Endocrinologist and Brigham Diabetes Program Director Marie McDonnell conducts a video visit with one of her patients.

Endocrinologist and Brigham Diabetes Program Director Marie McDonnell conducts a video visit with one of her patients.

If you asked Adam Licurse, MD, MHS, five years ago about telemedicine—the remote diagnosis and treatment of patients by means of mobile and telecommunications technology—he may have likened it to a science project.

“It has long been a cool idea, but the technology was not that good and the workflow was clunky,” said Licurse, a primary care physician at Brigham and Women’s Advanced Primary Care Associates, South Huntington, assistant medical director of the BWPO and associate medical director of Partners Population Health Management. “Providers were not reimbursed for their time, and the demand just wasn’t there.”

Contrast this notion with today, with advanced video technology that works as well as Skype and FaceTime and a clear demand from patients and providers to have new ways to connect with each other outside of the traditional health care setting.

“Telemedicine has taken off,” said Licurse. “A lot of doctors and practices are becoming really excited about it, and we’ve hit a point where patients are hearing about video visits and other technologies through media and their health plans and asking their physicians about them.”

BWH has been exploring telemedicine through several BWPO-led pilots for the past two years. These pilots consist of video visits and e-visits between providers and patients, as well as video consults and e-consults between providers.

“There is a large and growing group of departments and divisions at BWH that are offering video visits to replace or supplement outpatient visits for certain groups of patients,” said Jasdeep Sahota, MSc, EMBA, senior project manager for the BWPO. “The Department of Medicine, including Endocrinology, Gastroenterology and Primary Care, is the largest group, and the departments of Surgery and Psychiatry are also exploring these tools.” Fifteen to 20 additional groups are expected to begin using video visits in the next six months.

E-visits are underway through Partners Patient Gateway. Instead of patients asking their providers questions through the portal’s email functionality, patients use Patient Gateway to fill out a questionnaire that simulates the questions that clinicians would ask during an in-person visit. When providers later answer their patients’ questions via the portal, they have much more information at their disposal thanks to the robust questionnaire, which on the provider side is integrated into Partners eCare.

Provider-to-provider video consults are used when clinicians at different institutions need to connect with each other about a shared patient, sometimes directly involving that patient in the video encounter, such as through BWH’s current pilot with Spaulding Rehabilitation Hospital. The effort is focused on improving patient care and avoiding unnecessary hospital readmissions.

Lastly, through provider e-consults, primary care providers can get feedback from specialists on specific patient cases to see if a referral to a specialist is necessary. This type of communication has been happening informally for years but is now formalized through Partners eCare, with many primary care physicians and specialists participating.

“These tools are helping providers create more access for patients in their clinics,” said Sahota. “Video visits and e-visits are more convenient for patients who struggle to get into the city, and follow-up visits are quicker and easier for patients.”

Licurse says these tools also allow providers to better meet patients where they are, helping to make health care more patient-centric and lower-cost.

“At the highest level, these tools translate into better care for appropriate patients,” said Licurse. “With more tools for self-care, patients feel more engaged and empowered to participate in their care. Our goal is to continue to use these tools to tailor our care based on the unique populations we serve.”