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Patients can schedule video visits through the hospital website, in much the same way as they would schedule a traditional visit and provide information about their symptoms in advance of the visit through the scheduling application. At the appointed time, they meet with the doctor in a Web-based videoconference from a home or workplace computer equipped with a webcam.
"This has been integrated into our primary-care processes as of the last week," CIO Pravene Nath, M.D., said in an interview.
Video visits can be perfectly appropriate for several types of non-critical visits and follow-ups where the camera can capture important details of the patient's condition while allowing a "face to face" consultation between doctor and patient.
"One of our first patients had an eye condition, where the patient needed to look into the camera," Nath said. There are other conditions such as treatment of a skin rash. "These are cases where a quick visual is all that's needed, followed by a quick interaction of the patient talking with the doctor," he said.
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The eCare video visits service is being offered first to the employees of self-insured firms who contract with the hospital. That avoids questions about reimbursement for remote patient care, because those firms have a broad interest in the wellness of their employees. Still, Stanford's intent is to make the option available to everyone. "We're considering this an investment, so we're not waiting to solve every billing problem before we go forward," Nath said. A staged rollout will continue over the next three to six months, he said.
A video demo of the service (see below) was shown at the Epic user conference this week because it takes advantage of Epic's software for video consultations and integrates with the patient's electronic health record. Nath's IT team did additional development to create a consistent user experience for patients and integrate the process of scheduling and keeping the appointments into the physician's workflow. In addition, the service has been integrated with third-party identity verification services to make sure the person on the other end of the videoconference connection is who they say they are.
Stanford Hospital had conducted an earlier video care test on a smaller scale, where dermatology appointments could be conducted remotely from a clinic at an employer's place of business. However, this is the first time the service has been offered on a routine basis as a consumer service capable of operating on a much larger scale, Nath said. The experience so far has been that these visits produce "unbelievably high satisfaction" because patients can keep the appointments without taking so much time away from work, he said.
The Stanford eCare video visits are one of several virtual healthcare services the hospital is developing. Other scenarios are secure messaging between doctor and patient or submitting a still photo rather than conducting a live videoconference.
In addition to assigning doctors specifically to a virtual care team, the hospital has some specialists who will devote a portion of their day to remote care.
Maybe because the hospital is in the heart of Silicon Valley, the response from physicians has been positive, Nath said. "They feel like this is the sort of thing we ought to be doing at Stanford." It helps that the video appointments are being integrated into the doctor's schedule just like regular appointments, rather than being something extra tacked onto their workload, he said. Still, each physician will need to develop his or her own comfort level with the technology and decide when it is appropriate, he said.