Online Messaging at the Village Family Health Team

A case study in implementing patient-physician online messaging using Wellx. Originally prepared by Dr. David Verrilli for the e-Health 2013: Accelerating Change conference.

Transcript

1. ONLINE PATIENT MESSAGING AT THE VILLAGE FAMILY HEALTH TEAM Dr. David Verrilli • May 29, 2013 Presented at e-Health 2013: Accelerating Change 1
2. DISCLOSURES • Healthcare Made Simple, Inc., the makers of Wellx, provided: • Free use of Wellx for 6 months during the pilot period • Reimbursement for the costs of attending this conference 2
3. PROBLEM • Village FHT opened new location in January 2012 • 7 physicians, 1 nurse practitioner • Shared reception desk overburdened with rostering new patients, establishing processes, advanced access • Can online messaging address workload and workflow? 3
4. SOLUTION • Wellx is a secure website and mobile app for doctor-patient communication (wellx.ca) • Enables one-to-one messaging with MD and collaboration with team (e.g. assigning non-clinical messages to reception) • Used for answering questions, sharing results and sending broadcasts to all patients • Implemented with 1 MD and 1 NP in summer 2012; rest of team in Dec 2012 4
5. PATIENT ADOPTION 0 125 250 375 500 Jul ‘12 Sep ‘12 Nov ‘12 Jan ‘13 Mar ‘13 May ‘13 Patients Registered on Wellx Current Total: 495 registered users 58% of rostered patients over 15 5
6. MESSAGING VOLUMES 0 500 1,000 1,500 2,000 2,500 Jul ‘12 Sep ‘12 Nov ‘12 Jan ‘13 Mar ‘13 May ‘13 Messages Exchanged Sent Received PER PATIENT: Mean: 8.03 Median: 3 SD: 13.06 6
7. DAILY USE 0 18 36 54 72 90 Apr 15 Apr 22 Apr 29 May 6 May 13 Messages Exchanged per Day: Wed, Apr 15 - May 15 2013 Sent Received Time per Day: est. 10 - 15 minutes 7
8. WORKFLOW IMPACT • Catches overflow when reception is busy and patients can’t get through on the phone - increases patient satisfaction • Saves reception time to communicate specialist appointments • Saves physician / NP time to communicate results • Streamlines workflow when patients need specific information from MD (see diagram) 8
9. WORKFLOW EXAMPLE Before: • Patient calls to request information • Receptionist writes a message to MD describing the request • MD documents information for receptionist • Receptionist calls patient back to provide information • Hope that (a) patient answers phone and (b) doesn’t need further clarification… After: • Patient sends a message to request information • MD documents information for patient in a reply* • Patient can ask follow-up questions at any time * This is not “extra” work for the MD - they are doing the same work as before 9
10. CASE STUDY #1 • Patient presented to appointment with family history indicating malignant hyperthermia susceptibility • Following the appointment, I did further research to identify indication and options for testing and patient confirmed family history • Sent information to patient via messaging and confirmed indication for referral 10
11. CASE STUDY #2 • 76-year-old patient with atrial fibrillation on long-term Coumadin who identified the benefit of using online communication to manage his medication • Nurse identified high INR via labs and confirmed current dosing with patient via message • Nurse adjusted dose and scheduled repeat bloodwork • I was able to monitor this communication while it occurred 11
12. CASE STUDY #3 • Patient presented to appointment with rash, was prescribed a cream • I followed up via message to confirm whether the condition had improved or the patient was experiencing any side effects • Patient responded the next day to confirm that they had started the prescription and would update again in a week 12
13. LESSONS LEARNED 1. Patients don’t want to “bother” the MD: use is typically appropriate and when it is not, they respond to guidance 2. Need to set your own limits (when, what) and communicate them as required 3. Some things are still more efficient on the phone, e.g. negotiating a time when booking appointments 4. Provides opportunity to interact with patients about their treatment and health between visits 13