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Direct-to-Consumer Telehealth: One Hospital’s Virtual Care Plan

York Hospital recently launched its first direct-to-consumer telehealth service. Administrators see the virtual care platform as an important tool in population health and a step toward value-based care.

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- A small southern Maine hospital is using direct-to-consumer telehealth to put the community back into its community health mission.

York Hospital’s new Virtual Care service aims to give local residents a more convenient connection to the doctors they’ve known for so long. Tucked into Exam Room 7 at the hospital’s walk-in clinic on Route 1 – a newly opened facility carved out of a former auto dealership – the platform offers a pre-scheduled virtual visit with a York Hospital doctor during weekday hours for a variety of minor ailments.

Erich Fogg, clinical lead for the hospital’s virtual care walk-in service and lead provider for the hospital’s network of walk-in sites, says hospital administrators have been planning the platform since 2014. They wanted a small, branded platform that could address common ailments – sore throat, fevers, aches and pains – that would otherwise require a visit to the doctor’s office, perhaps the ER, or maybe one of the independent retail clinics popping up across southern Maine and New Hampshire.

“All of these people have physicians who live right in the area,” he says. “We wanted to give them something more convenient.”

Administrators at the 79-bed hospital, serving Maine’s southern counties and some New Hampshire residents across the nearby Piscataqua River, see the telehealth platform as an important link in bringing value-based healthcare to its patients.

READ MORE: The Benefits and Challenges of Telehealth for Specialists

They’re one of hundreds of small hospitals across the nation adding telehealth and telemedicine services to improve patient engagement, bolster population health programs and push their brand at a time when such facilities are pressured by retail clinics, online services and national health systems with “one-and-done” telehealth services.

“What we’re trying to do is support our community,” says Fogg. “We have brick-and-mortar places and we’ve been here for a very long time. We’re not trying to replace those; we’re giving our patients more access points to get the care they want.”

Fogg will be showcasing York Hospital’s path of direct-to-consumer care at the Northeast Telehealth Resource Center’s regional conference, scheduled for May 23-24 at the University of Massachusetts in Amherst.

The journey hasn’t been smooth, and with roughly a dozen visits recorded in the first three months (the whole office celebrates when a patient schedules a virtual visit), it hasn’t caught on as quickly as Fogg and Jerry Dubois, the hospital’s new director of telehealth services, would have hoped. But both feel it’s only a matter of time before local residents catch on to the service.

Fogg says the hospital bypassed the bigger vendors in the consumer-facing telehealth space because administrators wanted a small, easily configurable platform that would make use of the hospital’s own resources. The hospital didn’t want to launch an on-demand platform, he says, because administrators didn’t want to create something that would interrupt a doctor’s regular workflow.

READ MORE: How Nighttime Telehealth Services Can Improve Overnight Care

Once they settled on SnapMD, they configured a virtual visit platform that allows consumers to check in, register and schedule a same-day visit for a cash-only charge of $49 (a fee not charged if the patient ends up needing in-person care). The idea was to create a platform that both patient and doctor could log onto at the most convenient moment.

“I then took a brick-and-mortar exam room offline and made it into a telehealth room,” says Fogg, showing off a simple examination room equipped with a keyboard, two video screens, soft lighting and a shelf of instruments and York Hospital banner positioned in the background. Laminated guides give the doctors an easy reference to the list of conditions they can treat and best practices for diagnosing and treating those conditions.

Fogg and his team then turned to staffing. They canvassed the dozen-or-so physicians working through York Hospital’s walk-in clinics and found that several were uncomfortable with treating patients through a virtual visit. That uncertainty can show through in a video visit, so Fogg opted to include only staff who were fully invested in treating patients online.

With the platform and staff in place, hospital officials decided to test it on their own staff before turning it around for consumers.

Fogg says much of the early work on the platform revolved around ironing out the bumps in the road that no one had anticipated. Their first patient, a relative of a staff member working at Berwick Academy - a private school roughly 30 minutes away in South Berwick - couldn’t connect to the platform from her office because of a firewall, so she had to walk outside the building and call from her smartphone.

READ MORE: A Telehealth Primer: 5 Tips to Making the Virtual Visit a Success

“One patient, one learning experience,” Fogg says.

In fact, each early visit uncovered some little glitch that Fogg and his staff scrambled to improve, pointing out the value of early-and-often testing before going live. For example, which web browser works best and which one doesn’t? Which common health conditions can be treated online (and listed on the hospital’s website) and which would be better served with an in-person visit?

Fogg points out that a simple stomach ache, while seemingly easy to diagnose, has a wide variety of possible causes, some of which can’t be determined through a video encounter.

“How do you figure out what to treat and what can’t be treated,” he asks. “We need to come up with a list of conditions. We couldn’t be too restrictive, but we needed to make sure we could list [conditions] that we could treat.’

Likewise, Fogg says, if someone calls up complaining of chest pain and shortness of breath, he/she should immediately be told to seek emergency medical treatment. But because people are apt to seek a virtual visit for that reason – or for such conditions as uncontrolled bleeding, sudden dizziness and changes in mental state – administrators opted to include in the program’s online guide a list of conditions that merit a 911 call.

“It’s surprising what people coming into a walk-in clinic will say,” Fogg says.

With the Virtual Care platform up and running, Fogg and Dubois now want to see it grow and become an accepted avenue of care in the community. They’re looking to spread the word through hospital staff, with printed handouts and on the hospital’s website. Fogg also wants to work with hotels, campgrounds and businesses to make the service known during the busy summer tourist season.

“It’s been surprising how slow this has been – I’m used to things going much quicker,” says Fogg, adding half-jokingly that he can’t wait until the day when the entire office accepts a telehealth visit as part of a normal day rather than celebrating the scheduled encounter. “I feel like there’s some flipping of the switch somewhere that will get this going.”

More importantly, he sees this platform opening up other telehealth and telemedicine opportunities. York Hospital has a strong telestroke platform, recently launched a telepsychiatry evaluation service for its Emergency Department and is looking at telemedicine platforms for certain OB/GYN and pediatric services.

Fogg sees the platform as a natural fit for southern Maine’s school districts.

“Every school nurse has 25 or 30 kids a day coming through the office,” he says. “They’re very busy, and there’s a lot that we could offer to help them out,” not to mention helping parents who would otherwise have to take a day off from work to schedule a doctor’s visit.

Then there are the chronic care patients, and those needing post-discharge care.

“The potential for this type of service would be really cool – but then, when we’re thinking about this one service, we start thinking about other things that would be even cooler,” Fogg says.   

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