Virtual Visits: Why a Veteran Clinician Went from Skeptic to Champion (Video)

Movement disorders specialist Hubert H. Fernandez, MD, has come to really like Tuesdays. The reason? That’s the day when his schedule contains 12 slots devoted to virtual visits.

In this two-and-a-half minute video, Dr. Fernandez, Director of Cleveland Clinic’s Center for Neurological Restoration, shares his experience offering virtual visits via Cleveland Clinic’s Express Care® Online app, including why his initial skepticism fell away and how distance health has positively transformed the way he provides follow-up care to many patients.

Beneath the video we present a separate Q&A with Dr. Fernandez on specific ways virtual visits have shaped and enhanced his practice caring for patients with movement disorders.

Q: How have virtual visits impacted the way you care for patients in a big-picture sense?

Dr. Fernandez: Our goal has always been to serve as many patients as possible and improve access by seeing patients as soon as possible to minimize their anxiety and get them on the right path as quickly as possible. The problem with this model is that you end up with a steady stream of new patients who require follow-up care. Distance health through virtual visits has allowed me to carry out this model effectively, which would otherwise be nearly impossible.

Another advantage is that virtual visits have made our practice more truly national as opposed to just local or regional. Now a patient with a movement disorder from any of the 50 states can be managed expertly and followed with the same care and attention as someone who lives in Northeast Ohio, so long as they can come to see us once in Cleveland for an initial visit.

Q: How do virtual visits allow you to approach care differently at the individual patient level?

Dr. Fernandez: Parkinson disease is not a static illness. It requires constant adjustment of medications to maintain the patient’s quality of life or to address new challenges as the disease progresses. Therefore, when an adjustment is made, it’s ideal to find out whether the patient tolerated it and whether the goal was achieved. Without virtual visits, patients must wait until the next in-person visit for any new adjustment. With virtual visits, my titrations have become quicker and my goals higher and more precise because I know I can see and speak with my patients a month or two later to check on how they’re doing.

Virtual visits also have allowed me to more fully address the most important issues because patients know I can follow up, during the virtual visit, on any other issues that may not have been discussed or may need to wait until the more pressing concerns have been addressed. This results in clearer dispositions and much better compliance. My patients are relieved to know we’ll reconnect a month later and they’ll have a chance to raise any issues that arise from a medication trial.

Q: How do your patients like the technology of virtual visits?

Dr. Fernandez: They almost universally love it. Those who don’t have a smartphone, tablet or home computer will obviously decline my offer for a virtual visit. But the others almost always accept it — some more readily than others. But once they’ve tried it, they’re surprised at how easy it is to use. They love that they see my face, and I love that I see theirs. I can see firsthand whether patients and their families are happy, worried, upset or relieved, and it gives me significantly more data points to help me decide on my next move. While a phone call might let you pick up on a patient’s hesitation from the tone of his voice, it won’t allow you to see the worried face of his wife. Virtual visits let me know if I need to explain things slower because I can see that the patient is confused — or, conversely, if I need to explain very directly because I can see that the patient is getting a bit restless.

Patients also embrace the fact that loved ones who wouldn’t be able to join them for a trip to Cleveland can be with them during these visits. I once had a virtual visit with a patient who had two sons who wanted to join in — one sat next to his mother at her house while the other, who’s a Cleveland Clinic provider, sat next to me in my office. The four of us had a great discussion and together we created an excellent plan of care.

Q: What do you say to providers who are considering using distance health?

Dr. Fernandez: Remember the first computer you used, or your first cell phone, or the first time you used an EMR system? The first time is always intimidating, but can you imagine delivering care without an EMR and going back to paper charts? Or not having a computer or cell phone? That’s how I feel now about virtual visits. If you took them away from me and my patients, it would be extremely difficult to match the level of care I currently provide.

Q: What challenges need to be overcome to embrace distance health?

Dr. Fernandez: For me, the first challenge was overcoming my own fear: Will this work? Will my patients find the experience favorable and valuable? To an overwhelming extent, the answer has been absolutely. Patients would rather wait in the convenience of their living room than drive two hours in traffic, pay for parking, take off a half or full day from work, and wait in a lobby for their name to be called.

Now I face a different set of challenges, challenges that result from success. For example, how can I convince some patients it would still be good to see me in person at least once or twice a year? Or how can I make room in my schedule for more virtual visit spots? But these aren’t bad challenges to have.