Telemedicine as a Practice Model

Kaiser Permanente (KP) is a large, integrated, managed care consortium that employs doctors in all fields as salaried partners. It utilizes Epic Health Connect, a massive electronic medical record system through which ophthalmic testing, neuroimaging, laboratory results, and all patient visit notes and records can be easily accessed. Care is collaborative among KP physicians. All doctors are provided with a KP-issued iPhone with secure texting software and an easy to access directory of all of the other doctors in all subspecialties at all sites. Referrals to subspecialists are sent largely through a software called e-Consult, but less formal "curbsides" and more urgent inquiries are also common and may be initiated via Health Connect e-mail, secure text, or phone call. Because there are few dedicated neuro-ophthalmic practice units in the system and a very large catchment with relative ease of access to testing and ophthalmic and neurologic examinations locally across the region, the majority of neuro-ophthalmic consultation has operated via tele-medicine, even prior to the COVID-19 pandemic.