Kaiser Permanente Colorado finds there's more to telemedicine than video

By Jonah Comstock
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When people think about direct-to-consumer telemedicine, they often think of video visits or phone calls. But Kaiser Permanente Colorado has discovered that, for the integrated system, a simple text chat is an easier sell — as its impressive uptake numbers demonstrate.

“We trialed this as a mechanism by which we would be able to help our members avoid unnecessary ER visits, but it has turned into something far bigger,” said Dr. Ari Melmed, an ER doctor at Kaiser Permanente Colorado who oversees the Chat with a Doctor program.

“Predominantly, it’s people who either know they have something straightforward or are not sure if they need to be evaluated in person or if their condition is something serious. And we are able, via a chat service that allows for uploading photos but doesn’t use video, to resolve a huge percentage of these encounters.”

Chat with a Doctor works like this: When patients go to Kaiser’s main website or to book an appointment, they have the option to use the chat service instead. If they do, they’re connected directly to a Kaiser doctor who is chatting with a maximum of three other patients. The doctor can assess simple things and prescribe some medications. If the condition is more complicated, they connect the patient to a staffer who will schedule an appointment.

“What we’ve found is somewhere around two-thirds of the issues, we can resolve right there on chat,” Melmed said. “Someone thinks they’ve got flu or UTI or sinus infection we can help them determine whether or not they in fact do, and if they need antibiotics or an inhaler or a prescription for something we can enter that into their Kaiser medical record and get that sorted out.”

Melmed said the program now sees 100 to 200 visitors a day. He attributes the traction to two things: direct connection to doctors and the ease of the chat format. 

“One of the unusual things about this program is we put the physician up front rather than having the members go through a screening process of some sort,” Melmed said. “We’ve found that this is very surprising and highly satisfying to the members. They’re just not used to having instant access to a physician. It’s just unprecedented in most people’s healthcare experience. Our satisfaction is through the roof.”

As for chat, Melmed said that it’s the natural way people communicate in 2017. Even outside of healthcare, consumers text one another more easily and more frequently than they use services like Skype. But for some reason people expect healthcare to be different.

“I think chat is really under the radar,” he said. “Everyone is focused on video, video, video. There’s a rampant conflation of telehealth with video visits and the two should not be thought of as synonymous. There’s a whole other way of communicating and this is it.”

Ari Melmed will be speaking at HIMSS18 in Las Vegas in the session, “Chat with a Doctor: On-Demand, Asynchronous Physician Advice,” at 4 p.m. on March 7th in the Venetian, Palazzo E.