Scott Webb (Host): Many of us have heard of virtual reality, but have you heard of a VirtualER? Well, The VirtualER option at The Elliot Hospital allows patients to be seen and heard from wherever they are, and allows the doctors and nurses who staff the virtual ER to diagnose, prescribe meds, triage illnesses and injuries so we don't waste a trip and more. And joining me today is Dr. Matthew Dayno. He specializes in emergency and ambulatory medicine with The Elliot.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Doctor, thanks so much for your time today. I woke up with a little extra spring in my step today, because I knew we were going to be talking about the Elliot VirtualER and what that is and how it works. So, let's get started there. What is the Elliot VirtualER and how does it work?

Dr. Matthew Dayno: So, the Elliot VirtualER is a new program that we initiated in January, and what we did was out of the pandemic experience and realizing that virtual access to physicians or providers became increasingly more common in the pandemic and post-pandemic, and what we realized is that we could harness technology to try to bring the physician and the ability of physician triage closer to the patient trying to access care. And specifically, the Elliot has a very integrated healthcare system that is able to care for patients across various levels of acuity within the structure of our emergency medicine team and department.

And so, essentially, we run three urgent cares and our main campus emergency department all with the same board-certified emergency physicians. And what we were finding is that patients sometimes, they may have a condition or a new acute complaint that they're not really sure where to triage themself to in terms of physical location. And then, sometimes a specific ailment may be able to be at least attended to initially or completely via a virtual platform.

And so, using mobile phone and/or desktop computer integration is that putting the patient directly in front of the physician from our emergency medicine team. It would help either, A, triage the patient to the right location, so right place, right time, and/or be able to attend to the patient's concerns completely via the virtual platform. That makes sense.

Host: Yeah, it does. And you can really hear the benefits for patients, of course. Just wondering how quickly can a patient be seen? Is there a long wait? How does that work?

Dr. Matthew Dayno: We put this service up for same-day appointments. And essentially, what this is so a patient may have an acute issue that they need attention and they're trying to sort it out. Do I go to the emergency department? Do I go to urgent care? And/or is this something that I can ask a question to a physician that is used to caring for patients across the sort of the spectrum of acuity and try to help attend to that issue? It's both a triage function as well as the ability to potentially care for the patient entirely remotely via the platform virtually and potentially also add asynchronous testing, meaning a patient, they're concerned that they may have an infectious respiratory virus or a urinary tract infection. We can see them, evaluate them, and potentially attend to their condition virtually, but also order a laboratory test and they can present to our outpatient lab without having to wait in line for a physical visit, get that test done, and the followup appropriately attended to via the virtual platform.

Host: Yeah, it's really awesome. It won't be in all cases for all patients that they'll be able to do all the kind of one-stop shopping with the VirtualER, but good to know that's a possibility. Patients are probably going to wonder, then what information do I need? What do I need to have handy when I connect?

Dr. Matthew Dayno: Yeah. So, the other beauty of the system is that it is integrated into our electronic medical record, which for patients that are already involved in care throughout our health system, they already have their medical records embedded into this program. And so, the physician on the receiving end being able to see the patient can access their prior medical conditions, the medications they're on, their allergies, et cetera. It makes it very user-friendly. We have also increased the ability for patients that are new to the Elliott system to be able to enroll in this and interact with the system. The difference being that we wouldn't have the assistance of having their entire medical record already embedded.

For a new patient, things to think about are certainly prior medical diagnoses, prior medications, prior allergies. Those are really important in terms of interacting with the physician on a first time basis.

Host: Are there some types of injuries and illnesses that are just ideal for VirtualER versus some other things?

Dr. Matthew Dayno: Yeah, so what we tried to do is make this seamless in terms of both a triage and attending to the patient. And so an example would be You know, a patient has an ankle injury and they're not really sure, do I go to the urgent care? Do I go to the emergency department? Is this something that I go to my primary care physician? If you're left in that sort of quandary, this is perfect for that system. And so, we would be able to initially triage the patient, see them. And if it's a a simple ankle injury, we don't have a lot of other concerns around that. We could order the x-ray and move forward with a diagnosis and treatment plan with that.

The other benefit of the system is for patients that may have a laceration, they're unsure if this is a complex laceration that needs to be attended to in an emergency department versus an urgent care, we can help in terms of visualize that and direct them and somewhat sort of transition their care very easily into our urgent care or our emergency department. So, we're able to arrive the patient prior to them coming so their medical record is teed up and ready for the team that's receiving them physically in that space.

Host: Yeah. I was just going to ask you to take us through the process basically. So, let's say somebody schedules a virtual ER meeting or session or appointment and they have that and then it's recommended, you know, you probably still need to come to the physical ED. How's that process work?

Dr. Matthew Dayno: It would be the same for our three urgent cares or the ED. So, what we would do is direct and instruct the patient so we need you to go to one of those locations depending on what we make the plan around. And then, what we do is we can arrive them onto our electronic medical record or track board. So, it's anticipated that the patient is being seen at one of those locations where we direct them. The team that's working there physically when the patient arrives would complete a triage, but would acknowledge that they had been seen in the virtual program and what the plan of care, the directions or instructions were around that.

Host: Yeah. And you can see how just even the simple sort of triaging that would have gone on before they show up and also having the medical records, you can see how seamless this might be. Maybe not for everybody, but for most anyway. Wondering about billing, you can't get away from that in medicine. How's the service like this billed? Is it billed the same way as a typical ED visit?

Dr. Matthew Dayno: So, it's actually not. So, it's billed as an office-based visit to the insurance company. So, it would just be like if you were seen on a routine PCP visit. However, if we do escalate care, meaning we send them to our urgent care or our emergency department, there is no bill that's generated from that initial triage visit and they just receive the care based upon where they end up and complete their care.

Host: Oh, that's interesting. I like that. Most of us have PCPs versus having been to the emergency room, I would much rather pay my PCP co-pay, you know, than the emergency room visit. So, I could see the value in that. I just want to finish up today. Do you have any patient success stories, like patients that you know have gone through this, and really speak highly of the experience?

Dr. Matthew Dayno: Just generally speaking around sort of statistics so far in the first two months of being fully online, we've seen approximately 450 patients. Ratio and breakdown is about 70% of the patients were seen and completed their care via the virtual system, so they never set foot in a physical location. We were able to complete a diagnosis and a treatment plan virtually. The other 30% breakdown, about 10% were referred to the emergency department, 20% to our urgent care locations.

And successes, pretty simple stuff in terms of, we've had a couple of cases where a patient had pretty significant nausea and vomiting related to they had family members that were tested already and positive for flu A. They were uncomfortable, didn't want to leave the house, but they needed assistance in terms of medication for what's called the anti-emetics or anti-vomiting medication. So, we're able to send that electronically to the pharmacy. Family member was able to pick that up. They were able to stay at home, not have to go into a waiting room, infect a bunch of other people. Other examples are simple orthopedic injuries that we were able to attend to, get the x-rays, make a plan of care in terms of splinting, immobilization, orthopedic followup.

And then, some cases where patients were confounded in terms of, you know, is this an issue that they needed to be seen in the emergency department versus urgent care? Our urgent cares are staffed by our board-certified emergency physicians. We have access to some imaging and testing laboratory-wise in those facilities. The patients aren't usually contemplative around the fact that they could go to an urgent care for that complaint, so pediatric lacerations, et cetera. And so, we were able to direct them appropriately and absorb the patient easily into urgent care without having the patient waiting In the emergency department for a complaint that didn't necessarily need to be in the emergency department.

Host: This just sounds like a winner all the way around. It makes me want to do it myself, you know. Not that I'm eager to have a illness or an injury, but I'm hoping to do something like this and be a part of a VirtualER visit. So, thank you so much for your time and you stay well.

Dr. Matthew Dayno: No problem. Thank you. Appreciate it.

Host: And to schedule a VirtualER visit with the Elliot Hospital, go to elliothospital.org and search VirtualER.

And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.