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Expanded access: NowClinic® makes 15,000 visits by phone

Lo-Fu Tan, MD, Medical Director, On Demand Medicine

Southwest Medical

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Southwest Medical, part of OptumCare®, is one of Nevada’s largest multi-specialty medical groups. We’ve been caring for southern Nevadans since 1972. We have decades of experience and a drive to better our patients' lives.

By combining technology and information, we give our patients the right care in the right setting. We provide primary, specialty, urgent, senior, OB-GYN, pediatric and convenient care.

At Southwest Medical, the vision for On Demand Medicine and NowClinic® came from a desire to provide quality patient care in a timely fashion. Although Las Vegas is known as a bustling town, the city and its rural Nevada surroundings face a primary care provider shortage.

With clinicians in short supply, Southwest Medical has pushed forward with resourceful solutions to improve patients’ access to care.

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Growing care options

Improved access came in the form of a network of appointment-free clinics.

Thirteen On Demand Medicine facilities have opened to Southwest Medical patients over the past 14 years, giving several options to those in need of urgent care. With a roster of 13 clinics, broad amenities are available.

The 24-hour clinic accommodates patients around the clock. Six full-service urgent care clinics are equipped with laboratory service and x-ray and are able to handle more acute conditions, such as chest pain and abdominal pain.

Computed tomography (CT) scanning is available at three clinics for when sophisticated imaging is needed. Seven clinics handle low-acuity, common conditions and help carry patients through when primary care offices are booked.

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With these brick-and-mortar clinics, Southwest Medical’s On Demand Medicine division has done a great deal to improve options for patients in need.

But, always seeking to better serve even greater numbers of patients, in 2014, the division invested in telemedicine and the NowClinic® was created.

With support from a pioneering program at OptumCare, the Nevada NowClinic® technology and team were built from scratch.

By using a portal that integrates with the Southwest Medical Electronic Medical Record (EMR), clinicians are able to view patient medical and social history, critical details that aid in delivering quality care.

Using a staff of clinicians hired and trained for telemedicine has a dual purpose. The clinicians develop expertise in the subspecialty of telemedicine. Also, over time, patients and providers build therapeutic relationships as they become familiar with one another.

NowClinic® visit basics

Most common, low-acuity illnesses fit remarkably well within the scope of a NowClinic® telemedicine visit. Patients are able to access the system 24 hours a day using a landline phone, computer or mobile device.

The vast majority use their cell phone. Other requirements are that patients be within the state of Nevada during the call (as clinical licenses are granted by the state) and in a safe and reasonably private location.

After clicking the NowClinic® application icon, patients log in with a password or fingerprint. They are brought to a screen where they can select from the name and photo of available providers. Patients can choose to consult the same provider they have seen before.

Next, a screen with estimated wait time, typically less than eight minutes, comes up. Once the provider is ready and has been given a brief review of the patient issue and medical history, he or she will appear on the screen to welcome the patient.

The assessment is nearly identical to an in-person visit. The patient describes their symptoms and the clinician asks follow-up questions that narrow the differential. All the while, they observe the patient through high-definition video and audio.

If the clinician is comfortable with the assessment, he or she will advise the patient on treatment for symptoms. If prescription medication is needed, the script will be sent electronically to the patient’s pharmacy of choice. Work excuse notes are sent via email attachment.

Common diagnoses

Top conditions diagnosed via NowClinic® are cold, flu, urinary tract infections, skin rashes and conjunctivitis.

These low-risk but uncomfortable illnesses requiring a doctor or APC’s advice are ideally treated in the home, where patients are more comfortable and less likely to expose others or be exposed to contagious disease in a waiting room.

Quality reviews confirm the appropriateness of clinician care by telemedicine. Few cases (7%) are referred to an in-person visit. Rare cases (0.07% of visits) require emergent care.

If the provider notes an emergency, he or she will place the call to emergency responders and stay on the line with the patient until they arrive. Ninety-two percent of all NowClinic® visits are treatable over the application.

Impact of telemedicine

Lowering barriers to treatment is a significant benefit to patients of NowClinic®. By eliminating hang-ups with transportation, difficulty making an appointment and unpredictable wait times, Southwest Medical can treat more patients with a system that gets 95% user approval!

Happy patients mean that the NowClinic® users are multiplying. Year 1, 2014, saw 5,000 visits. In 2017, 15,000 patients were seen. More than 40,000 total users have enrolled.

The goal at the start was to find a resourceful, innovative method of opening greater access to our patients. NowClinic® has proved to not only meet these criteria, but has become an essential tool in our mission to provide all of our patients with high-quality care.

 

This publication is informational and for educational purposes only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice.