Direct to Consumer Strategies

ePoster Presentations

EP-128 - Characteristics of Unresolved E-Visits in an Acute Care Telemedicine Program

Monday, April 30
9:55 AM - 10:10 AM
Location: Education Zone, Booth 2416, Screen 3

Context: Electronic visits (e-visits) are asynchronous electronic interactions between patients and providers through a secure patient portal. An e-visit program was implemented in December 2015 at the Medical University of South Carolina in Charleston, South Carolina to provide non-emergent acute care. As this new method of patient care continues to grow in use and develop into more areas of medical care, the quality of these visits remains of significant interest to insurers, healthcare systems, healthcare providers and to patients themselves. Studies often examine and present findings from e-visit programs in which the visits were resolved (ie the patient's problem was addressed, and they were billed for the encounter). There is limited information on the reasons why E-visits may remain unresolved, such as patient factors, severity of illness, and appropriateness of presenting complaints. In an effort to continually improve the quality of e-visits provided at our institution, we take the unique approach of analyzing factors associated with unresolved e-visits.

Methods: This study involves a retrospective chart review of 1575 e-visits submitted by adults ( > 18 years old) from December 2015 to July 2017. Patients could request e-visits for more than 20 common acute conditions, which include heartburn, diarrhea, influenza, rash, red eye, sinus problems, urinary problems, and vaginal irritation.
Descriptive statistics evaluating the characteristics of all e-visits as well as those which were not resolved were calculated. Chi-square tests were used to compare resolved and unresolved e-visits, evaluating differences between patient factors (age, gender), disease factors (condition being evaluated), and e-visit factors (response time, time the e-visit was submitted) All analyses were performed using SPSS.

Results: A total of 1575 e-visits were submitted from 18 December 2015 to 9 July 2017. Most e-visit were submitted by women (80.1%) and patients 18-45 years old (57.7%). One-fourth of patients (25.7%) submitted more than on e-visit. Most e-visits were successfully completed (92.5%). E-visits that could not be completed were more likely to be submitted by men than women (10.5% vs 6.4%, p=0.12), patients > 65 years old (6.6% for patients 18-45, 7.2% for patients 46-64, 13.5% for patients 65 and older, p=0.046), and have a response time over 20 minutes (12.4% vs 5.2%, p <0.001). Almost one-fifth of skin problems were not completed (18.1%), which was statistically significant (p<0.001).

Conclusions: Most submitted e-visits were resolved. For those that went unresolved, patients were more likely to be men and older. Rash and other skin problems were the most likely presenting condition in the e-visits to be unresolved. Improvement in e-visit resolution rates may require amending the e-visit template to obtain more information (eg more precise questions and requiring a photo). A variety of reasons could be associated with men and older patients having a lower resolution rate. For instance, these patients may have more complex conditions, they could be providing less information through the e-visit questionnaires, or providers may feel less comfortable treating older and male patients because of perceived worse health. Thus, further evaluation of the underlying causes for our findings is needed.

Learning Objectives:

Marty Player

Assistant Professor
Medical University of South Carolina

Marty Player received his Bachelors of Science from the South Carolina Honors College at USC and Medical Degree from the University of South Carolina. He completed a residency and a chief resident year in Family Medicine at Christiana Care Hospital in Wilmington Delaware in 2005. He subsequently completed a 2-year faculty development fellowship and Masters in Clinical Research (MSCR) at the Medical University of South Carolina in Charleston (2005-2007). He has been faculty in the Department of Family Medicine since 2007 and was promoted to Associate Professor in 2016. He is working on the development, implementation, and evaluation of electronic visits and video visits within primary care as well as a telemedicine program to offer HIV pre-exposure prophylaxis to high-risk patients.

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Vanessa A. Diaz

Professor
Medical University of South Carolina

Dr. Diaz received a Bachelor of Science and Medical Degree from the University of Miami, then completed residency at Memorial Hospital in Savannah, Georgia. She subsequently received an MSCR from the Medical University of South Carolina (MUSC) during a two-year academic fellowship with the Department of Family Medicine from 2002-2004. She then joined the faculty in the Department of Family Medicine at MUSC, where she served as Director of Clinical Services from 2011-2016. She is currently Research Director for the Department of Family Medicine and a tenured Professor. Her interests include telehealth, health disparities, and faculty development. Dr. Diaz is originally from Panama and is fluent in Spanish.

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Emily Sigmon

Telehealth Urgent Care Coordinator
Medical University of South Carolina

Emily Sigmon, MHA, is the Telehealth Urgent Care Coordinator at the Medical University of South Carolina (MUSC) Center for Telehealth. Emily is the primary coordinator for the acute, critical and trauma care telehealth programs which include acute care e-visits and video visits, and is the external coordinator for telehealth programs located in correctional facilities and skilled nursing facilities. She is an active member and contributor to the South Carolina Telehealth Alliance’s Direct-to-Consumer Workgroup, which is focused on enhancing access to care through direct connections with patients and through nontraditional clinical settings. Additionally, Emily has years of experience in the analytics field and was an analytical advisor for the perioperative suite at MUSC. Her mission is to add value to her telehealth programs by harnessing data-driven strategies to create innovative solutions.

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