Mayo sees the kiosks as allowing it to extend its reach to patients' workplaces and elsewhere, said Dr. Matthew Bernard, primary-care service line chair for the clinic's southeast Minnesota region.
“To me, (the partnership) was the natural evolution. We've done visit care forever, and now we're getting into nonvisit care,” Bernard said. The clinic is currently in negotiations with employers regarding future kiosk placements while assessing how its own employees and physicians use the kiosks.
During the pilot, it hopes to answer questions about patient and physician satisfaction, as well as whether kiosk use reduces its overall cost of care while maintaining quality. It expects that the cost will be “significantly less” than its current models, Bernard said.
Virtual care, using a variety of media, has been growing. A September 2014 study in Health Affairs that examined the secure messaging program at Beth Israel Deaconess Medical Center, Boston, for example, found strong increases in the level of utilization from 2001 to 2010. By 2010, 23% of the system's patients had enrolled, with messages per physician growing from 11.9 messages per month to 32.9 messages per month.
The Northern California branch of Kaiser Permanente found similar increases in a review of data from February 2014, with virtual visits growing from 4.1 million in 2008 to 10.5 million in 2013. Based on that data, Kaiser Permanente Medical Group CEO Robert Pearl wrote that “I expect that by 2016, with the expanded use of video, the number of virtual visits—including secure e-mail, telephone and video encounters” will surpass the number of in-person office visits for Kaiser in Northern California.
And a Deloitte report projected that there could be 75 million virtual visits in North America in 2014, about 25% of their estimated total addressable market.
In contrast to other media, Bernard expects the kiosks to deliver a greater variety and depth of information, with the attached medical devices delivering more physiological data than before. Bernard thinks the kiosk might be particularly helpful with rashes, which in his experience tend to be better seen than described.
One of the challenges the pilot will face is scheduling doctor time, Bernard said. “There's not a lot of dead space in the calendar,” he said, so it might be difficult for doctors to handle additional demand. As time goes by, he expects doctors and nurses might have a specified e-visit day on their calendars to review virtual-visit data.
Creating scheduled time to deal with virtual visits or messages has been a common solution. In an August 2013 study in Health Affairs, authors interviewed six medical groups and found two—Colorado Permanente Medical Group and Group Health Cooperative, a Seattle-based integrated delivery and insurance system—specifically scheduled “desktop time” for their physicians.
Mayo has been investigating other remote care options as well. It recently announced plans to integrate with Apple's HealthKit, which will aggregate health data from sensors and export it into EHRs, along with plans to launch apps and other methods of extending care.
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