Integration of video conferencing with the electronic medical record systems replaces followup visits.
Three weeks after undergoing a kidney transplant, Michael Merzon had a follow-up visit with his surgeon. But their meeting wasn’t in the doctor’s office or at the hospital. The visit was virtual—with Merzon sitting in the back seat of his car.
While Merzon’s wife—who donated one of her kidneys to him—was having her hair done in anticipation of going back to work, Merzon used his smart phone to have a video visit with David C. Mulligan, MD, chief of Yale Medicine Transplant & Immunology and director of the Yale New Haven Transplantation Center.
Dr. Mulligan’s appointments with Merzon and another recent kidney transplant recipient on Oct. 20 marked the first time that a New England health care provider has conducted video visits with patients using Epic electronic medical record technology. The new telemedicine program is a collaboration between Yale New Haven Health and Yale Medicine.
Since the video consultations were fully integrated with Epic, Dr. Mulligan was able to see and talk with the patients while viewing recent test results and other vital medical information.
It also is believed to be the first time in the United States that this technology has been used for follow-up visits with transplant patients, Dr. Mulligan says. Yale Medicine and Yale New Haven Health are planning to expand the use of the technology to other clinical programs.
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The two transplant patients had a number of in-person follow-up visits immediately after their surgeries. But as they progress in their recovery, they are now able to conduct some of their visits by video, saving a tremendous amount of time and disruption to their daily lives. “Instead of two and a half hours, it’s half an hour,” says Thomas Martinsky of Stratford, the other patient who held a video visit with Dr. Mulligan on Oct. 20. “It takes half an hour, and then I can get back to work. It’s all great.”
Martinsky used a tablet computer to have a virtual appointment with Dr. Mulligan from his home. He was concerned about some leakage from his incision, so he held the tablet over the incision area and gave Dr. Mulligan a clear picture of the wound. Dr. Mulligan told him that the leakage was normal and would probably stop within a few days.
“It’s all about being more patient centered,” Dr. Mulligan says. “We have to get out of the archaic way of thinking about delivering health care. We have to break that mold and create a better experience for the patient.”
Telemedicine has the potential to transform how health care is delivered—and how it is paid for, Dr. Mulligan says. In the future, instead of patients being billed separately for each doctor visit after a medical procedure, insurance companies are likely to authorize “bundles” of both in-person and virtual visits, he says.
Typically, transplant patients come back to the Yale New Haven Transplantation Center about 25 times during the six months after surgery for follow-up visits and consultations. If some of those visits can be conducted by video, patients are saved from the time and hassle of driving to New Haven and sitting in waiting rooms, Dr. Mulligan says. There are also financial benefits for patients, as they don’t have to take time off from work or find child care in order to go to their appointments. And transplant patients with weakened immune systems benefit from not having to go to a medical facility where they would be exposed to other patients.
In addition to enhancing patient care, telemedicine also has benefits for researchers, providing investigators with broader access to patients and making it easier for patients to participate in studies.
Nationally, telemedicine programs have grown dramatically in recent years, with a projected 700 percent increase in telemedicine use by 2020. Yale has a variety of such programs, including TeleStroke, which allows neurologists to provide remote treatment for stroke patients; the InSight Tele-ICU, which uses advanced telemonitoring and clinical analysis to enable care for intensive care patients across the health system from a single location; and FaceTime smartphone calls between behavioral health providers and patients in Yale New Haven Hospital emergency departments. Yale New Haven Health and Yale Medicine have formed a joint steering committee to coordinate and centralize the expansion of telemedicine programs and develop pilot programs.
Though it’s still in its early stages, the new telemedicine program for transplant recipients appears to be a hit with patients. Merzon, who works in construction, says his video visit with Dr. Mulligan was extremely convenient and spared him the bother of taking time off from his job. Most importantly, he says he is enjoying life after surgery: “I’m back at work and I feel so energized.”