Oregon state employees like the convenience of rapid access to a clinician
"Does this mole look okay?"
It's a common enough question in health care, but one not usually uttered across 50 miles. Larlene Dunsmuir, a nurse practitioner for Providence Health eXpress, carefully studied the image on a video screen and told the patient the mole appeared benign. Dunsmuir urged her to see her doctor to be certain and sent her on her way.
The exchange only took a few minutes, about as long as it took the patient to get back to her workstation.
Time savings is a key selling point for Providence Health eXpress, a telemedicine clinic open to thousands of state government employees in Salem, Ore. Patients make appointments by telephone for minor ailments, then go to a private and secure examination room in one of the state office buildings near the capitol.
They communicate by video and voice transmission with Dunsmuir and her coworkers, who are 50 miles away in an office building in Beaverton, a suburb of Portland, Ore. Officials at both Providence Health & Services of Renton, Wash., which operates the clinic, and its program partner, the Oregon Public Employees' Benefit Board, say patients find it convenient and a successful substitute for traditional in-person visits with clinicians.
Most patients get their appointments on the same day they call for one, and provided their complaints fall within the clinic's limited scope of practice, most are video chatting with a nurse practitioner within two hours of their original calls.
Providence Health eXpress began May 24 with a ceremony that included Oregon Gov. John Kitzhaber, who participated via video link from the appointment room. Kitzhaber called the clinic "a great example of how we can reorganize the health care delivery system to be more cost-effective."
For Kitzhaber, the service means state employees won't have to take a day off to visit a doctor for minor ailments. For employees, it means they can see a health care professional and use up an hour or less of their sick-leave time.
Providence Health eXpress is available to state employees on regular workdays. It is not for spouses, dependents or retirees. For the time being at least, the employee is not charged an insurance co-payment for the visit.
Once inside the appointment room, patients have full privacy. The communication between patient and clinician is via a T1 line, which is more secure than a standard telephone line. Dunsmuir said she talks with patients, examines their physical ailments and makes diagnoses. She said Providence Health eXpress can write prescriptions and always sends an after-visit summary by fax to a patient's primary care doctor, if she or he identifies one.
On average, she said, the staff has eight patient visits per day. She said common complaints are about allergies, colds, headaches and skin irritations, such as athlete's foot. "They'll put their feet right up on the table, and we'll zoom in with the camera." Said Dunsmuir, a nurse practitioner for 19 years, "I'm amazed how comfortable people are in this setting."
Dr. Ray Costantini, regional medical director for Providence Health eXpress, said the organizers of Providence Health eXpress developed a list of 50 minor ailments that the program can tend to. Costantini said the service is not designed to treat serious chronic conditions.
"If someone is trying to manage diabetes or has congestive heart failure, this is not the place to go," Costantini said. "We make sure that the callers' conditions fall within our list."
Costantini said any company or insurance group considering a program such as Providence Health eXpress needs to clearly determine the scope of service and consider its value in time savings to workers and employers.
"This is not a technology product. It's a service solution," he said. "You have to be guided by the patient's expectations and convenience."
Costantini said Providence Health eXpress probably makes most sense for large, self-insured employers, but could be put to use at workplaces with as few as 100 employees. Providence hopes to expand the service to other employers.
About 18,000 Oregon state employees work in the Salem area, and 12,000 of them are within walking distance of the building that houses the Providence Health eXpress appointment room. Ingrid Norberg, spokeswoman for the Public Employees' Benefit Board, said the board provides information on the availability of the Providence Health eXpress service directly to state employees and posts it on its general website.
Norberg said employees who seek help from Providence Health eXpress obtain permission from their supervisors and use accrued sick-leave time as they would with a traditional office visit to a doctor. She said the state is pleased with the program and is considering expanding it.