The two-minute virtual doctor visit

Virtual care has cemented itself as a mainstay of the American healthcare system. More patients want remote access to care. More physicians want to provide convenience. And most major insurers are now paying for it.

The technology is responding. High-quality smartphone cameras, faster internet connections and connected medical devices let providers replicate an in-office primary-care visit at a much lower cost.

But while video visits help busy patients or those in rural areas, they do little to address the nation’s growing problem with physician burnout, said Dr. Ray Costantini, founder of Portland, Ore.-based virtual care startup Bright.md.

Costantini, who became “a little disenchanted with telehealth” during his time heading up digital health services at Renton, Wash.-based Providence Health & Services, said that telehealth often takes more time than an office visit. And time is something busy physicians do not have to spare. So in 2014, Costantini created Bright.md’s SmartExam platform to make each virtual visit two minutes long. To compare, physicians spend about 13-16 minutes with a patient in an in-office primary-care setting, according to a 2016 Medscape physician compensation report.

SmartExam works like this: Patients log into the platform and answer a series of questions about their symptoms and health history. They can upload images of a rash or take a guided physical exam. Patients then fill out their pharmacy and billing information. The process takes about eight to 12 minutes.

Then, SmartExam combines the patient’s responses with information pulled from their medical record to come up with a likely diagnosis. It sends all of the information in a chart-ready note to the physician who can then select the appropriate diagnosis and treatment plan—or enter a new one—and send a prescription to the patient’s selected pharmacy, if needed. All the information is added to the patients’ medical record. The process takes just two minutes.

The promise of patient convenience without the extra burden has won Bright.md a growing fan club among hospitals and medical groups including Greenville (S.C.) Health System, Rush University Medical Center in Chicago, and Adventist Health Medical Group in Portland, Ore. Costantini declined to say how many health systems Bright.md works with, though it is currently available to more than 7 million patients.

That number is sure to grow. The startup, which raised $3.5 million in funding in 2015, was named one of Gartner’s “cool vendors” for health IT in 2016. It’s the chosen platform for the cohort of eight major health systems evaluating telehealth under the leadership of consultancy Avia in Chicago.

Adventist Health Medical Group, which operates 34 clinics throughout Portland’s metro area, will make SmartExam available to established patients at several clinics starting in April, and roll it out to all patients by the end of the year. It will encourage those with simple conditions to seek care through the platform, allowing clinics to free up in-person appointments for patients with more dire conditions.

SmartExam can diagnose more than 350 conditions—such as ear pain, seasonal allergies, rashes, coughs and colds—that make up between 30% and 60% of the care delivered in primary-care offices, Costantini said.

These are low-acuity conditions that are “managed all the time over the phone, though providers are disinclined to do that because there’s no reimbursement,” said Dr. Ralph Prows, Adventist’s chief medical officer. Reimbursement for SmartExam, which is billed as an e-visit, is about $40 to $65 per visit, Costantini said. It’s a win-win, because providers get paid and patients pay just $20 for treatment, he said.

In April, Rush University Medical Center will offer SmartExam to primary-care patients. “We wanted to give people options that really work for them,” said Dr. Anthony Perry, a physician and vice president of population health and ambulatory care at Rush.

Costantini is reluctant to characterize SmartExam as solely addressing low-acuity care. He says the startup is building modules to diagnose more conditions

This story first appeared in Modern Healthcare’s Transformation Hub, ModernHealthcare.com/Transformation