With the pandemic-induced boom in telehealth, patients across the board are more comfortable than ever seeking telemedicine advice and care.

As patients can turn to telehealth to increase access to specialists who can help solve important health challenges, regardless of their location, virtual care opportunities will continue to transform traditional healthcare in 2023 and beyond.

Gokce Sezgin is the head of marketing and patient liaison at The Clinic by Cleveland Clinic, which provides direct access to specialists through its virtual second opinion service.

We interviewed Sezgin to learn how virtual second opinions have improved health equity, and how the telehealth platform integrates into clinical workflows and works behind the scenes to collect patient data.

Q. What is The Clinic by Cleveland Clinic and how does it reach the underserved in areas that lack specialty care?

TO As a joint venture between Cleveland Clinic and [telehealth technology vendor] Amwell, the clinic empowers patients, regardless of location, to move toward better outcomes with greater peace of mind.

The reality for many of us is that access to a specialist who can meet our health care needs varies dramatically based on our location. Specialty care deserts, which are areas of the country where specialists simply aren’t available, make it difficult to schedule an appointment with the right doctor for a single opinion, let alone a second opinion.

Today, more than a third of Americans live in a county that does not offer adequate access to primary care providers, hospitals, pharmacies, or trauma centers. This situation is likely to get worse as tens of thousands of doctors are expected to leave the profession by 2030.

The clinic offers easy and secure access to Cleveland Clinic’s world-renowned medical expertise from the comfort of home. Through this digital health service, people can review their diagnosis and treatment plan and receive an opinion in about two weeks.

We support individuals at every step of the process, from collecting and reviewing medical records to identifying the best specialist for their personalized needs. Patients can contact their assigned Nurse Care Manager directly to ask questions, provide additional information, and receive updates on the status of their cases.

Q. The clinic has 3,500 specialists and more than 550 advanced subspecialties. How has access improved patient outcomes overall?

TO In 2021, the clinic commissioned third-party research to conduct an independent review to measure the impact of our virtual second opinion program.

The study considered a total sample of 417 cases registered by the clinic in the course of the second and third quarters of 2020. The primary care and second opinion plans differed in 300 medical records of patients who had self-referred for an online second opinion. .

Indeed, 72% of the expert opinions uncovered a possible change in diagnosis or a recommended modification of the treatment plan.

Supporting patients on the path to better outcomes starts with making sure they’re on the right track from the start, and our experience shows that access to expert physicians can be a vital part of the care process.

Q. In terms of a specific use case, how do virtual second opinions improve outcomes for cardiology patients across the country?

TO Cardiac, vascular and thoracic conditions are key specialty areas for a second opinion.

US End-shutdown and world report has ranked Cleveland Clinic as the No. 1 hospital for cardiology and cardiac surgery for 24 consecutive years.

More patients now have access to the best diagnoses available through virtual second opinions.

As an example, a patient named Alan, age 76, struggled to determine his care options after being diagnosed with a heart valve defect. Initially, Alan and his wife had met with a cardiac surgeon near his home, who told her that he had a valve that needed to be repaired or replaced. The surgeon wouldn’t know until he looked at Alan’s heart valve during surgery if repair or replacement would be needed.

Through a virtual second opinion, a cardiac surgeon at the clinic who specializes specifically in heart valve surgery reviewed Alan’s existing medical records and evidence.

He determined that Alan was an excellent candidate for a repair.

Q. How does the Amwell telehealth platform integrate with the clinic’s existing electronic health records, clinical workflows, and patient portals?

TO To provide virtual second opinions, clinics leverage the Amwell platform to serve as a stand-alone technology solution that can be accessed via web or mobile browsers.

Individuals begin the second opinion process by registering online and accessing the telehealth platform to initiate or schedule a video visit with a nurse care manager to learn about the individual’s medical concerns, services to date, any diagnoses current or treatment plans.

The nurse documents the individual’s specific questions for the expert physician in Cleveland Clinic’s Epic electronic health record system.

After admission, the clinic facilitates the collection and review of appropriate records and images.

With the Care Everywhere feature, the EHR ingests records from other participating healthcare institutions directly into the patient’s master record.

When documents are not available through Care Everywhere, the clinic uses technologies like AMBRA to collect records electronically or manually via electronic upload or fax. Members can also electronically upload their records and images securely through the platform, if they have them.

The clinic matches the person with the most appropriate clinical expert, who then analyzes the case and prepares an opinion to deliver both via a video visit via the platform and in a written report, which is shared securely with the patient through the platform.

Q. Interoperability is a challenge at the national level. How is the clinic working to address secure and seamless transfers of patient information?

TO For record collection, direct process record connectivity helps ensure maximum speed, accuracy, privacy, and ease of use of an individual’s medical record.

If a treating physician has access to Care Everywhere, this same connectivity can be used in reverse to share documentation and results with the treating physician.

The integrated, health system-level nature of the external medical records collection process has an average response time of five business days on record requests in the US.

Andrea Fox is a Senior Editor at Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is published by HIMSS Media.