A limited number of common non-emergency medical complaints that can be effectively managed without the need for a physical examination can be treated by clinicians using asynchronous online medical consultations between healthcare providers and patients that are conducted within the boundaries of a secure patient portal in an electronic health record (EHR).
By addressing the issues of physician shortages and overcrowding in ambulatory care facilities, e-visits improve access to healthcare. This means that the procedures for an in-person visit and an electronic visit are different, as seen below:
The typical patient and provider (physician or advanced practice provider) workflow for an ambulatory, in person, visit.
Figure 2: The typical patient and provider (physician or advanced practice provider) workflow for an E-Visit, online.
Differences
The first difference is in the first stage. The e-visit allows for patient scheduling where an individual selects the available time based on the physician's schedule. Also, it allows the provider to set a customizable daily schedule and therefore, the patient does not need to visit the physician's premises. However, when it comes to the inpatient ambulatory visit, the doctor waits for the arrival of the patient and then pull out the medical records, a process that may take some time, especially if the provider does not have an EHR attached.
Secondly, in an e-visit, the consultation process which involves the doctor inputting the patient's details, sending of notes of visit details to patients for viewing, and developing customizable chart occurs electronically ("Reimbursement - eVisit® Telemedicine Solution", 2017). However, for the inpatient visit, the physician takes over the responsibilities of inputting the patient's history, chooses appropriate diagnostic devices, and deciding on the course of action in a one-on-one conversation.
A noticeable difference is a treatment in e-visits is virtual while in the ambulatory setting, the patient must undergo labs and procedures. Through the charting and notes, e-prescription, viewing the health history, the physician recommends the best treatment ("Reimbursement - eVisit® Telemedicine Solution", 2017). In these situations, it is not possible to perform lab procedures or physically examine the patients, like in an ambulatory care setting. Also, the physician can observe the patient physically, prescribe the medication, and recommend the best treatment on a one-on-one basis.
For both the patient and provider, e-visits offer the convenience of scheduling visits at their available times but for the ambulatory care, the patient has to physically visit resulting in the problems of overcrowding and physician shortage, and this is inconvenient to both (Gidwani et al., 2012). E-visits are only appropriate for a limited range of nonemergency conditions, requiring no physical examination. On the other hand, for the ambulatory visits, the conditions are severe such as cardiac issues, and such require a physical examination, necessitating the need for labs and procedure process.
Despite the above differences, there are similarities in the workflows for both the e-visits and the ambulatory in-patient visit. First, both involve a qualified medical provider who must comply with all relevant state and federal regulations, for instance, privacy and confidentiality of the patient information. In the first stage of both, there is a consultant must retrieve and input the patient's medical history, and use this information in prescription. Also, there is communication or consultation between the provider and the patient, though by different means, one virtually and the other physically.
References
Gidwani, N., Fernandez, L., & Schlossman, D. (2012). Connecting with patients online: E-visits. Consulting report prepared for the US Department of Family and Community Medicine Academic Health Center
Reimbursement - eVisit® Telemedicine Solution. (2017). eVisit® Telemedicine Solution. Retrieved from https://evisit.com/your-practice/provider-experience/reimbursement/
