) – both patient and provider portal options offer a more seamless experience
    • Integration with your patient scheduling system removes barriers to care and ties patients more closely to your health system
  • ZipTicket effectively provides service continuity between virtual visits and in-clinic services, increasing the number and type of conditions your virtual care platform can address

Check out our Best Practices Guide to Virtual Care

Launching Virtual Care: Myth vs. Reality

If you are interested in launching a virtual care service, you are not alone. While market estimates vary, one thing all analysts agree on is that virtual care, also known as telemedicine, is growing rapidly and will continue to do so for the foreseeable future. This growth – past, current and anticipated – has flooded the marketplace with companies that offer telemedicine services, as well as three big myths related to launching a virtual care service.

Myth: We don’t have the clinical capacity to support virtual care.

Reality: You can manage thousands of virtual visits annually with your current staffing.

Outsourcing may initially seem appealing, but with external clinicians serving your patients, you lose control over clinical quality and may experience greater patient leakage. By leveraging marginal capacity through a virtual care platform, you can actually increase the number of patients treatable by your current clinical staff.

Myth: If you build it, patients will come.

Reality: Virtual care is a service, not a technology.

If you build in-house, you’ll have ultimate control. But that comes at a premium cost and with significant time investment. And, you don’t have any guarantees that the tool you build will match patients’ needs and expectations.

Myth: Embedding virtual care in our organization will be too hard.

Reality: Integrating virtual care takes as little as 60 days.

Buying a virtual care platform offers a middle road for cost and control, and the software as a service model makes for a quick launch. By starting small, securing organizational buy-in and scaling appropriately, you can grow your service to meet additional patient needs and maximize clinical efficiency.

Balancing the costs and rewards of your options can be challenging. How is a health system to decide what model of virtual care is best for them?

Start by checking out our ebook To Outsource, to Build or to Buy? for valuable information that will help get you started on the path best suited to your health system.

Can Virtual Care Reverse Clerical Burden Induced Physician Burnout?

The healthcare industry is faced with a crisis: physician burnout. An article in the September/October edition of Family Practice Management labeled physician burnout an “epidemic.” And this epidemic is costing health systems in a major way.

Physicians experiencing burnout are less engaged, leading to higher levels of turnover and an increased likelihood of medical errors – both of which can dramatically affect a health system’s bottom line. Moreover, burnout may lead to increased substance abuse, depression and suicide among medical professionals.

While there is no one single cause of burnout, recent research published in Mayo Clinic Proceedings indicates a correlation between use of EHR/EMR systems and physician burnout. Mirroring findings from a report issued in 2013, this new research indicates that things have not improved over the past several years.

The link between EHR/EMR systems and physician burnout is the amount of time spent on administrative or clerical tasks, such as data entry. The more time physicians are required to spend entering data into their EMR, the lower their job satisfaction and the higher their likelihood of burnout.

Traditional Telemedicine Falls Short

Traditional telemedicine, where physicians interact with patients via telephone or video chat, doesn’t lessen the burden of data entry. Physicians must still spend significant time on documenting the encounter. This type of telemedicine service requires a physician be waiting at a computer terminal for a patient to request a virtual visit. Consequently, physicians supporting telemedicine may be tasked with additional clerical or administrative work to fill the time between patient calls.

Far from lessening administrative burden, this may actually put greater strain on clinicians who support a direct-to-video telemedicine service.

Technology May Still be the Answer

While traditional telemedicine doesn’t offer a solution to physicians’ ever-growing list of administrative tasks, technology applications can still offer some respite. QuantidaMD, a community and educational resource for physicians, suggests that mobile health and virtual care might offer a solution to combat burnout. They indicate that technology can empower patients to take control of their health, as well as offering physicians simple means of capturing patient data.

Mobile health (mHealth) and virtual care have the potential to significantly decrease the amount of data entry required of physicians. In a recent whitepaper on mobile technology, Athena Health noted that mobile devices and apps can help optimize clinical workflows and patient care through clinical decision support, enhancing clinical efficiency, and providing tools for engaging patients and supporting population health.

So, How Does that Work in Practice?

At Zipnosis, we view virtual care technology as a means to meet patient needs while making life easier for physicians. We leverage an online adaptive interview, which asks the same questions a clinician would and records patient responses. Clinicians then receive a comprehensive clinical note, along with clinical decision support in the form of curated diagnosis and treatment options. Physicians can diagnose and prescribe treatment for common conditions with just a few taps on their smartphone or tablet.

The best part? All data from the virtual visit is securely transmitted to the health system for inclusion in the EMR, eliminating the need for physicians to spend their time entering information into an EMR. And, we offer health systems deeper integration options, which can further simplify the process and enhance physician experience.

People don’t seek out a career in medicine because they want to spend hours each day on data entry. Rather, they want to solve problems and help patients. At Zipnosis, our goal is to offer innovative access to mainstream medicine, while easing the burden on providers. We’re gratified to find that our obsessive focus on ease of use has created a platform that can help address this growing cause of physician burnout.

Maintaining Quality in Healthcare Continuum

Imagine having the equivalent of a clinic in your pocket without the concern that the quality of care would be less than you want or deserve. When done well, virtual care can improve access, decrease cost, and save time without sacrificing quality and continuity of care.

As the market becomes crowded with organizations offering various iterations of telemedicine, healthcare organizations must consider several key factors to determine whether a particular offering is right for the organization. For instance, will clinicians within your network field the inquiries of your patients or will they be handled by clinicians outside the network? Another key factor is whether you will have the ability to integrate information about a patient’s visit into your electronic health records (EHR) system – a key element for providers who strive to utilize all information about a patient in their encounters.

Through its virtual care solution, Zipnosis patients receive treatment for minor medical conditions quickly and safely from healthcare providers within their own network. Patients are treated using its pioneering software-guided online interview that mimics the questions physicians would ask in a clinic. An in-network clinician reviews the interview and either offers a treatment protocol, triages the patient into a phone or video encounter or directs them to visit a clinic.

The entire process is grounded in evidence-based medicine and complies with national best-practice guidelines. If at any point the patient provides information indicating a serious illness, Zipnosis will determine that virtual care is not appropriate and direct the patient to the most appropriate level of care. For example, if a patient believes she/he has a sinus infection and also indicates a fever of 103, the Zipnosis platform will stop the virtual visit and recommend an appropriate in-person site, such as the health system’s urgent care clinic.

With its white-labeled, fully integrated virtual care platform, Zipnosis also offers the technology that will enable you to seamlessly integrate patient visits into your EHR.

Virtual care, if designed to fit not only into the slipstream of your patient’s life, but also into the continuum of care your organization strives to provide, can make clinical care more convenient while maintaining quality – one patient at a time.