At Massachusetts General Hospital (MGH), Dr. Ronald Dixon leads research in alternative methods of health care delivery, specifically relating to general internal medicine. A graduate of Dartmouth Medical School, he’s now the Director of the MGH Virtual Practice project as well as the Director of the hospital’s Center for the Integration of Medicine and Innovative Technology’s (CIMIT) Delivery System Innovation Program. Of particular interest is Dixon’s use of asynchronous telehealth to manage patients with chronic diseases.
This week, we sat down with Dixon to chat about asynchronous telehealth and how this technology can be used to improve the quality and efficiency of health care delivery.
What inspired you to research alternative methods of health care delivery?
I became interested in all of my patients with hypertension and diabetes and the fact that they had to come into the office to get medications renewed and blood pressure and diabetes checks. How many of these medical visits that people come in for are actually necessary for them to be present in the “physical form”? I wondered if you could use a different way of “seeing them” to manage the issue — that’s how I became interested.
I was told by my then manager that I should not do it because it was not helping the practice’s bottom line-which made me even more interested. It seemed to be a “no brainer” and it made complete sense. This led me to become more interested in the business side and how it works.
Specifically, how did you become interested in asynchronous telehealth as a research focus?
Although you could do effective evaluation and management with videoconferencing, there really is no efficiency gain for the clinician. A fifteen minute visit on a videoconference on-line is equivalent to a fifteen minute visit in person. Then when we looked at the asynchronous tools, we found a significant efficiency gain.
Given that much of the expense in health care is related to chronic disease management and many of the visits that we see are related to chronic diseases, we ended up building a tool to test this model for chronic disease management asynchronous visits. Once we did a pilot study with the tool that we developed with asynchronous technology, we found a 4.5 times efficiency gain from a time standpoint.
Can you summarize the project?
In this project, the clinician delivers a chronic disease assessment questionnaire via a secure electronic message for the patient to complete at home. Once returned, the patient’s clinician reviews the patient’s responses to the questionnaire, and sends the patient a secure message with revised treatment recommendations based on the patient’s response to the questionnaire.
We are also using synchronous technology to integrate with the asynchronous visits. With the system we developed, we can follow up with asynchronous visits with phone calls, video conferenced visits, office visits, or another asynchronous visit. All with the idea that you are creating a virtual practice on top of the physical practice and they are actually integrated.
These are not independent of each other. We sense that the overall model of integrating health care delivery with both synchronous and asynchronous visits, with a heavy leaning towards both in-person health care delivery and asynchronous virtual health care delivery, is probably the way forward. Patients value their relationships with their providers and see virtual care as an adjunct to the in person care that they receive.
What are the findings and lessons learned from your project?
Good physician and patient satisfaction. We have also had interesting findings in our depression population. We found that ten percent of depressed patients indicated they were suicidal during the asynchronous telehealth visit, but a percentage of these had never said this to their clinician in the office visit. So it actually changed their care management.
Patients have busy lives and multiple priorities. By giving them the opportunity to have their health care interaction when it fits their schedule and availability, they are more likely to engage and focus on their health — leading to better outcomes faster.
You have demonstrated that asynchronous technology has been useful in managing patients with chronic illness. Do you see asynchronous technology being used in other populations?
The chronic disease population is the sweet spot since it encompasses the majority of the visits. Asynchronous Technology has been in use for acute disease and is a business model of certain companies. I think that is firmly established– CVS has Minute Clinics. So there are a lot of disruptors in the acute illness space, but we think the value is in the chronic disease space.
Sharon Marable, MD, MPH, FACP is a Board Certified Internal Medicine physician who is interested in health care innovations in population health, chronic disease management and clinical quality improvement, particularly for underserved & disparate populations. Marable has also served as a medical and health policy consultant for charitable foundations, legislators and government entities. She is the Vice-Chair of the Massachusetts Medical Society’s Committee on Diversity in Medicine and a member of the Society’s Committee on the Quality of Medical Practice. Marable’s joys outside the field of medicine include pilates, fitness, reading inspirational books and raising her godson.
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