E-Visit Pilot Program Aims to Improve Patient Care, Remission Rates

Thanks in part to focused quality improvement initiatives, inflammatory bowel disease (IBD) remission rates at Cincinnati Children's have improved steadily since 2007, plateauing at 80 percent. With no new medications available, clinicians began looking for innovative solutions to make existing medications and treatments more effective.

Pediatric gastroenterologist, Chelly Dykes, MD, began exploring the idea of piloting a follow-up e-visit option for patients who have received treatment in the clinic for a mild to moderate flare up of IBD symptoms. These are the type of patients who have been most recently sick and for whom adequate follow-up is crucial.

"Some forget to come back, some don't want to miss school or work and others prefer to deal with symptoms on their own rather than make the trip," Dr. Dykes says. "We felt that e-visits would be a less burdensome way for these patients to receive follow up care, and give physicians 'real-time' information to treat them from a distance."

An early step was to establish eligibility criteria. "We designed the pilot program for patients who are stable, including those who are newly diagnosed with IBD or have recently seen a physician at Cincinnati Children's due to a mild to moderate flare up," Dr. Dykes says. "E-visits are not a good fit for patients who are just beginning puberty or dealing with growth issues, or for kids whose disease is very active."

The pilot program began in November 2014 with five of the division's 32 pediatric gastroenterologists offering e-visits to eligible patients. Families who wish to participate are given a target date for completion. The parent or guardian logs on to My Chart, the electronic health records portal, to fill out a questionnaire that asks for detailed information about general well-being, symptoms, eating habits, psychosocial concerns and peripheral issues, such as vision problems and joint pain. Older patients may be asked to fill out a separate questionnaire that asks similar questions. This process allows the patient to fill out the questionnaire at a convenient time, rather than come to the medical center for a scheduled visit during business hours.

The patient's physician reviews the responses, and makes recommendations through My Chart. Recommendations could include a medication change, follow-up diagnostic testing or no change at all. These e-visits are not covered by insurance, and families are asked to pay a flat fee of $50. This out-of-pocket cost can be far less than those associated with a clinic visit, such as gas and lost work time.

While it is too early to tell whether this new platform will improve follow-up adherence or patient outcomes, patient and family feedback has been positive. Dr. Dykes anticipates that the more regular communication between patients and their physician could encourage patients to participate more fully in their care, recognize warning signs before flare ups occur, and speak up sooner about concerns.

As her team refines the e-visit process, she expects that all pediatric gastroenterologists who see patients in the IBD clinic will participate. "Over time, we might expand our eligibility criteria to include more patients, and add an interactive video component to the e-visit," she says. "Eventually, e-visits could be adapted for other patient groups, such as those with eosinophilic esophagitis, constipation, and probably within other subspecialties, such as for headaches and cystic fibrosis."

For more information about the Schubert Martin Inflammatory Bowel Disease Center, please call 513-636-4415 or email ibd@cchmc.org.