E-Visits
Research Objectives:
The aim of this randomized controlled trial is to evaluate the value of using a web-based clinical workflow prototype to conduct follow-up dermatologic care for patients with mild to moderate facial acne. In addition the trial will evaluate user satisfaction, clinical outcomes and efficiency (time).
Drivers:
Patient access to dermatologic care is threatened by the existing dermatologist work-force shortage. The use of communication and information technologies has been promoted as the answer to our burdening supply and demand problem, though its efficacy as a substitute for in-patient visits has yet to be established.
Study Overview:
A clinical workflow prototype was developed in collaboration with RelayHealth. The web-based system allows patients with facial acne to have follow-up visits using a customized online questionnaire (‘e-visit’) and to upload digital images of their faces. The system also allows the physician to respond to the online questionnaire, prescribe new medications, and be reimbursed for the visit. Physicians have up to 3 business days to respond to a patient’s e-visit.
All patients are initially assessed in the office where baseline photos of their faces are taken. They are then randomized into two groups: e-visits vs. office visits. Patients in the e-visit group are trained to self image their skin and use the web-based system. All patients have 4 follow-up visits spaced 6 weeks apart.
Results:
The study began in September 2005. One hundred and sixty patients were recruited from the dermatological practices at Massachusetts General Hospital and Brigham and Women’s Hospital.
Preliminary findings from the first 60 patients who have completed the study reveal that patients are generally young, educated and female. Patients’ in both groups reported similar satisfaction with their care and improvement in their acne. It took e-visit patients less than 20 minutes to complete an e-visit. Whereas follow-up visits for the control group took about an hour – this included travel time. Dermatologists’ satisfaction with the improvement in their patients’ acne was similar in both groups and they were able to assess acne using digital images in the majority of cases.
Early results are encouraging and suggest that e-visits are well liked by patients. E-visits are an efficient way for patients to receive care, offering dermatologists a more convenient way to effectively manage non-urgent cases.
"I didn't feel alone at all, which is surprising because you're sitting at your desk alone... I was able to develop a nice rapport with my doctor."
Christine (right), E-Visits patient
E-Visits video