Implementation of a Virtual Vascular Clinic with Point-of-Care Ultrasound in an Integrated Healthcare System: A Feasibility Pilot Study
Judith C. Lin, M.D., Janelle M. Crutchfield, BSN, Valerie Gunn, MBA, Josephine Klapec, RVT, Courtney Stevens, MBA.
Henry Ford Hospital, Detroit, MI, USA.
OBJECTIVES: Using secure HIPAA-compliant videoconferencing technologies, telemedicine may replace traditional clinic visits, save patients’ time and travel, and improve utilization of scarce surgeon and facility resources. We report our initial experience of virtual clinical encounter (VCE) by evaluating vascular surgery patients within an integrated healthcare system.
METHODS: In this proof-of-concept feasibility pilot study, we conducted telemedicine evaluations of vascular patients at a tertiary care institution from October 2015 to August 2016. Patients were offered synchronous virtual visits from a surgical provider in lieu of an in-person visit. VCEs were refined through iterative cycles of improvement using the lean startup method and bricolage: Video-based software Microsoft Skype for Business® over HIPAA-compliant networks for patient-provider interaction; clinical data entry in the EPIC® electronic medical record for documentation; and established satellite facilities with existing vascular laboratories for imaging and lab testing. We evaluated feasibility, demographics, encounter type, healthcare resource utilization, and patient satisfaction via SurveyMonkey® questionnaires.
RESULTS: Over a 10-month period, 55 patients undergoing 82 VCEs with an average age of 57 (range 29-79) and 41 females (74.5%). Ethnicity included 43 white (78.1%), 9 black (16.3%), 1 Asian (1.8%), and 2 Mediterranean (3.6%). Diagnosis included arterial (abdominal aortic aneurysm, carotid occlusive disease, peripheral artery disease) and venous (deep vein thrombosis, varicose vein) disease. Among the 82 VCEs, visit types were 15 (18.3%) new, 30 (36.6%) postoperative, and 37 (45.1%) return; 74 (90.2%) include point-of-care ultrasound during their telemedicine visits at our on-site vascular laboratory, 1 computed tomography scan, and 7 (8.5%) without any same-day imaging; 35 (42.7%) were single VCE while 47 (57.3%) multiple VCEs at our two virtual clinic locations. All 55 patients responded to our questionnaire: 91% states that they would highly recommend virtual visit to a friend or colleague; 100% find their virtual visits more convenient than the traditional method, and were able to communicate clearly with their provider; quality responses were overwhelmingly positive.
CONCLUSIONS: Secure virtual visits can be conducted using commercially available hardware and software solutions. VCE allows more access for patients who require additional care while decreasing overall in-person clinic utilization. Synchronous telemedicine with point-of-care ultrasound was effective in evaluating common vascular conditions. Virtual care may be used for management of patients with chronic vascular disease.
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