Ready or Not, COVID-19 Put Telemedicine on the Fast Track

Will you ever go to a doctor’s office again?

If life before COVID-19 was a volcano of activity, with hot red flows in constant motion and jets of super-heated air blasting into the sky, pandemic life has a post-eruption feel with lava slowing, cooling, and freezing into blackened shapes. The activity, though, is not gone. It’s still flowing briskly underneath the surface because it must. Life continues in any way it can and it still has many of the same needs.

 Lifewire / Julie Bang

COVID-19 did not, for instance, make our physiologies any less complex or our bodies less-fragile or susceptible to damage and illness. It’s true, hospitals are seeing fewer broken bones, heart attacks, and attacks of appendicitis. However, chronic illnesses and mental health issues persist, and the sporadic, unexplained malady emerge daily. We still need our doctors, our therapists, checkups, and support. And the healthcare professionals need ways to see below the surface, beyond our disconnection, to help us stay well and survive. We all need telemedicine.

In my home, we’ve already used iPhone cameras, phone calls, and video to connect with doctors on everything from regular therapist check-ins to post-op consultations. It’s been a bit of a roller coaster ride. In the early days of the stay-at-home order, one video call was upended because, as far as we could tell, the telemedicine system’s servers were overloaded. In another instance, the app we were told to download failed and the surgeon resorted to post-op photos snapped by my wife with her iPhone and a voice call consultation.

person on video doctor visit
Telemedicine can look like this. PTZOptics

Portrait of a Phone

None of this surprises me. Until now, most telemedicine (aka “telehealth”) was viewed as a nice-to-have and infrequently used option, not the only avenue for millions of people to connect with their healthcare professionals.

“I had one or two doctors dabbling in it before, but it really was a mad dash for everyone to get implemented in the last few weeks.” said Julie Chiesa an 18-year healthcare IT consultancy vet who runs InfoDirectors.

One of her clients, Alan K. Matsumoto, MD, understood that telemedicine would eventually be part (a small part) of his Arthritis and Rheumatism Associates practice in Maryland. The practice’s current electronic medical records provider NextGen even had a nascent telemedicine system, but it was not ready when the pandemic hit. “We were in a panic, primarily to take care of our patients,” said Dr. Matsumoto.

Patients Care

The lack of preparation is, for some, still on display. Those I spoke to on Facebook about their own experiences with telemedicine describe an industry in transition, with doctors, healthcare professionals, and their patients still feeling their way around.

“Honestly, the whole process felt like when I first got my medical marijuana. It was disorganized and felt kind of like a fake doc visit,” said author and tech industry pro Seth Meyerowitz. He had no fewer than four separate video conference calls for one gout medication refill, including chats with the physician’s assistant, the receptionist, an office manager, and the doctor.

Before the pandemic 0 percent of Dr. Matsumoto’s practice was telemedicine. Now? 'Of the practice we’re currently doing, it’s well over 90 percent.'

They asked him to show his foot to the screen and to take his own heart rate with his hand by checking his pulse and counting until they told him to stop.

Someone else on Facebook described a doctor asking him if he had his own blood pressure cuff and another described their screen freezing mid-checkup.

Others, though, sounded pleased with the experience. Perhaps this is because doctors and their practices are adapting, too.

Before the pandemic 0 percent of Dr. Matsumoto’s practice was telemedicine. Now? “Of the practice we’re currently doing, it’s well over 90 percent,” Dr. Matsumoto told me.

What Changed?

Even though remote medical treatment is now a necessity, it would not have been possible at this scale without key changes to the healthcare system.

Starting late last month, Federal and State governments relaxed telemedicine rules, allowing doctors to start using non-Health Insurance Portability and Accountability Act (HIPAA) compliant video platforms. From the Health and Human Services update: “A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients.”

The law changes allowed Dr. Mastumoto to mix and match a telemedicine system with whatever their customers were comfortable using, including Skype or FaceTime.

What They Use

Much like consumer technology, there is no standard set of tools for connecting with and evaluating patients on telemedicine. Especially with the relaxed rules, there are a wide variety of software solutions colliding with a sometimes “what’s on hand” collection of hardware.

Among the platforms healthcare providers are using: 

 Chiesa, who has been helping healthcare professionals implement telemedicine systems for weeks, said that the systems integrate with doctor’s existing documentation systems. The learning curve is on the telemedicine side. I wondered about the tools these doctors use. Is it all iPads and iPhones? Are they using standalone webcams or cameras integrated into their laptops? “I work with practices all over the country and I can truly say it runs the gamut,” said Chiesa.

That relaxing of HIPAA rules is also helping insurance companies get on board with covering these video-based checkups and consultations. “No one was really ready for it because the payors weren't really paying adequately for telemedicine until the pandemic,” explained Chiesa.

People on video call
You can choose how you want to communicate with your doctor. (Getty). Getty Images

The Time is Right

Despite the hodgepodge of solutions, there may be no better time than now for the use of telemedicine. At the turn of the century, homes and offices lacked fast and reliable broadband access and mobile broadband didn’t exist at all. Few owned cell phones with cameras and feature phone screens were tiny with low resolutions. While some consumers (and maybe doctors) owned webcams, they too were low resolution, and few had computers or laptops with integrated cameras.

It’s not just connectivity and hardware that wasn’t ready. 20 years ago, “electronic medical records had really just started to show [up]. Doctors would’ve been relegated to phone calls or even house calls again,” said Chiesa.

Kinds of Treatment

Telemedicine is, obviously, not going to replace surgeries or dental work. I, for example, have been walking around for two months with a temporary cap that was supposed to last me two weeks.

Some practices, like Dr. Mastumoto’s, which focuses on arthritis conditions and auto-immune disease, would still prefer face-to-face consultations. “A lot of things [like drawing blood and injections] we can accomplish in person that we can’t over phone,” said Dr. Matsumoto, adding, “Also, we’re all trained in that physical examination.”

For general checkups, even those that require some diagnostics, though, the potential is there. We’re already wearing Apple Watches (and other wearables) that can check our heart rate and take electro-cardiograms. Companies like Aetna have been working with Apple for years to integrate these smart watches into their healthcare regimens. Ultimately, that digital data is portable and should be available to your telemedicine professional of choice. There are obvious limits. Even the most routine blood draw requires a lab tech, though some can come to your home.

For mental health services, telemedicine can be a godsend. Therapists and psychiatrists don’t necessarily need to sit in the same room with patients and a phone call (or even texts) can do in a pinch. Still, telemedicine’s video component provides a crucial layer of emotional connection.

Doctor visit
Without 21st century technology, we'd be back to house calls. Yours, Mine, and Ours / Desilu Productions/ Fandango

Good Medicine

In any other age, telemedicine might have continued its slow, plodding path to most of us having experienced it at least once. However, in the age of COVID-19, telehealth is suddenly a nearly universal experience. Unless you need emergency room care or are suffering from the worst effects of the COVID-19 virus, your doctor will try to treat you at home.

Even though things are happening quickly, the telemedicine experiences people reported to me were, with some caveats, surprisingly positive. “Everyone seems to be finding their way during these uncertain times,” said Meyerowitz. “I found the process to be more convenient as well as safer than leaving my house and visiting a doctor’s office. However, the process was a bit messy and leaves a lot of room for improvement.”

Sheila Gagen, a full-time editor who works from home, described to me a telemedicine appointment she had with a new doctor (not uncommon in telehealth situations) to go over test results. She told me the doctor “explained everything thoroughly and encouraged questions.” While she did eventually follow-up with an in-office visit, “I probably spent more time talking with her remotely than I would have in her office. It was great.”

Getting Ready

A telemedicine visit is a lot like your first video conference call and there are ways to prepare. I got these smart tips from Chiesa:

  • Check technology prior to the visit
  • Make sure video and audio work
  • Check if you need to download a specific telehealth app
  • If you’re on a desktop or laptop, check if the software requires Chrome instead of Internet Explorer
  • Be prepared: Have all your histories/medication lists readily available.

So What

The COVID-19 Pandemic will end and much of life may return to normal, but the lessons we’ve learned here, especially about healthcare, will be long-lasting and may have permanent effects. Doctors who successfully treat and care for patients via video may ultimately find telemedicine more efficient and routine office visits could become a thing of the pre-pandemic past.

Even Dr. Matsumoto, who prefers in-person visits knows the genie is out of the bottle. “I do think that the comfort level of doing this has increased dramatically for all of us and it’s a skillset that we’ve had to learn, and I think, personally, I’ve gained more respect for the skillset of doing telemedicine. For certain patients and certain areas of country I think telemedicine will increase dramatically.”

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