This morning, on National Public Radio’s (NPR) Morning Edition, there was a nice 5 minute segment on e-Consultations. With the two big insurers Aetna and Cigna now reimbursing physicians for conducting such e-Consultations, we will be seeing much more of this in the future. During the NPR spot they interviewed an internist who actively performs e-Consultations, via physician-consumer communication and PHR platform RelayHealth.
One of the chief complaints I have heard from physicians (besides the issue of reimbursement) is the fear of being inundated with emails. While this could become a problem, it doesn’t have to be that way.
At the recent HIMSS conference, I had the pleasure to get an in-depth demo of RelayHealth’s PHR solution. As I stated in my write-up then, nice solution, though more physician centric than consumer. The RelayHealth solution provides secure communication between the physician and consumer where in addition to an e-Consultation, a consumer can request a prescription refill, a referral or even schedule an appointment. And for those e-Consultations, it prompts a consumer at the beginning of the inquiry to provide the co-pay via credit card before proceeding. That step right there will limit the barrage of emails that physicians fear. And if that payment step doesn’t do it, the lengthy questionnaire that follows may also limit those emails.
After the consumer processes the co-pay, they are taken through a thorough questionnaire with branching logic to describe their symptoms. Not sure if it was the person doing the demo at HIMSS or not, but the number of questions he had to answer during the demo was daunting. Unfortunately for the consumer, the RelayHealth solution provides no feedback to the consumer as to how far along they are in the questionnaire process, which can get frustrating.
If you manage to survive this process, your physician will receive an in-depth profile of your current symptoms and likely provide you guidance via a return email, or if deemed necessary, schedule an appointment. The complete e-Consultation is captured in the consumer’s RelayHealth PHR account, which is under the consumer’s control but sponsored by their physician.
While I have a couple of minor gripes with the RelayHealth platform, it is a powerful solution overall and something that I could see myself using to facilitate communcation with my physician(s). During my meeting with RelayHealth they also informed me that the PHR, though sponsored by the physician, is owned by the consumer. Thus, if you move to another part of the country or just change doctors, your RelayHealth PHR is not tethered to the physician, but goes with you.
This sounds great in theory, but what happens if your new physician does not use RelayHealth?
Well, you are left with a PHR that does not connect. This is one of the challenges with this solution and for that matter Medem and all tethered hospital-consumer portal solutions. Their greatest value is in facilitating physician-consumer communication. These companies have invested heavily in that capability at the expense of providing other features. This is fine as long as you have that communication capability, (i.e., a physician using it) but value quickly evaporates without it. RelayHealth, Medem and similar companies will need to form partnerships with other Web-based, health service providers to deliver sufficient value to the consumer while we await greater adoption among physician practices.
Let me tell you what Relay Health really is: one more way for the medical staff to ignore you. Our local Navy Medical Center keeps encouraging us to use it, but it doesn’t work. If they get back to you at all, it is long after you have given up and called for an appointment. I thought it was going to be a great way for me to avoid unnecessary office visits, as my immune suppressed system means I get sick EVERY TIME I visit the doctor, no matter what precautions I take. No dice – can’t get a response. For example: I requested a cough syrup refill on Jan. 27th and received a notification that my request was received by the nursing staff, and they would contact me. This is Feb 15th, to date I have heard nothing further. If I could have gotten t I might be better now, but the constant coughing keeps me from sleeping and the sore throat it causes keeps me from eating right. I’m sicker now than when I originally went to the doctor!
Sharon,
Yes, there are plenty of instances wherein a healthcare organization will install some special software, such as RelayHealth to foster patient engagement and “empowerment”. But it can also go horribly wrong, through no fault of the software itself. The problem is usually a combination of lack of staff training and poor workflow. If the software is not installed correctly wherein it effectively alerts a clinician and that clinician is trained in how to effectively and efficiently respond, to say an appt request or Rx refill, then as you have sadly experience, nothing happens and you end up wasting more time ultimately having to call to get something done.
This is horribly inefficient for you and the medical staff. Your best recourse may be to contact the individual at the base hospital who is given the title of “Patient Advocate”. It is their job to hear such concerns, bring them up in internal executive meetings which will hopefully lead to some staff training and changes in workflow.
Best of luck and I think we have all shared similar frustrations at one point or another with this crazy healthcare system.
John