The virtues of virtual visits

By Jane Sarasohn-Kahn

Rush-Presbyterian Medical Center's Virtual Integrated Practice (VIP) is more evidence that remote health care can improve health outcomes.

At Rush, a team has been refining the VIP model for the past four years. The VIP's objective is to improve chronic disease management for older people by deploying an
interdisciplinary team using communications technology.

The main challenges in primary care for VIP's target patient population are:

• Multiple chronic problems
• Polypharmacy
• Physical disability
• Functional impairment
• Economic stressors

The Holy Grail here is that when these patients are optimally-managed, VIP can identify missed opportunities for primary prevention and avoid eventual disability.

As the population ages, more chronic conditions ensue. Traditional institutionally-based care in hospitals and nursing homes is based on synchronous, face-to-face care. VIP disrupts that institutional model by embracing a team-based, asynchronous co-located model. Clinicians on the patients' team interact in the medical record and enhance ongoing team communication about the patient's progress.

The VIP team consists of a nurse, a social worker/case manager, a physician, a pharmacist and a physical therapist. Here's the "co-located" part: They're in different settings, and they relate to the patient at different times. But they're coordinated via information technology -- the electronic patient record.

One of the most important lessons the team learned in its four-year study is that patients expect the professionals on care teams to communicate with each other. This is typically not a streamlined, efficient or effective process in traditional primary care.

Toolkits are available here for several health issues: diabetes, nutrition, urinary incontinence/overactive bladder.

The study is funded by the John Hartford Foundation of New York.

Jane's Hot Points: The critical success factor with VIP is that the patient is at the center of the process. The team emphasizes self-management training in all interactions, and establishes monitor-able goals throughout the encounters. Messages are triggered to team members and to adjacent professionals as needed, which may include a nutritionist, an ophthalmology, or a podiatrist, for example. With the patient as an integral member of the virtual team, outcomes are improved. It's not about the technology per se -- which clearly enables this concept -- it's the process: the right caregiver at the right time using the right technology.