E-visit a doctor: A new service allows patients to send an electronic message to Sanford Clinic, hear back from a doctor and have a prescription sent to a pharmacy. Reporter Jon Walker interviews a Sanford official and a patient
A visit to the doctor now comes without the visit.
Sanford Health has begun offering an electronic option in clinical care. A patient with a health problem can sit at a computer, type a summary of symptoms, attach a credit card number and hit the send key. A response from a Sanford provider with a prescription or medical advice comes back in four hours or less. It costs the patient $55.
The format depends on a patient’s skills in self-diagnosis and the medical system’s ability to respond without any conversation or face-to-face interaction, but it’s mostly a bow to consumer convenience in the computer age.
“It’s so a patient can receive information they can trust as opposed to just Googling,” said Louise Papka, a physician assistant in acute care for Sanford.
Michele Kleinwolterink, 44, said it helped her. She could feel a sinus headache developing two weeks ago as she drove to her job as executive assistant at Bluestem, a private equity company in downtown Sioux Falls.
“I knew I needed to go to the doctor but it was a busy day,” she said. “Sinus headaches don’t just go away. You need meds as soon as possible.”
From her desk, she logged on to her account at My Sanford Chart, the health system’s online records platform. A prompt directed her to an e-visit page, where she answered questions and described her condition in a box allowing a narrative up to 250 characters.
“You answer the same questions you would in the doctor’s office and tell them about your pain,” she said.
It took her 10 minutes. She filed her request and waited.
Sanford pledges a response within four hours but says the average is half that time. It was shorter for Kleinwolterink.
“It only took 10 minutes ... to get an email back from a doctor and they said, ‘You have a prescription waiting for you at your pharmacy that you selected,’” she said.
Sanford has been doing a trial run with the program and last week began offering it to all patients in South Dakota, Iowa and Minnesota. It hopes to add North Dakota this summer. Patients filing an e-visit likely are not communicating with their own doctor but with someone in Sioux Falls who is either a physician or an advanced practice provider such as a physician assistant or nurse practitioner. Sanford has been receiving 20 to 30 requests a week.
7 nonemergency conditions covered
It’s only for adults, only for patients enrolled in the My Chart program and only for seven conditions that are not emergencies. The seven are sinus headache, pink eye, urinary tract infection, vaginal discharge, diarrhea, cough and back pain.
Helping patients control their health
Self-diagnosis plays to a Sanford goal of having patients take ownership of their own welfare, which is one pillar of the national health reform movement. Patients still will visit clinics to see doctors, and they still can call for what still is free advice over the telephone. The e-visit is an option for those with relatively minor problems, who prefer texting and don’t want to sit in a waiting room.
“A lot of problems, a patient is looking for confirmation,” said Dr. Dan Heinemann, chief medical officer at Sanford Clinic. “They don’t have anything serious that they can’t continue to manage at home. ... If I have chest pain, this is not going to do it. But if I have a cough, it’s relatively easy.”
Medicare doesn’t cover an e-visit, but some insurers do. Kleinwolterink said she paid $25 of the $55 fee with a credit card and that Blue Cross Blue Shield covered the rest.
The health charts are a secured format requiring membership and a password entry to ensure privacy. Identity fraud is always a concern in health care, with the intent usually to misuse insurance. The e-visit, though remote, is reliable communication, said Terri Carlson, vice president at Sanford Clinic.
“Our risk folks prefer this over telephone calls. We have objective data in the questions patients have answered,” Carlson said.
Sometimes intimate details in writing
Still, the e-visit marks a cultural shift for patients to commit to writing private details about their health in order to communicate with a website. Some of the seven conditions, such as sinus headaches and back pain, are generic problems, while the others are more intimate.
“It’s a sign of the times to be using technology ... to be making that connection between the consumer and the health care market,” said Lorna Saboe-Wounded Head, assistant professor of consumer affairs at South Dakota State University. “With the social networks, maybe people are more willing to explain the problems they have, even if it’s very personal.”
Safeguards for prescriptions
Randy Jones, executive director of the South Dakota Board of Pharmacy, said health providers are allowed to prescribe drugs by electronic format without seeing a patient. It should be an established patient-doctor relationship that includes safeguards to prevent prescriptions that are improper or premature, he said.
“If they say I’ve got this hacking cough, do they know if it’s viral or bacterial without a lab exam? The answer is no. I would have some concerns,” Jones said. “If the prescriber has valid concerns, they should require that patient to come in for a physical exam and potential lab tests.”
Sanford says it has those safeguards in place. Under those circumstances, “it can be done with care,” Jones said.
Heinemann said the questions a patient must answer serve as a filter.
“If a patient says in an e-visit, ‘I’m really short of breath, I have pain when I breathe,’ those are red flags and probably the individual needs to get in to see a doctor,” Heinemann said. “Most of the time ... I think we can do a pretty good job without seeing the patient.”
