Can Online Care Reduce Other Visits

Cost and convenience concerns have created a market for alternative methods to access medical care other than in-person doctor visits.  One of those methods is use of email to asynchronously exchange information with a physician or other provider, which is one form of creating an e-visit.  The Mayo Clinic has reported on its pilot project to use such a system as an alternative for patients.  The results are very enlightening.   (Mayo Clinic Study)

Mayo used a fairly robust system, one that provided a structured method for the patient to enter information, including history, and if appropriate, filling out some assessment questionnaires.  The patient could also attach photographs.  The patient would submit the data and then a clinician would respond within 24 hours.  In all but unusual cases, the timeline was met.  The patient would be notified by email that they could get results on the portal.  About 4300 patients registered for the service and there were 2531 consultations for 1159 patients over the two year trial period.  Women were the primary users, at 71%, and they often were filing the information for a younger or older relative.  A wide variety of patient conditions were treated by the e-visits, with the largest categories being  sinusitis, depression and back pain.

The patient’s primary care physician did 89% of the responses and usually when they didn’t it was because they were absent or the patient asked for the first available doctor.  Most visits were during working hours and most frequently on Monday.   The charge for the visit was $35, which is a fraction of the charge for an in-person physician visit.  Mayo also believes it cost the clinic less to do an e-visit like this than an in-person visit.  Mayo estimated that the e-visit prevented an office visit 40% of the time.   In addition, the e-visits likely saved lost work time and productivity for some patients and their employers.  If the results of this pilot are generalizable, very substantial health spending savings could occur through widespread use of e-visits.