Implementation of Telemedicine in an Outpatient Ostomy Clinic

Introduction: Telemedicine improves access to care and is conve- nient for patients. A meta-analysis found ostomy care provided through telemedicine reduced stoma-related complications. Reimbursement from Medicare for telehealth visits is the same as in-person visits. An academic medical center in the Midwest set a goal to increase acces- sibility through virtual visits. Ostomy patients were waiting up to four weeks for appointments due to limited clinic space; therefore, a half-day virtual clinic was proposed to improve access to ostomy care, as well as to meet the institution’s goal. An inpatient ostomy APP was seeing an average of less than one patient per the proposed half day. Methods: During the twelve-week trial, a half-day virtual clinic schedule allowed the outpatient APP to provide virtual visits outside of the space limitations of the clinic. The inpatient APP transitioned to the outpatient clinic for in-person visits for the half-day. Candidates for virtual appointments were patients who were scheduled for annual visits, visits for rashes, or follow-up visits. The process for virtual visits included, prior to the appointment: support staff sent instructions for the visit by mail and through the electronic health record one to two weeks prior to the appointment; support staff sent a measuring guide with the letter; and patients could send photos of the stoma with the measuring guide and the back of their used wafer through the patient portal. During the visit the provider conducted a review of systems; reviewed previously sent photos or viewed patients changing the pouching system; developed a plan of care; and discussed recommendations. After the appointment, the provider completed patient instructions; the provider sent a message for staff to order samples or ordered durable medical equipment; and the provider sent a message for staff to schedule a follow-up appointment. Results: During the twelve-week trial, patients scheduled in both half day clinics increased access to the ostomy clinic by 10%. Of the virtual visits, 91% were successfully completed. Discussion: With the success of the trial, the half-day virtual clinic schedule became permanent after six weeks. Virtual visits are an effective way to provide care to many ostomy patients.