Mission Health's virtual care success lies in EHR, telehealth integrated workflow

The Cerner EHR adds the Zipnosis telehealth notes after each virtual visit and recently used its integrated platform to address a pertussis outbreak.
By Bill Siwicki
01:22 PM
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Mission Health in Ashville, North Carolina

Since it launched its virtual care telemedicine program in October 2016, Mission Health in Asheville, North Carolina, has completed 1,200 patient visits. In November 2017, the provider organization saw its highest overall use with 178 total visits; 155 of those were treated via its Mission Virtual Clinic program and 23 were triaged out for additional evaluation and treatment.

"Since July 2017, we have seen steady growth in the use of Mission Virtual Clinic," said Steve North, MD, clinical director, Mission Virtual Clinic, and a family physician at Mission Health.

The provider organization uses Cerner for its EHR and Zipnosis for telemedicine.

"I believe this growth is due to a combination of increased marketing to the community, increased community acceptance of the care delivery, and increased provider acceptance resulting in fewer referrals out," said North.

Mission Health now is recommending Mission Virtual Clinic in combination with its primary care practices, North added.

[Also: AHIMA posts telemedicine toolkit to prepare hospitals for wider adoption of tech]

Beginning this month, patients who are on insurance plans offered by Mission Health Partners will be able to log into their insurance account and access the Mission Virtual Clinic platform. The organization believes this will help patients see Mission Virtual Clinic as an integrated part of the comprehensive care offered through its health system and ACO.

"The Mission Virtual Clinic is online convenient care for common illnesses from the comfort of the patient's home for only $25, no matter the type of insurance," North explained.

Because of more and more success stories like Mission Health, telemedicine is on the rise. This month has brought several new developments on the telehealth front, as vendors look to capitalize on the recent momentum of virtual care. Among them: InTouch Health, which has expanded its telemedicine offerings with an eye toward both direct-to-consumer delivery and in-house providers, and Teladoc, which debuted an integrated mobile app with a single, patient-centered point of access to answer a wide array of medical needs.

[Also: Telemedicine's market momentum prompts vendors to expand, connect with larger patient populations]

For Mission Health, the telemedicine and EHR technologies are integrated, and there are two levels of integration between the Cerner and Zipnosis platforms.

"The first is the direct import of all Zipnosis encounters into the Cerner EHR as a distinct 'virtual clinic' note type," North explained. "If a patient does not have an existing chart within our Cerner system, a new chart is created."

The second level of integration results from Zipnosis' "ZipTicket" protocols, which offer patients an easy way to receive testing for strep throat and influenza through the Mission Virtual Clinic. These results are entered into Cerner by the lab staff and interfaces with the Zipnosis protocol resulting in the correct response being sent to the patient based on the algorithm.

[Also: Value-based care will reinvigorate EHRs, boost AI, advance home telehealth]

"Primary care providers then are able to see: the ZipTicket flu swab; rapid strep, with culture for kids under 18; and urinalysis results, in the context of their standard Cerner workflow," North explained.

Mission Health added a pertussis protocol aimed at addressing an outbreak in its community. The pertussis post-exposure prophylaxis protocol was something it had explored earlier this past fall following a much smaller outbreak in another community.

"We had about 25 patients with potential exposure come to our urgent care practice and needed to stay in their cars with providers going to the parking lot to treat them and not spread the virus," North said. "At this time, we had already begun education with our Mission Virtual Clinic providers regarding this protocol. We planned to launch on Dec. 15."

But the spread of a whooping cough outbreak came to Mission Health's attention shortly after Thanksgiving. So Mission Health made the decision to launch the pertussis protocol ahead of schedule, activating it on Nov. 29.

"On Nov. 30, I led a videoconference introducing the medical directors of the Henderson and Buncombe County Health Departments to the protocol," North said. "We also began a social media campaign and informed our own providers of the pertussis PEP protocol being active."

One week after the launch, Mission Health had seen three cases treated with pertussis PEP through Mission Virtual Clinic. The provider organization currently is working to expand knowledge of the Mission Virtual Clinic protocol, as well as ways to increase access to this protocol for all patients who may have been exposed.

North believes, based on Mission Health's experience, that the technology-based way of caring for patients will expand in the future and become more important.

"The integration of virtual care into all aspects of medical care will continue to grow as patients and providers become more comfortable with the modalities used to deliver this care," he said. 

"Successful integration of Mission Virtual Clinic into our health system will be seen when our primary care triage nurses and on-call providers recommend Mission Virtual Clinic as a treatment option for patients and we see a decrease in the office visits for the acute conditions treated through Mission Virtual Clinic," said North.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com