Implementation of Telehealth Visits in an Tertiary Referral Center

Abstract

Introduction: Inflammatory bowel disease (IBD) care has become complex and access to care is not uniform in the US. Implementation of telehealth (TH) visits into practice can increase access to providers with expertise in IBD; can be used to improve the efficiency; and can decrease the costs. We describe the experience of patients that underwent TH visits at a tertiary referral center. Methods: Adults with IBD were eligible to undergo TH visits if they had completed a consultation at our center and were insured by Blue Cross Blue Shield. Eligible patients provided informed consent to participate in the TH visit. Patients received an email with instructions on how to download the TH software (VidyoDesktop™ version 3.0.4(001)) which was downloaded onto the patient's desktop or laptop computer, tablet, or smart phone. An office assistant conducted a test visit to make sure that the connection was adequate. Patients that completed TH visits were sent a 19-item survey to describe their experience. Results: 89 TH visits were conducted from April 2015 to May 2016; 21 patients completed the survey. 53% were male, 83% were Caucasian, and 89% had at least some college education. All patients reported receiving all necessary information before the TH visit. 65% and 18% of patients reported using the system was not complicated at all or slightly complicated respectively. 88% reported having no to very little difficulty hearing or seeing the provider during the visit. 71% reported that the TH visit took significantly less or less time than a routine encounter; 88% said that all concerns were addressed. All patients felt that TH visits were more convenient than a face-to-face visit. 1 patient reported feeling slightly less safe transmitting personal information, 1 patient was nervous, and 1 patient had significant technical issues during the TH visit. 53, 18%, and 6% of patients had a 1-2 h, 2-3 h, and >3 h round trip for an face-to-face visit respectfully. 53% reported that the TH visit saved them 1-3 h and 41% reported that TH saved them > 3 h. 94% reported they would definitely like to have a TH visit in the future. Conclusion: Implementation of TH visits in a tertiary referral center is feasible and patient satisfaction with TH is high. Use of TH to increase access to IBD specialty care is likely; however barriers exist to implement TH visits broadly including licensure requirements and resistance by payers to reimburse providers for TH visits.