Most e-visit users didn’t need follow-up care, research finds

Simple, quick format for basic health concerns part of Kaiser Permanente’s growing toolbox of virtual care options

By Jan Greene
Senior Communications Consultant

Four out of 5 Kaiser Permanente Northern California members who used a simplified online e-visit for a basic health concern did not need follow-up care in the following week, a new analysis finds.

The results indicate that e-visit consults are a useful addition to Kaiser Permanente’s growing array of virtual care options, says lead author Reena Bhargava, MD, an internist with The Permanente Medical Group and medical director of the Kaiser Permanente San Jose Appointment & Advice Call Center. “Patients can log in and complete an e-visit at a time that’s convenient to them and get a clinician’s response within a couple of hours, if not minutes,” Dr. Bhargava says. “We found this option works successfully for most patients and raised no quality concerns.”

The study, published March 24 in JAMA Network Open, evaluated e-visit use during the second half of 2019, before the pandemic. The authors examined 21,070 e-visits and found 81% did not involve any kind of follow-up visit during the following week.

Dr. Bhargava and coauthor Mary Reed, DrPH, a senior research scientist with the Kaiser Permanente Division of Research in Northern California, discuss the findings.

What is an e-visit and how does it differ from other virtual visits available from Kaiser Permanente?

Dr. Bhargava: E-visits were launched at Kaiser Permanente Northern California in July 2018. They provide quick and safe care for our patients who prefer to do things online. There’s a turnaround time of 2 hours or less for a physician to review your concern and to have your prescriptions waiting, your lab orders placed, and instructions or advice for you — that’s the beauty of an e-visit.

From the physician’s point of view, we have access to the patient’s electronic medical record along with the patient’s submitted responses to concise questionnaires. Physicians can do a quick assessment and within an average of 2 to 3 minutes take care of the clinical issue.

Reed: The e-visit exists in an ecosystem of multiple ways to get care at Kaiser Permanente, both virtual and in-person. Other virtual visits include appointments to talk with a physician by phone, which has been available at Kaiser Permanente since at least 2006, or by video visit, which was started in 2015. The term e-visit or virtual visit may also refer to an online experience managed solely by an algorithm. In contrast, the ones we studied here all actually had hands-on physician involvement.

What were you hoping to find out with this analysis?

Dr. Bhargava: When we design a new care system, it is essential to ensure that it is efficient and provides an excellent care experience that is clinically safe. With this study, we found that we provided patients with an additional, convenient option for getting timely care, and most of the time they needed no follow-up within 7 days. We know that some patients do need to come back for follow-up care with any type of visit. However, when 81% do not message their clinician nor need a follow-up visit, e-visits are confirmed as a successful mode for providing care. We are really happy with this success rate.

As part of this study, we also did a sampling of patient charts and found no evidence of quality concerns for patients who used the e-visit system. The exclusion criteria built into e-visits direct patients to higher level of care when needed, and our physicians use the smart sets developed to manage patients within the e-visit. We were pleased with the finding that we are providing effective and safe care with e-visits.

The e-visit platform has been expanded for use in the COVID-19 pandemic. Can you explain how?

Dr. Bhargava: In March 2020, at the start of the pandemic, we developed an innovative platform to allow our members to get their COVID-19 concerns and symptoms managed. We knew there would be a huge volume of questions and concerns related to COVID-19. The fact that we already had an e-visit platform allowed us to quickly pivot to it during the pandemic.

What other questions would you like to research about e-visits?

Reed: This has been a really productive partnership between the Division of Research, our technology group, and the operational and front-line clinical leaders. We’re planning to continue to study and understand the way that this affects patient access to care and convenience, including during the pandemic as we further expand to more e-visit options.

Note: e-visits may vary between Kaiser Permanente regions.

Jan Greene is a senior communications consultant with the Kaiser Permanente Division of Research in Northern California. This article was originally published on the Division of Research website.