Patient and clinician experiences with telehealth for patient follow-up care.

OBJECTIVES: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. STUDY DESIGN: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. METHODS: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys. RESULTS: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in "the overall quality of the visit." VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment. CONCLUSIONS: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.

Challenges And Opportunities Faced By Large Health Systems Implementing Telehealth.

Executives at large health systems across the United States have an interest in developing or expanding telehealth programs. While interest is increasing, telehealth implementation teams (or e-health teams) often face challenges that can hinder the successful transition from pilot to full-scale implementation. Here we share lessons learned by four large health systems that have faced and largely surmounted these challenges. For e-health teams to successfully engage senior leaders in new telehealth initiatives, it is essential to align proposals with the strategic goals of the institution and use patient stories to highlight the benefits of telehealth. To manage the demand for telehealth offerings from patients and dozens of clinical departments, e-health teams should develop a framework for deciding what's most important. To get large medical staffs to adopt telehealth workflows, e-health teams should nurture telehealth champions at each staff level and incentivize them with career development opportunities and rewards. To enroll a heterogeneous population of patients in telehealth programs, e-health teams should use multiple methods of education to accommodate different learning styles. And finally, health systems should develop telehealth-specific outcome measures and repeatedly use them to motivate improvement.

Practical Issues in Delivery of Clinician-to-Patient Telemental Health in an Academic Medical Center.

BACKGROUND: In the age of online communication, psychiatric care can now be provided via videoconferencing technologies. While virtual visits as a part of telepsychiatry and telemental health provide a highly efficient and beneficial modality of care, the implementation of virtual visits requires attention to quality and safety issues. As practitioners continue to utilize this technology, issues of clinician licensing, treatment outcomes of virtual visits versus in-person visits, and cost offset require ongoing study. METHODS: This review provides an overview of the topics of technology, legal and regulatory issues, clinical issues, and cost savings as they relate to practicing psychiatry and psychology via virtual visits in an academic medical center. We review the telepsychiatry/telemental health effectiveness literature from 2013 to the present. Our literature searches used the following terms: telemental health effective, telepsychiatry effective, telepsychiatry efficacy, and telemental health efficacy. These searches produced 58 articles, reduced to 16 when including only articles that address effectiveness of clinician-to-patient services. RESULTS: The technological, legal, and regulatory issues vary from state to state and over time. The emerging research addressing diverse populations and disorders provides strong evidence for the effectiveness of telepsychiatry. Cost savings are difficult to precisely determine and depend on the scope of the cost and benefit measured. CONCLUSION: Establishing a telepsychiatry program requires a comprehensive approach with up-to-date legal and technological considerations.

Evaluation of skin cancer in Northern California Kaiser Permanente's store-and-forward teledermatology referral program.

OBJECTIVE: To determine whether teledermatology referrals yield a shorter time to biopsy of the most common types of skin cancer versus conventional dermatology referrals. SUBJECTS AND METHODS: A retrospective chart review was performed of California's Central Valley Kaiser Permanente conventional dermatology or teledermatology referrals that yielded a positive skin cancer biopsy over a 7-month period. Four primary care clinics at Kaiser Permanente's Stockton Medical Center in California's Central Valley were included. Patients who were studied were treated for squamous cell carcinoma of skin, basal cell carcinoma of skin, and malignant melanoma. We compared the time interval between initial evaluation and biopsy of the most common types of skin cancer for teledermatology versus traditional referrals from primary care. RESULTS: Our study criteria were met by 293 patient cases (58% conventional referrals and 42% teledermatology referrals). The mean time to biopsy of skin cancer was 13.8 days for conventional referrals (median, 12.0 days) versus a mean of 9.7 days (median, 9.0 days) for teledermatology referrals (p<0.0001). CONCLUSIONS: The use of teledermatology in remote areas results in a shorter time to biopsy than traditional referral methods as a result of improved triaging measures.