Telehealth visits at Rochester Regional Health dramatically up, says family medicine physician who leads the program
By Chris Motola
Q: I heard your office now has more telehealth visits in a day than you had in all of previous years.
A: Yeah, that’s true. In 2018 we piloted video visits for Rochester Regional Health. We had about 32 for the year. This year we’re on track for maybe around 400,000. So there’s been a huge increase. Obviously the demand is there for mitigating the risks of COVID. So I think it was one of those things where we were in a decent position to offer video visits, because we’d already been using them in some capacity. So it went relatively smoothly. We also have the benefit of having 90% of patients online and engaged with our portal, so having that percentage connected has been a huge benefit.
Q: So most of your patients aren’t having any issues with the tech involved?
A: That’s a great question. When we look at our patient population, we have a wide variety of technical skill levels. We range from IT people who are obviously very familiar with it and would even prefer to do it online to the elderly, some of whom haven’t embraced technology on the same level. But across the board, I’d say we’ve been very successful. We’ve had very few people who can’t do it. I can probably count them on one hand, in which case we can fall back on a telephone visit. The first telehealth visit can sometimes be a bit cumbersome, but now that we’ve been doing it for four months, many patients have had multiple visits, and they’ve pretty much gotten the hang of it. Some of them even prefer it.
Q: What role did you play in developing the policy?
A: Our telehealth policy has been formulated by myself and our office staff, in conjunction with the lead nurse and other providers. We developed a policy that was really intended to keep things as close to 100% remote as we could. When a patient calls, they’re triaged by nursing and then runs it by us as to whether the patient needs to be seen, and put it on our schedules. We would then evaluate them by video visit. There was always at least one provider in the office who was also doing video visits, so if we decided the person needs to be seen, that provider could see them in person. The other two providers would be doing video visits from home. The idea there is to minimize our footprint in the office and provide quality of care without putting anyone needlessly at risk.
Q: What are you able to do through video?
A: There’s a number of things. It gives us a little bit more information than a phone call, and quite a bit more than an email. We’re able to see the patient and gauge the stress the patient is under. Most cameras are high enough quality that you do a good skin exam. Knowing the patient’s history can help when you’re seeing the patient visually to get a sense of how they’re feeling. We’re limited at this time — we can’t check the heart and lungs, we can’t palpate the abdomen. My hope is that in the future digital peripherals will be available, which can add benefits to visual visits and improve the quality of care we can deliver remotely.
Q: Do you feel the crisis has made you more efficient?
A: More efficient? Yes. We’ve been able to see patients quickly without having them commute into the office. That said, we’re not at the point where a video visit is equivalent to an in-person visit, so in my view there’s a little bit of a loss of quality of care. So, while they are efficient and safe, the quality of the visit isn’t the same; there’s no hands-on and you also lose a bit of that personal touch. I think that’s one of the things we need to keep in mind as we move forward. So efficiency is great and beneficial, but inefficiency can also provide opportunities for that important personal touch.
Q: Did your experience in private practice help you develop some of the policies?
A: After my fellowship, I opened my private practice in Pittsford. That’s 13 years ago now. It was just me and a computer and a phone. I was using a patient portal, which is pretty much asynchronous telemedicine to practice more efficiently and cut down on paper and phone calls. So when we talk about efficiency, my attitude is it’s good to be efficient at all times except when you’re with the patient. At that point, you want to be sure you’re addressing the patient’s needs.
Q: With the lockdown winding down, at least for the moment, what do you see sticking around, and what do you think will be discarded?
A: I think we’ve done a great job mitigating the COVID risks. Because of that our levels right now are low. I don’t believe it’s going to stay that way. I think we may, by the fall, be looking at a situation similar to the one we had in March and April. My hope is that we’ll continue to promote those behaviors and continue to mitigate those risks. As a practice, we’ve started the reopening process and have been seeing patients in person since June. We’ll continue to see patients as appropriate while using video visits through fall until there’s an immunization, treatment and point-of-care testing. My hope is that insurance companies will continue to agree with that.
Lifelines
Name: Eric Wilcox, D.O.
Position: Lead physician at Rochester Regional Family Medicine
Hometown: Rochester
Highlights: Precepts physician assistant students from Rochester Institute of Technology. Was one of the original members of the telemedicine steering committee and is a current member of the RRH/NTID (Rochester Regional Health / National Technical Institute for the Deaf) partnership steering committee to assess the needs and initiatives for deaf and hard-of-hearing patients. He’s also the telemedicine provider for the JCC Wolk Children’s Center and School Age programs, which went live in July.
Education: Touro University College of Osteopathic Medicine-Mare Island
Affiliations: Rochester Regional; Unity; Strong Memorial
Organizations: American Board of Family Medicine
Family: Mary-Beth, wife: Children: Kelsey, Quinn, Torin, Everett
Hobbies: Reading, basketball, woodworking, innovative medicine