Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program

Vahagn C. Nikolian, MD; Aaron M. Williams, MD; Benjamin N. Jacobs, MD; Michael T. Kemp, MD; Jesse K. Wilson, BS; Michael W. Mulholland, MD, PhD; Hasan B. Alam, MD


Annals of Surgery. 2018;268(4):700-707. 

In This Article

Abstract and Introduction


Background: Telemedicine in surgery holds promise for improving access and decreasing costs, but its role remains ill-defined. This pilot study was performed to investigate the safety, feasibility, and financial implications of providing postoperative care using an electronic clinic (eClinic) at a university hospital.

Methods: An easy-to-use and secure eClinic platform was constructed in Epic (Epic Systems Corporation, Verona, WA). Patients undergoing laparoscopic cholecystectomy, appendectomy, and hernia repairs on an adult acute care surgery service were enrolled in this program over an 11-month period (March 2017 to January 2018). Patients with prolonged hospitalizations (greater than 4 nights), perioperative complications, drains, and open wounds were excluded. Demographics, clinical outcomes, encounter time, patient satisfaction survey results, and cost analysis were compared with the traditional clinic (tClinic) patient population.

Results: Two hundred thirty-three eligible patients (61% female; mean age 41 ± 16 years) were enrolled in this program. Their demographics were no different than the tClinic. Frequencies of readmission, reoperation, and emergency department visits (2.7%, 0%, and 4.2%, respectively) in the eClinic group were also similar to the tClinic group. However, total visit time was significantly shorter in the eClinic group (14 vs 145 minutes, P < 0.01). Anonymous surveys demonstrated a high degree of satisfaction, with 85% of patients expressing desire to utilize the eClinic again. This program enhanced the capacity for new visits to tClinic, with a resultant projected increase in additional operative cases and revenue for the health care system.

Conclusions: A safe and efficient postoperative telemedicine program can be constructed utilizing a widely available electronic medical record system, which can improve patient satisfaction, optimize throughput, and increase gross charges for the healthcare system.


Telemedicine is defined as "the use of electronic information and communication technologies to provide and support health care when distance separates participants."[1] With the proliferation and widespread adoption of communication technology, including computers and smartphones, the electronic arsenal available to the medical practitioners and health systems has exponentially increased. Since its implementation, telemedicine has rapidly expanded within the field of medicine. Telemedicine has afforded improved access to care, greater resource efficiency, and decreased costs compared with traditional face-to-face office visits and has been utilized in a wide array of fields in medicine, including radiology, cardiology, dermatology, psychiatry, and internal medicine.[2–8] Although the concept of telemedicine has been criticized by some as threatening the traditional doctor-patient relationship,[9] the potential benefits observed with medical technologies merit its ongoing consideration and refinement by the clinicians.

In recent years, the application of telemedicine to the field of surgery has sparked significant interest.[10] Numerous studies have demonstrated successful initial implementation of telemedicine in general surgery and subspecialties, including thoracic, transplant, endocrine, and vascular surgery with patient procedures ranging from soft tissue excisions to laparoscopic appendectomy and cholecystectomy to kidney transplant and thoracotomy.[10–15] Some centers have utilized SMS messaging, telephone calls, and automated messaging services to serve as an extension of the traditional clinic (tClinic), to aid in monitoring drain outputs, symptom management, and quality of life following surgery.[12,15–17] Others have utilized it primarily as an alternative to tClinic for standard postoperative return visits.[17–22] In recent years, the United States Department of Veterans Affairs (VA) has prioritized telemedicine utilization in furthering care to its veterans and its use is now even a health care performance goal for the 2014 to 2020 fiscal years.[23]

Although telemedicine has clearly demonstrated improved access to care, decreased patient costs and time, and high rates of patient satisfaction,[10] its role in surgery remains ill-defined at this time. Early prospective studies demonstrate the relative safety of telemedicine in surgery,[10] but its feasibility, sustainability, and financial implications require further investigation. This pilot study was performed to investigate the safety, feasibility, and financial implications of providing postoperative care using an electronic clinic (eClinic) at a university hospital.