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Store-and-Forward Telehealth Service Replaces the Office Visit

Rush University Medical Center's new SmartExam service uses a store-and-forward telehealth platform to treat patients with minor health concerns. It's an ideal platform for a hospital just beginning its digital health journey.

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- Rush University Medical Center has launched a store-and-forward telemedicine platform for non-emergency cases, giving patients an effective alternative to the doctor’s office or retail clinic visit.

Rush SmartExam is the Chicago-based hospital’s first patient-facing telehealth service, says Amanda Tosto, RN, MS, director of population health and a practitioner in Rush UMC’s Department of Health Systems Management. And it’s deliberately styled to fit into the daily routines of both patient and doctor.

“This is so logical from a physician’s standpoint,” she says. “It’s a part of what we do every day. We’re just making it more convenient for our patients.”

“Patients will be able to get a medical evaluation electronically from the comfort of their home for non-urgent conditions commonly treated by a primary care physician,” adds Anthony Perry, MD, Rush University Medical Group’s chief medical officer and one of the first physicians to use the new platform, in a press release. “People have busy lives and we want to create convenient and high-quality options that work.”

Rush UMC is one of the first health systems in the country to launch an asynchronous service for common health issues, bypassing the more common but more technically complicated virtual visit. Telehealth experts say it’s a good starting point for healthcare providers just starting out on the primary care patient engagement route, provided that state’s telemedicine regulations allow store-and-forward telehealth.

The service targets what many consider to be the low-hanging fruit on the healthcare tree: a health system’s current patients, who are included in the system’s electronic health records and are looking for quick and easy access for a minor concern. These are the patients that doctors want to keep out of their waiting rooms, emergency departments or competing walk-in clinics, and who could be served on a simple telehealth platform.

“This gives our patients another option to get care from Rush in a more convenient way,” says Tosto, who’s shepherding the service through its first weeks of operation. “It’s an online clinical interview, not a virtual visit. It’s very detail-oriented and patient-friendly, which is exactly what [these patients] are looking for.”

Qualifying patients have to be at least 18 years old, have an established primary care physician at Rush and have visited that doctor within the past year. They must also register for the service on MyChart, the hospital’s electronic health record platform.

To request an e-visit, a patient logs onto rush.smartexam.com and fills out a questionnaire of between 25 and 75 questions, a process that takes about 12 minutes. A Rush physician logging in from the back end reviews that questionnaire within an hour, develops a diagnosis and treatment plan, which can include prescriptions, and send a text message to the patient. The patient can then access an after-visit summary through SmartExam.

The service is available from 8 a.m. to 7 p.m. weekdays and 8 a.m. to 3 p.m. on weekends, excluding holidays. A $30 fee, not covered by insurance, is charged at the onset of the e-visit but not collected until diagnosis and treatment is delivered.

The service is designed for low-acuity concerns like general cold and allergic reactions, rashes, sinus pain, sunburns, flu, earaches, sore throat, bladder infections and acne. In some cases a photo is required, and the patient is given detailed instructions on how to take an effective photo.

“When someone doesn’t feel well, it may be difficult for them to get out of bed and walk or drive to a doctor’s office. Having an e-visit is a convenient way for patients to get advice for common health issues, such as coughs, colds, flu, and ear pain,” Christen Tibbs, MD, an assistant professor of internal medicine at Rush and e-visit physician, said in a press release announcing the service.

“If we determine that the patient has a condition that requires more thorough, personal analysis and examination, we will advise the patient to see a provider in person,” she added. 

Tosto says the e-visit platform “challenges us to step outside our in-clinic, in-person box,” but is a natural evolution for a health system looking to expand its services to patients.

“We’re really just beginning what I would say is a revolution in telemedicine,” she says.

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