As the highly contagious novel coronavirus, also known as COVID-19, continues to explode with new infections in new locations every day, many patients want to avoid physician offices and other public places where they may come in contact with the virus. However, it’s crucial for those who are elderly, chronically ill, or with compromised immune systems to continue to receive care when needed.
For medical practices that have not yet embraced telemedicine, this could be the perfect opportunity to get patients on board and start providing an additional service that could eventually grow the practice. As more people use Skype and Zoom to keep in touch with grandchildren and other family members, patients may be more receptive to telemedicine than physicians expect. And with a wide array of easy-to-use, cloud-based telemedicine systems available, it’s simple to start offering telemedicine and keep patients safe while continuing to treat them.
For instance, at Long Island Select Healthcare (LISH), physicians conduct virtual video visits for patients using a HIPAA compliant app on a tablet that enables the provider and the patient to have a secure conversation. Doctors use telehealth for scheduled mental health visits and for scheduled medical visits, including follow ups and medication checks, and on demand visits for urgent care.
Patients use the tablet provided by LISH to log into a virtual waiting room at the time of their appointment. They select the provider they are scheduled to see. The provider logs into the system and selects the patient from the list of waiting patients. This activates the video and both parties can see and hear each other. The patient can see both the provider and themselves on the screen. “Video lets us see our patient’s expressions and body language, as well as hear what they or their caregiver has to say, which makes it possible to assess, diagnose and treat many conditions,” says Dr. James Powell, chief medical officer and interim CEO at Long Island Select Healthcare.
LISH launched its telehealth initiative as a pilot program, choosing a selection of patients to try it out. It took some conversations to explain the process, the benefits and the technology to the selected patients and their advocates and caregivers. “We got them excited about the convenience, flexibility and safety aspects of telehealth, and praised them for being the trailblazers,” Powell says.
To get started, LISH selected upcoming appointments and arranged with patient and provider to make them telehealth visits. Those early video appointments were important learning experiences. LISH staff helped patients through the inevitable challenges with connecting to wifi, exploring boosters and hotspot solutions. Team members went to each patient’s residence to help with the first, second and even third video visit. Staffers also made reminder phone calls before scheduled video appointments, so the patient or group home staff would remember to use the tablet instead of get in the car. “We responded as quickly as we could to each hurdle so we would not lose momentum or trust,” Powell says. “Fortunately, when patients have a successful visit from the comfort of their own home, they love it and are motivated to do more.”
Today, LISH has 187 patients taking advantage of telehealth options. We continue to learn and refine our approach. And we are more convinced than ever that being able to offer virtual visits and other types of virtual care will enable us to take superior care of our patients.
Creating a hybrid approach
Of course, not all healthcare visits can be handled via video or phone. There are times when a provider needs to examine or treat a patient in person. But experienced telehealth providers say that’s the beauty of telemedicine: They’re able to conserve time so that they have more time to spend with the patients who really need their attention in person.
“Level 1, 2 and 3 visits take up precious office hours, resulting in longer wait times for patients with more demanding needs,” says Samant Virk, M.D., a neurologist and founder of MediSprout, a telemedicine platform that allows doctors to quickly implement telehealth into their practices. “By using video for straightforward, low-complexity visits like maintenance check-ins and prescription refills, doctors can reserve in-person time for level 4 and level 5 visits.”
For instance, telemedicine visits are ideal for most medication refills, minor urgent care (such as UTIs, colds and rashes), diabetes and hypertension follow up, lab results, post-op visits, birth control and fertility, and mental health, says Tisha Rowe, M.D. founder of telemedicine platform RoweDocs.
While it is important for people to be exposed to telehealth and understand its benefits, Sashini Seeni, M.D., general practitioner at DoctorOnCall, cautions against substituting in-person visits to diagnose illnesses with telehealth consultations. “Telehealth functions not to diagnose but rather to reveal a list of possibilities regarding your symptoms,” Seeni says. “A proper diagnosis is made with proper history taking with examinations and necessary investigations. When it comes to non-diagnostic medical advice, it is convenient to get it from a telehealth platform. It saves time for both the patient and the healthcare professional.”
Prepping a practice for telehealth
At LISH, it was easy to get providers engaged and excited about telehealth: “Everyone recognizes it is the future,” Powell says. But it took some time to develop the infrastructure needed to facilitate telemedicine.
For instance, LISH contracted with an IT team to get up to speed technology-wise. It needed robust internet access, computers updated with cameras and microphones, and new laptops. Practice leaders also had to restructure some roles, create procedures for scheduling, and create new telehealth fields in the EMR (although it has not yet integrated telemedicine with the EMR). Training staff—including call center, schedulers, providers and care coordinators—is an ongoing process, Powell says.
However, some cloud-based telemedicine platforms are positioned to help providers manage a quick and smooth transition to video healthcare visits. Some platforms can get providers up and running in a few days or less.
Getting patients on board
Offering telemedicine options can reduce demands on crowded medical facilities and create cost-saving, resilient healthcare systems, Seeni says. However, to capitalize on the benefits of telehealth, patients must be willing to give the method a try.
Not every provider or practice has the bandwidth to send staffers into patients’ homes for the first few video visits, like LISH. Instead, Rowe recommends teaching patients to use the telemedicine app while they’re in the office so they will have it ready and understand how it works when they need it.
Some physicians worry that their elderly patients—those who may need to stay away from crowded offices most—will resist using telehealth technology. But that’s not necessarily the case, Rowe says. “It may take longer for them to adopt it but once they do, they love it,” she says. “Telemedicine allows elderly patients to maintain their independence. Those who rely on others for transportation are no longer bound to others for appointments. It also allows family visits so they don’t have to relay info to family members.”
Once they’re accustomed to the technology, patients largely value the convenience and personal attention available with telehealth visits. “Besides being safer, telemedicine saves time and money,” Rowe adds. “I have patients doing visits from work, home, in the car and even at Target.”