Mark Berger of CHI Franciscan Health System speaks at ATA 2016.
In the next 2-3 weeks, CHI Franciscan Health System in Tacoma, Washington, will activate telemedicine kiosks in one of its urgent care centers. It’s been a long journey to get there, as attendees of the 2016 American Telemedicine Association annual conference in Minneapolis heard Monday morning.
“We’ve been in a position to go live, but our learning curve has caused us to tap the breaks a few times,” said Mark Berger, telemedicine coordinator for the health system.
The kiosks represent an extension of Franciscan Virtual Urgent Care, a Web- and telephone-based telemedicine service to treat many common emergent conditions for a flat fee of $35. They came about after a physician noticed two-hour wait times at an urgent care clinic during flu season, said Lana Adzhigirey, program administrator for Franciscan’s Virtual Health Services.
The vision behind Virtual Urgent Care is to improve access to care, strengthen primary care practice, enhance the patient experience and innovate for population health, Adzhigirey said during a presentation entitled, “Who Died and Made Us the King of Kiosks?” (This is healthcare. Hopefully, nobody died.) In other words, Franciscan wants to make retail telemedicine “the new normal,” according to Matt Levi, director of Virtual Health Services.
In a nod to convenience and patient satisfaction, the health system has three flavors of telemedicine. There’s Franciscan Anytime for employees, Franciscan After Hours, a telephone service for primary care and Franciscan Virtual Urgent Care, a video telemedicine operation that’s open to the public. The kiosks will serve the third one.
As a New York Times article from last July noted, CHI Franciscan contracts out its urgent care telemedicine to provider-focused telemedicine company Carena in nearby Seattle. Now, about 70 percent of urgent care problems get resolved after one virtual consultation. “This has been amazing for patients and for the system,” Adzhigirey said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
It has been a struggle at times, though. In primary care, which can include urgent care, Franciscan wants to find the appropriate care, setting and cost. The telemedicine team is still looking for “equilibrium between supply and demand, which can be difficult,” according to Adzhigirey. It’s hard to control the volume of patients.
“We have to find flexible ways to offer the same excellent care despite the ebb and flow of demand,” Adzhigirey said. Sometimes there are bottlenecks because of people who should not be on the waiting list, but rather in the emergency department or perhaps in a nonurgent environment. “It’s our responsibility to provide the better match of supply and demand,” Adzhigirey said.
That consideration prompted CHI Franciscan to appoint a “virtual urgent care concierge” to help guide people through the process of using the kiosks in a “semi-private area” in the urgent care center, Berger explained.
The less-than-ideal privacy raised questions, but HIPAA says that the clinic must only take “reasonable” steps to ensure privacy. That means Franciscan didn’t need to make any structural changes to its facility, since it’s really no different than having two people share a hospital room, according to Berger.
The health system decided to add headsets and white-noise machines to the kiosk setup to create a little bit more privacy for patients. The powers that be decided on touchscreen monitors, a keyboard and mouse, an enclosure for the computer and secure software for the kiosks. “We’re still going back and forth on the enclosure,” Berger admitted just weeks before go-live.
“Flexibility is important. You think you have it figured out, but then you walk into that room and things change,” Adzhigirey said.
Photo: Twitter user Alicia Gallegos
