After converting scheduled office visits to telemedicine in March, Boston-based Beth Israel Deaconess Medical Center implemented a capability within its EHR that allows patients to complete pre-visit surveys before the physician begins the virtual exam, according to a NEJM Catalyst report.
In response to the COVID-19 pandemic and physical distancing requirements, BIDMC went from having zero telemedicine visits per day to more than 250 visits daily. Clinicians said one of the biggest challenges of the rapid increase was the lack of support regarding pre-appointment work; previously, information such as vital signs and the patient's chief complaint were completed onsite by medical assistants.
"Now, even absent a physical examination, clinicians quickly noted that telemedicine encounters were taking more of their time and, at times, seemed less focused than in-person visits," the report states.
To help physicians manage the additional tasks, BIDMC implemented an initiative dubbed OurNotes, which allows patients to electronically review clinical notes before and after a visit. OurNotes is an extension of OpenNotes, a program BIDMC clinicians launched in 2010 that provides patients access to their clinical notes.
Healthcare Associates, the primary care practice at BIDMC, has been participating in the pilot of OurNotes since February 2019. The program works by sending patients a message through the EHR patient portal two days prior to their scheduled visit, asking them to complete and return an electronic form that provides a brief medical history and their goals for the visit. Once submitted, the forms are saved as independent and permanent records in the EHR. Clinicians can then review them prior to or during a visit.
With the rapid telemedicine implementation, BIDMC expanded OurNotes and updated it specifically for telemedicine visits. The health system changed the pre-visit questionnaire to gather patient information such as current medications and vital signs, for individuals who had proper equipment at home.