4 Helpful Tips About Telemedicine Everyone Should Know

Telehealth, telemedicine, and virtual visits are all names for the ability to have a nearly complete medical visit with your healthcare professionals. Until COVID-19, telehealth was more popular in remote areas without access to primary or specialty care, and was used in consulting roles such as radiologists reading imaging studies from home or physicians in the US discussing cases with colleagues in remote areas of the world. As a result of COVID-19 more insurance plans are covering and paying more for telemedicine visits with physicians, nurses, psychologists, and other medical professionals. From both a healthcare provider and a healthcare consumer standpoint, telemedicine is now out of the box and a majority of consumers and providers want to keep it that way.

1. Appropriate visits during the Pandemic: new patient evaluations, follow-up post procedure (routine), follow up established patient routine—prescription refills, medication check-ins, non-urgent questions/new developments, psychological counseling for established patients (some think even non-emergent new visits), physical therapist follow ups (particularly visits with 2-way video), urgent/emergent screening by dentists, medical generalists and medical specialists.

2. Technology required is different NOW and since the pandemic started than what it was prior to and what it will return to in the fairly near future. HIPAA requirements have been loosened to allow for more accessibility and wide adoption, but will be tightened again. Right now, Skype, FaceTime ,and Zoom are acceptable. In the future, a more secure platform will be required, not just optional. Ideally, a front facing-camera for the patient and their smartphone, iPad or laptop, their ability to click on a link to start the session, and a microphone (built-in is fine).  Internet connection and/or data service on their device. From a practitioner standpoint, the same is required, but also includes the software to the telehealth program. Programs are as simple as sending the patient a text message with a link which they can click on and it places them into the waiting room—or as complex as one requiring the patient to download an app or software. For the minimally tech savvy patient, the former is ideal and less likely to create failure or frustrations.

3. Pro/con of scheduling through your physician vs. through pharmacy (i.e. CVS Minute Health Clinic is an example of an in-person visit scheduled online) Many physician offices have similar options through their websites for new patients or through the patient portal for established patients. In the past week, many clinics have returned to at least partial in-person staffing in lieu of those working remotely from home.  

Pros:

• • • Calling the office to schedule an in-person visit requires that the phone be answered, but the advantage of scheduling online is your freedom to see the available visits for your patient type —new, established, physical exam, medication check, for example, and vary depending on the office. The patient is in the driver’s seat . . . or not if they don’t have to be. 
    • To have a visit from the privacy of your own home or 2nd home or friend’s home rather than deal with leaving the house, managing traffic, and sitting in a waiting room is convenient.  It’s refreshing. It is on your time and as long as you have a quiet place with a reliable smart device, you can achieve your visit without many of the typical hassles. Payment can be online.  Results online.  

Cons:

• • • The thing that cannot be done online versus in person is the human touch. Vital signs such as Blood Pressure, Heart Rate, Respiratory Rate, Temperature, Oxygen Saturation, Height/Weight at the time of the visit, and some physical examination items. But a good history would tell me if the patient is having symptoms from blood pressure too high/too low, pulse too fast/too slow, etc. Inspection is possible including having the patient take an arm or leg through range of motion, opening their mouth, moving their eyes etc. Palpation or touching the arm/leg for the exam to feel for warmth or putting the stethoscope on the chest to listen to heart/lungs is not but a great history and inspection can count for a large part of the assessment and plan as a result of the visit.   

*For example, I can see a new patient for a musculoskeletal problem via telehealth once all of the MRI reports, x-rays, any pertinent labs and the initial paperwork has been submitted to me for review and discussion during the virtual visit. We can devise a plan and I can even schedule the patient for the pain injection in the office where vitals can be taken, directed physical examination of the area of focus will be performed, likely paired with a quick diagnostic point of care ultrasound if indicated, and the procedure is done; follow up can be routinely online again unless the patient needs to be seen.  

4. How to vet an online doctor if it’s someone they’ve never met: reviews, just as they do prior to deciding to see any other physician, or choosing a financial advisor, or finding a reputable carpenter. Word of mouth from friends/family/coworkers count for some referrals, but the vast majority of patients Google their prospective physician.

Flexibility, convenience, time-saving, and efficient. It’s the way of COVID and over 83% of patients surveyed are likely to use telemedicine after this health crisis. Requirements include adopting a HIPPA compliant secure product and for those in the insurance-based practices, for insurance to continue to cover and reimburse telehealth visits at elevated levels more consistent with in-person rates. I am a huge fan of telemedicine and have adopted it into a permanent place in my practice.