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John Scott

August 23, 2022
Conversation 4

Welcome to Collective Conversations, a series of discussions aimed at highlighting people and groups working to improve health through better health care systems.

In this conversation you'll hear from Dr. John Scott.

Dr. Scott provides a lot of great insights to this timely topic of digital medicine and I'm confident you'll appreciate them as well.

Joy Lee: Some people are confused by telemedicine versus digital medicine. Can you clarify the similarities, differences, and how people should think about these terms?

John Scott: I think it’s easiest if you start with a mental picture of three circles with the smallest circle being telemedicine. So, telemedicine is the clinical care that includes the evaluation, diagnosis, and treatment of medical conditions. And then, a bigger circle that encompasses that telemedicine smaller circle also includes things like remote patient monitoring, e-consult, project ECHO. So, a little bigger, more expansive than just the clinical care. And finally, the largest circle is digital health, and that includes both telemedicine and telehealth, but it adds things like provider search, looking up health terms on your website, the portals (e.g., MyChart), mobile health – kind of apps that we might prescribe for patients, some of the Epic tools that we’re going to be trained on in the next couple years. And then this larger term called the digital front door, which describes how patients can access their providers and their health information through digital tools.

JL: Let’s focus on telemedicine first. How has it, in its various forms, changed the landscape of care delivery at UW Medicine? For instance, how has it affected access or ability to reach certain populations?

JS: If you go back to February of 2020, it’s helpful to share some numbers. So, we had about 200 providers who were using telemedicine and have come through all the training. And we were averaging about maybe between 200-300 visits a month for all of UW Medicine. So, each provider, on average, were just seeing about 1-2 patients per month – so not really big numbers. At the peak of the pandemic, May of 2020, we had over 33,000 telemedicine visits. And that has kind of wax and waned throughout the pandemic. But we got our second highest number just in January 2022 – so pretty recently, we had 31,000 visits. So, if you look across the board of all ambulatory visits for UW Medicine, that’s approximately 20%. So, this has become a pretty unusual way of interacting with patients to pretty common. And I think the benefit for patients is that it’s way more convenient.

One of the things I do is review all the patient comments for telemedicine visits. And that’s probably the most common benefit they cite is that they didn’t have to get in their car and drive, find parking, pay for parking, and spend, in some cases, many hours in that whole process. So, I think the patients that have benefitted the most are folks who live a long way away, especially those who might be needing tertiary or quaternary care and they live long ways which is why this has been a great benefit. The other folks that I think have really benefited from this are folks who have disabilities. So, maybe they are in a wheelchair and it’s really quite difficult for them to get in-person. We’d like to say it’s up to the patients and providers what kind of modalities they want to use for their clinical visits. There are still some patients who are willing to make that drive and pay for the parking. And then there are other patients who might live pretty close but is just very busy and with their needs, telemedicine is appropriate. So, I think it has introduced a lot of flexibility and convenience for our patients.

JL: What metrics and outcomes is the telemedicine program using to evaluate progress?

JS: A very obvious one is the number of visits each month – and I just shared those. And it’s interesting – they do kind of correlate roughly with where we are with the COVID pandemic. So, when there are more and more cases, people prefer not to risk exposure. So, that’s one that we are always tracking.

Then, we look at financial performance – how many dollars we are making each month. We look at the payer mix and one interesting thing there is we do see a little higher proportion of commercial patients who are using telemedicine compared to other payers. And kind of dive down more deeply on that, it’s the video aspects of telemedicine where we see a little bit more commercial. When we look at audio-only, then we see a lot more people who are Medicaid patients using the audio-only. So, I think that speaks to some of the technical challenges and I think we can talk about that a little bit. But, we track that.

We look at patient experience – so, the rubric here is the willingness to recommend, and we’re at our goal of 93%. And then, one of our particular goals since last year, is looking at successful telemedicine visits – these are visits that are scheduled as telemedicine and actually happen with a video visit for our Spanish-speaking patients. And we knew that there was a little bit of lag – some challenges maybe with language and some of the technical challenges of getting on telemedicine for Spanish-speaking patients, that was around 88%. And then we introduced some videos to walk people through how to connect about six months ago, and we’ve seen successful telemedicine visits go up to 94% for our Spanish-speaking patients, so that was a nice accomplishment last year.

In the future, some of our goals are going to be looking at MyChart activation and usage – right now, we are around 60% and we want to bump that up to 70% because that’s really the way a lot of the functionalities can be successful for our patients. And then the other key rubric for this next year is the percent of our visits that are scheduled online – so, right now, we are around 7%, which doesn’t sound like a lot, but we are a little bit above average compared to other Epic users, and we want to increase that to 10% by the end of the year, and eventually I can see this being close to 50% in future years. So, those are some of the metrics and outcomes we are looking for. But at the end of the day, we are hoping to make it easier for patients to schedule visits and to interact with their care team.

JL: Let’s shift to digital medicine. What do you see as the role of apps and other digital platforms in care delivery going forward?

JS: I think this is where it’s really important for folks to understand that the healthcare industry is changing with a lot of the traditional providers and new entrance making digital strides – think of Amazon Care, notably they just purchased One Medical last week, so very much in the news. So, patients are really demanding some more accessible and better healthcare experiences. So, we know that UW Medicine has to innovate to kind of keep up with some of these non-traditional providers as well as our traditional competitors. And we’re really trying to ensure patients have access to these services when they need them and that the health system remains the provider choice for the Pacific Northwest and beyond. So, to achieve that strategy, UW Medicine launched the Digital Health Office, that’s governed by this group called the Digital Health Oversight committee, this is our cross-functional team that’s leading this digital consumer engagement and talk about this thing called the digital front door. And the digital front door, what it’s trying to do, is to bring together all the existing technologies within UW Medicine – so those include the website, include some of the apps and there are hundreds of thousands of apps out there, I’d say 90% of them are not very good, so we’re trying to help vet those for patients and make sense to prescribe them or encourage the patients to use them. There are other digital health services but we want to have a unified experience – so that means single sign-on, single password, whether you’re on a desktop or your mobile or you’re accessing it through the UW Medicine website, it’s going to be a very similar experience. So, this is really key for UW Medicine to accomplish our goals and those are healthcare goals providing high quality care and help them meet their personal health goals.

JL: Some have argued that for different reasons, tele- and digital medicine could either reduce or entrench inequity. What do you see as their potential impact on equity? Do they differ by situations?

JS: I think that was one of the big lessons we learned from the very quick rollout of telemedicine is in the first couple of months, there were fewer patients who didn’t speak English who were unable to access telemedicine and also the technology was a barrier. We’ve made a lot of strides in the last couple years to make it easier, so I think that’s one of the first goals of what we’re doing is trying to make it as easy and simple as possible – you want to hide all that complexity on the back end. The second is you just need to measure it and that needs to be part of our dashboard, so we are recording the usage of online scheduling tools by the various sociodemographic variables and then when we see that there is maybe one group that is lagging, we’ll take a deeper dive to try to design strategies to adjust and to make it easier for that group. The other thing is that we are trying to link to the tools and training, we need to make sure the patients know how to use it and that our providers and staffs that are interacting with patients, they know how to teach the patients, that’s really important. You can’t just turn it on and say here’s the screening tool. You kind of need to show them how to do that (e.g., using YouTube videos or in-person, things like that). And then the last thing, this is really important for everyone, is that we are taking what we call an omnichannel approach – that means that if there are patients who don’t like interacting digitally, they just want to pick up the phone and call just like they always do, that they are going to have a much better experience. So, what we are trying to do is offload a lot of the basic tasks that now people are calling the contact center or the transfer center for and allow them to do some of what we call self-service. So, this really will set up the call centers for success – they can get to those calls more quickly and maybe spend a little bit more time with folks who have more complicated needs or they’re just not comfortable using digital tools. So, those are some of the core principles we’re employing to make sure that we do not worsen the digital divide but make healthcare accessible for everyone in the UW Medicine system.

JL: Thank you so much for the transparency and the great information that you shared with us today.

JS: You’re very welcome.