Transforming Care In The Digital Age

By Kevin Smith, DNP, FNP, FAANP

Can modern virtual care close the gap between patient-reported symptoms and what’s recorded in the EHR?

A recent study (Valikodath et al) in JAMA Ophthalmology found a disconnect between patients’ self-reported symptoms and the information recorded in the electronic medical record (EMR). Specifically, symptoms were more frequently recorded on a patient questionnaire than in the EMR.

The authors of the study — which likely has clinical applicability that extends beyond ophthalmology — stated the inconsistencies may be due to “time constraints, system-related errors, and communication lapses.” Records that are inconsistent with patient-reported symptoms could negatively impact care quality and continuity of care, as well as foster inaccuracies in data pulled for medical research.

The solution to this potential healthcare dilemma could come from what may seem, at first glance, an unlikely place: modern virtual care best practices. Health systems and individual clinical providers can utilize a comprehensive virtual care platform founded on structured, evidence-based online adaptive patient interviews that offer best practices-driven care pathways to effectively treat minor acute conditions. Utilizing this type of platform essentially removes the disconnect between patients’ self-reported symptoms and the information recorded in the EHR.

In order to address the issues identified in the JAMA Ophthalmology study, the platform must be built on a modern technology stack that enables deep interoperability with the EHR system. This approach leaves virtually no room for provider error or miscommunication between provider and patient. It also helps ensure each patient’s symptoms and prescribed treatment plan are fully and accurately captured in the EHR, effectively addressing the concerns about consistency raised by the authors of the recent study.

Here’s How

Based on our experience at Zipnosis, a virtual care platform designed to support evidence-based practice can address each of the three issues noted in the study that may lead to inconsistencies between patient-reported symptoms and those recorded in the EHR.

• Issue No. 1—Time Constraints: A virtual care platform that starts with structured online adaptive patient interviews creates time efficiencies for both the patient and the provider. This systematic approach guides the patient through the same questions that would be asked in the face-to-face setting, but with greater consistency. The system then aggregates the patient’s reported symptoms and medical history into a comprehensive clinical note. This patient history data is then paired with curated provider pathways that filter diagnosis and treatment options to the most appropriate options based on patient symptoms and national best practice guidelines. This reduces variability and enables providers to diagnose and treat patients in a fraction of the time.
  
  Importantly, in an in-person care setting, busy providers may feel rushed when their patient load is high, and may inadvertently overlook questions that could reveal information critical to an accurate diagnosis — or the patient may share a symptom that the time-pressed clinician does not capture in the EHR. The digital capture of this information and integration directly into the EHR via a virtual care encounter eliminates that possibility while also enhancing provider efficiency and facilitating more effective patient-provider interactions, since the provider has access to thorough symptom information from the start of the visit.
  
  In fact, while patients are promised a diagnosis within 1 hour of completing the online adaptive interview in the virtual care setting, diagnoses, and treatment plans for many simple acute conditions can be delivered within 10 minutes or less due to the high level of efficiency surrounding the patient-provider interactions. Health systems that staff their virtual care services with their own providers can create further time and resource efficiencies by utilizing excess clinical capacity. Additionally, modern virtual care platforms that include analytics tools can track metrics such as operational efficiencies and cost savings, as well as clinical quality measures such as guideline adherence rates and antibiotic stewardship.
  
  A well-designed virtual care platform can also determine whether a patient’s symptoms can be treated online, and if not, direct them to the appropriate level of care, including in-person care within the health system. It is also essential that virtual care delivery be flexible and configurable so that, for example, real-time phone or video interations are supported when needed and laboratory services can be incorporated into the workflow as clinically appropriate.
   
• Issue No. 2—System-Related Errors: When patients enter their own symptoms directly into the online adaptive interview tied directly to the EHR, and the provider in turn enters the patients’ diagnoses and treatment plans (and/or next steps if the condition cannot be treated by a virtual visit), the room for system-related errors is notably minimized.
   
• Issue No. 3—Communication Lapses: In general, communication lapses are one of the most critical issues facing healthcare organizations today, potentially leading to medical errors and patient safety issues. A modern virtual care platform that digitally captures detailed, relevant patient symptoms along with provider diagnoses and treatment plans reduces — and potentially eliminates — the possibility of human error and communication gaps during the provider-patient interaction.

How Virtual Care Serves As A Digital ‘Front Door’
An optimized virtual care platform represents a truly meaningful use of technology to fully and accurately capture patient symptoms in the EHR and also supports convenience, access and, consistently delivered, guideline-adherent care. It’s important to note virtual care does not replace in-person care, but rather supplements care and serves as a digital “front door” into a health system.

With influences such as value-based care and consumer-centric healthcare driving the industry, virtual care is more important than ever as a means of delivering efficient, high-quality care at the lowest cost possible. As an integral part of the care continuum, virtual care can produce return on investment in the form of measurable operational and clinical outcomes and durable financial returns for healthcare organizations.

About The Author
Dr. Smith is chief clinical officer of Zipnosis which offers a platform that integrates traditional telemedicine capabilities with transformative online virtual care technology and provides expanded patient access, high-quality care, and proven clinical efficiencies.