Healthcare is a language all its own. It has a unique lexicon that allows doctors, nurses, and staff to communicate with each other. Pain can be dull or acute, fractures can be hairline or compound, and internal injuries can be ventral or dorsal and thoracic or abdominal. All of this terminology matters a great deal in delivering care and in assuring positive patient outcomes.
Likewise, the world of healthcare insurance billing also has its own lexicon and intricacies and just as in the examples above, the terminology matters. There are e-visits and hosted visits and synchronous and asynchronous care. The technology required to facilitate these visits differs, security considerations may differ as well, and the amount of payment each type of visit receives may be different as well. I will say that there may be some slight variation in these definitions depending on the state or locality and the insurance provider, but we want to give you a general overview of each so that when you hear the terms in the future, you’ll be able to quickly make sense of them.
The e-visit is an electronic visit between a patient and their Primary Care Physician (PCP and/or another Qualified Health Professional (QHP). An e-visit happens electronically via email or through a web based solution like live chat. In either case, an e-visit cannot be held through traditional email that is not encrypted, as any private health information (PHI) could be compromised, violating HIPPA regulations. Proper encryption needs to exist to facilitate e-visits. E-visits can be asynchronous as in the case of email or synchronous as in the example of a live chat session. As a caveat, if a QHP is the one facilitating the e-visit, they are required to have access to a PCP electronically as a resource during that visit.
Store and Forward
This is a type of telemedicine service that is typically used for interprofessional communication, especially between PCPs and specialists. “For instance, teleradiology relies heavily on store-and-forward technology to allow technicians and healthcare professionals at smaller hospitals to share patient x-rays for diagnosis by a specialist at another location.” The nature of this collaboration and the necessity of the specialist to review data before reaching a diagnosis means that this typically is an asynchronous service. Patients and specialists like dermatologists may sometimes have asynchronous visits if the patient is required to provide some type of data first for later review and evaluation/discussion. The importance of a secure destination for the data being stored, as well as encryption on the lines of communications between parties involved are all paramount for protecting PHI here as well.
A hosted visit is a virtual consultation between a patient and their PCP that occurs face to face, meaning that video teleconferencing systems leveraging high definition cameras and displays can be used to facilitate that interaction. Due to the face to face nature of this visit, it is obviously synchronous; happening in real time for a fluid two-way communication between the patient and the PCP. Again, the health care provider must use hardware or software solutions that meet the encryption standards developed by HIPPA to protect any PHI that may be discussed.
To sum up, E-visits and Store and Forward systems both require encrypted messaging using hardware and software that protects stored photos or personal data. This data could include information captured from wearable devices or sensors as well as patient history. Hosted visits however rely on video teleconferencing systems to provide virtual face to face conversations. The real time nature of these communications does not exempt them from encryption requirements protecting PHI, so the proper hardware and/or software strategies must also be in place to mitigate risk.
Knowing the difference between these services and the terminology used to describe them cannot only help determine the technology strategy for your facility or practice, but can also assure that the services are billed correctly for timely payment.
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About Bob Higginbotham
Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at email@example.com