Engaging Physicians in Telemedicine ‘Curbside Consults’ Leads to Quality Care

Thursday, September 24th, 2009
This post was written by Melanie Matthews

Kim Dunn, M.D., Ph.D., director of the HealthQuilt Project, assistant professor at the University of Texas School of Health Information Sciences and founder and CEO of Your Doctor Program, L.P., explains how to engage physicians in telemedicine to provide quality care.

The medical doctors who will participate in the HealthQuilt Quality Health Record (QHR) pilot will look at the protocol and customize it to their practice, which takes about two minutes per protocol, explains Dr. Dunn. That training, provided by the Your Doctor Program, L.P., overcomes the traditional provider barrier of, “I practice differently,” which often prevents physicians from participating in quality initiatives. It also overcomes the reluctance of the specialists, who often have big concerns about telemedicine source locations.

“Let’s say I’ve seen a patient, and I’m diagnosing him with depression,” says Dr. Dunn. “There are about five medications I feel comfortable using for depression. Or let’s say the patient’s case is really complicated — they’re elderly or have major problems and I’m feeling out of my league. We have two ways to use telemedicine to access specialty care in this case. First, via the QHR, I can go to our telepsychiatrist’s cell phone. He’s contractually obligated to answer his cell phone and speak with me. I ask the psychiatrist to look at this patient’s QHR when he gets the cell phone call. We have a one- or two-minute conversation, and then he messages me with his recommendation. The whole “curbside consult” takes about four minutes. Since I, as a medical home physician, manage the care plan, we automatically follow up on the outcomes of care. This is a form of Continuing Medical Education (CME) for the physician as we incorporate that into their annual practice-based CME program. “Through this collaborative practice model we’ve been able to impact that patient’s care through that process, and the patient hasn’t had to have an additional appointment. There hasn’t been a delay in their treatment,” says Dr. Dunn.

But in some cases, the psychiatrist may say, “I don’t really know what to do with the patient.” HealthQuilt’s second option is its embedded live interactive telemedicine inside the QHR via a $100 webcam that enables the team to do acceptable quality video so there can be specialist-to-patient interaction, Dr. Dunn explains. “We are now piloting payment to physicians for this.”

Live interactive consults can also be scheduled, she adds. “Often, you really just need to talk about the problem and get a few questions answered, and then you can schedule either a live interactive follow-up via telemedicine or an in-person exam.

“Also,” Dr. Dunn continues, “We don’t want to impact the usual referral patterns of the medical home doctors. We’re not trying to upset the apple cart with the specialists in the community. That would be a very bad decision on our part. We’re not trying to change the physician’s usual referrals pattern. We’re trying to augment that with new knowledge, processes to improve care, practice-based continuing education and specialty care access via quick ‘curbsides.’ Our telemedicine is a DM strategy and a continuing education strategy provided by the Your Doctor Program, L.P. The medical home doctors can choose to use it or not. They may decide to use usual care processes, which is fine.”

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