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Health Care Manag Sci. 2018 Dec;21(4):475-491. doi: 10.1007/s10729-017-9404-8. Epub 2017 May 18.

The impact of e-visits on patient access to primary care.

Author information

1
Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA.
2
Center for Quality and Productivity Improvement, University of Wisconsin, Madison, WI, USA.
3
Dean Health System, Madison, WI, USA.
4
Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA. jingshan.li@wisc.edu.

Abstract

To improve patient access to primary care, many healthcare organizations have introduced electronic visits (e-visits) to provide patient-physician communication through secure messages. However, it remains unclear how e-visit affects physicians' operations on a daily basis and whether it would increase physicians' panel size. In this study, we consider a primary care physician who has a steady patient panel and manages patients' office and e-visits, as well as other indirect care tasks. We use queueing-based performance outcomes to evaluate the performance of care delivery. The results suggest that improved operational efficiency is achieved only when the service time of e-visits is smaller enough to compensate the effectiveness loss due to online communications. A simple approximation formula of the relationship between e-visit service time and e-visit to office visit referral ratio is provided serving as a guideline for evaluating the performance of e-visit implementation. Furthermore, based on the analysis of the impact of e-visits on physician's capacity, we conclude that it is not the more e-visits the better, and the condition for maximal panel size is investigated. Finally, the expected outcomes of implementing e-visits at Dean East Clinic are discussed.

KEYWORDS:

Cycle time; E-visits; Panel size; Patient access; Primary care; Queueing

PMID:
28523477
DOI:
10.1007/s10729-017-9404-8
[Indexed for MEDLINE]

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