Virtual Visits Offer Convenient Alternative to Follow-up Office Appointments

Nurse practitioner uses service for diabetic patients

In September 2014, Cleveland Clinic’s Endocrinology & Metabolism Institute began piloting virtual office visits through its online service, Express Care Online. An endocrinologist and nurse practitioner conducted some follow-up visits with diabetic patients online rather than in person. “It has been fantastic!” says Pam Combs, MSN, BC-ANP, CDE. “It’s important to provide healthcare access to patients at a reasonable cost. I think online visits are the wave of the future.”

How virtual visits work


Pam Combs, MSN, BC-ANP, CDE

Since the program was launched, Combs has held virtual visits with three patients and scheduled upcoming appointments with three others. “When patients are getting discharged from the hospital, I give them a handout that talks about Express Care Online and provides step-by-step instructions for getting started,” says Combs. Those who choose virtual visits for follow-up appointments then schedule an appointment time with Combs.

The Endocrinology & Metabolism Institute has set aside a room for Express Care Online appointments. In the comfort of their own home, patients can use a computer, tablet or smartphone to sign into a virtual waiting room. Then Combs begins the appointment, which typically lasts 15 to 30 minutes. Combs’ computer screen is divided in two, with the patient appearing via webcam on one side and pertinent patient information from the electronic medical record on the other.

“We are able to see one another and visit,” says Combs. “I can do an assessment, have a dialogue with the patient about what’s going on with them and come up with a plan of care.” Like any follow-up appointment with a diabetic patient, the virtual visit includes a review of discharge instructions, blood sugar readings and medications as well as a discussion about diet and nutrition. Time is also set aside for patients to ask questions.

The advantages of online appointments

“Express Care Online is a service we can offer patients who aren’t close to Cleveland Clinic’s main campus,” says Combs. One of her patients is a busy company executive who lives 45 minutes south of the hospital. Combs and the endocrinologist split four appointments with the patient in a year – two virtual and two in the office. “This is absolutely the answer for this patient,” says Combs. “It’s too hard for him to get here every few months because of his job.”

Another patient retired to Arizona a month after being released from the hospital following complications related to his diabetes. “There is a lot that goes on with relocating. When he hit the ground in Arizona, he didn’t have to immediately find a primary care physician,” says Combs. “He could have virtual visits with me as frequently as he needed so I could make sure his blood sugars didn’t get out of control during the transition to his new primary care physician.”

Another benefit of Express Care Online is affordability. There are no facility fees or co-payments. Patients pay $49 for a basic appointment, while more complex endocrinology appointments can range from $75 to $100 and last between 30 minutes to an hour. The patient pays via credit card at the time of the appointment.

The program, piloted by the Endocrinology & Metabolism Institute, has since rolled out to many areas in the Cleveland Clinic health system. “Any time you offer quality care at a reasonable cost and have high patient satisfaction, as we do with Express Care Online, it’s going to be a success,” concludes Combs.