Real-Time Virtual Consults, Kaiser Permanente Colorado

I didn’t know what to call this post, so I just used the signature line on every one of Jan Ground’s (@janground) email these days:

newsflash!!! REAL-TIME VIRTUAL CONSULTS now live with Colorado Permanente Medical Group dermatologists AND NEUROLOGISTS

Jan is Kaiser Permanente Colorado (@KPColorado) “Innovation Hunter.” There’s a person like Jan in every region of Kaiser Permanente who help usher in the future, so when I let Jan know that I would be visiting, she suggested I go see the specialties of…. Neurology and Dermatology.

This is Dr. Tim Grayson (@tim_grayson). He’s the Chief of Dermatology for Kaiser Permanente, Colorado (@KPColorado). I went to see him (and shadow, of course!) at the building photographed below his, Kaiser Permanente Rock Creek Medical Offices, with three of my colleagues, including our Chief Communication Officer, Diane Gage-Lofgren (@dianelofgren).

The day prior, I spent time in the practices (shadowing, of course!) with Peter Bergmann, MD, Lynsee Hudson Lang, MD, and the Chief of Kaiser Permanente Colorado Neurology, Robert Schabbing, MD.

When you think of telehealth, typically people think about dermatology as a great specialty to do this work. Neurology comes up, but usually not for outpatient care, usually for stroke medicine. And in dermatology people usually think about “store and forward” rather than real time video, which is happening for both specialties, as Jan points out in every one of her emails.

Real time , HD quality video (what it looked like to me), allows the physicians/clinicians to interact with the patient, and get to know each other as people, to add life to a a clinical consultation – the patient, who may be in their primary care physician’s office leaves feeling “seen,” whether they are 1 mile away or 30 miles way from the consulting specialist.

What’s happening here, then, is not trying to apply technology to make the specialty run smoother, it’s applying technology to make patient’s lives run smoother.

Members/patients have an interest in getting consultations quickly, of course, AND they have an interest in their doctors collaborating better in the long run. This is harder to do in systems where physicians get paid for every consultation “unit,” but in integrated care, where specialists are paid to ensure the skin health or neurological health of an entire population, the collaboration comes naturally.

I’m going to quote myself from a post just this past friday, that was rolled into another blog post (see: Community Medicine – Total Health – Dialogue with and from the future at Penn State Hershey | Ted Eytan, MD – there was a lot going on in Colorado):

  • Dermatologists, who are using video technology to connect to their primary care peers (and their patients) to make sure they are excellent clinicians in their own practices, and make themselves available as clinicians as well. We were told the average time to see a dermatologist at Kaiser Permanente Colorado is now 3 days. Let’s repeat that: 3 days.
  • Neurologists, who are doing the same, using video technology also to connect, and in the foreground, synthesizing for every patient a substantial amount of thinking and knowledge across all their specialty colleagues for every single patient. A complicated neurology case can have 2, 3, 4 specialties consulting, and to have their work bundled together in one comprehensive electronic medical record is beyond priceless. And, it’s not just the bundling of their knowledge, it’s the bundling of their collegiality. To be part of the same medical group delivering the care brings a level of respect and commitment to that person and their family in the exam room that’s hard to replicate.

Disclosure/disclaimer: I did not actually see any live video consults when I was in Colorado, just a demonstration of the technology (but did observe excellent care being delivered through shadowing). Neurology has just begun its service, Dermatology is farther along.

If a consult did come in while I was there, it would have been interesting to see, but really the interesting part is the fact that a primary care physician/clinician (and their patients) throughout this region have access in real-time to a specialist who’s willing to teach, and learn about their patients. That’s what I saw from both Chiefs and colleagues – the desire to be there, wherever “there” is for patients.

Thanks again, Jan, and our colleague Bill Marsh, MD (@MDAI) for continuing to push the boundaries of being there, Debbie Lantz, RN, my guide in Neurology (and also care provider for a touch of altitude acclimation), Tim, Rob, Lynsee, and Peter, and the members of @KPColorado for hosting and teaching us. As much as the Center for Total Health (@kptotalhealth) in Washington, DC is a vision for the future of health, all we are really doing is showcasing what’s already happening every day in places like Colorado.


Ted Eytan, MD