Prospective Study to Evaluate the Safety, Feasibility, and Financial Implications of a Post-Operative Telemedicine Program
Vahagn C. Nikolian*, Aaron M. Williams*, Benjamin Jacobs*, Michael T. Kemp*, Jesse Wilson*, Hasan B. Alam
University of Michigan, Ann Arbor, MI
OBJECTIVE(S): Telemedicine holds promise for improving access and decreasing costs, but its role in surgery remains ill defined. This prospective study was performed to investigate the safety, feasibility, and financial implications of providing post-operative care using an electronic clinic (eClinic) at a university hospital.
METHODS: An easy-to-use and secure eClinic platform was constructed in Epic® (Epic Systems Corporation). Patients undergoing laparoscopic cholecystectomy, appendectomy, and hernia repairs on an adult acute care surgery service were prospectively enrolled in this program over a 6-months period (March-September 2017). Patients with prolonged hospitalizations (>4days), perioperative complications, drains, and open wounds were excluded. Demographics, clinical outcomes, encounter time, patient satisfaction survey results, and cost analysis were compared to the traditional clinic (tClinic).
RESULTS: 155 eligible patients (61% female; mean age 41+/-16yrs) were enrolled in this program. Their demographics were no different than the tClinic. Frequencies of readmission, reoperation, and emergency department visits (2.5%, 0.6%, and 1.9%, respectively) in the eClinic group were also similar to the tClinic group. Total visit time was significantly shorter (14 vs. 165 minutes, p < 0.01). Anonymous surveys demonstrated a high degree of satisfaction, with 85% of patients expressing desire to utilize the eClinic again. This program increased the capacity for new visits to tClinic, with projected additional gross revenues totaling $5.7M/year for the division.
CONCLUSIONS: A safe and efficient post-operative telemedicine program can be constructed utilizing a widely available electronic medical record system, which can improve patient satisfaction, optimize throughput, and increase revenues.
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