Telemedicine grows during COVID-19. Here’s why it may be here to stay

Telemedicine, developed for NASA in the 1960s, has come of age as patients have sought medical attention online while ordered to stay at home and socially distance during the new coronavirus pandemic.

Kimberly Rene of Ferndale is one of those patients.

Rene, 48, has been treated for epilepsy and unspecified seizure disorder for two decades. She does not drive. A round-trip bus ride to St. Joseph hospital in Bellingham takes three hours. Add a one-hour appointment and her doctor’s appointment consumes four hours of her day.

Since the start of COVID-19, she has had two video visits with her medical doctor and one with her neurologist.

“This is the way I prefer to do it, if it’s an option,” Rene said. “It’s so much more convenient. I had more time. I was more relaxed. The doctor seemed more relaxed. It felt just like I was talking to him in my living room.”

Rene said she could understand how the process might be intimidating for someone who isn’t tech savvy, but they should not let that prevent them from the experience. Hospital personnel called her ahead of the appointment, walked her through the process step by step, and placed her in a virtual waiting room.

“It was just like Skype,” she said. “The doctor was on time. It was just great.”

PeaceHealth, Family Care Network and Northwest Gastroenterology are among local medical practices offering telemedicine or video visits.

What can be seen by video?

Almost any reason for a visit can be done via video. Here are just a few examples:

▪ General wellness check.

▪ Skin concerns such as rashes and wounds.

▪ Chronic conditions such as diabetes and heart disease.

▪ Medication review and refills.

▪ Mental wellness such as stress and anxiety.

At PeaceHealth, most video visits are for primary care, said Dr. James Bochsler, vice president and medical director of PeaceHealth Medical Group Northwest Network.

COVID-19 Testing

“Video visits allowed physicians to keep patients safely at home and continue their important medical care,’ Bochsler said. “We also used it to evaluate patients who are fearful that they may have COVID and then allow us to order the testing.”

Since April, PeaceHealth Medical Group has held more than 16,000 video visits; in the Northwest network, it has done more than 5,600. The average appointment is 20 minutes but varies. The most common video visit is a follow-up for chronic medical conditions.

Most physicians seem to like video visits, Bochsler said, but, as with any new process, others are more reluctant.

“Video visits are excellent for most of our common visit types. They are commonly used for follow-up visits, medication check-ins, and follow-up of mental health conditions (depression, anxiety),” Bochsler said. “We also have them available for certain types of acute visits that do not require an extensive physical examination and are now doing Medicare wellness visits using telemedicine. “

The facial features and tone of voice are actually quite good at expressing emotions such as empathy or compassion, Bochsler said.

“Other than a hug (which we all miss) or touch, it is very like an in-person visit for this,” he said.

On the flip side, video visits are not ideal for acute visits that require a physical exam such as abdominal pain or a cough when there is a need to listen to the lungs. Many rashes can be evaluated by a video visit but the clarity is not as good yet, so we oftentimes need to get a picture or to see somebody in person for these, Bochsler said.

Vital signs or clinic tests such as hemoglobin A1c cannot be done over video so some follow-ups and medical checks that require vital signs may need to be done in person, Bochsler said.

“We are doing some child wellness exams but cannot give vaccines over the video visit so many of these will require a face-to-face visit,” Bochsler said. “We also cannot do a full physical exam over the video so we will need to see patients for wellness exams that require physical exam such as for sports physicals.”

Bochsler said the process is safe and has been widely used. If there are any concerns identified in the video visit that require a face-to-face, providers can convert to a face-to-face visit quickly if needed, he said.

PeaceHealth uses a special Zoom platform for healthcare that is encrypted and can only be accessed through its portal (My PeaceHealth), so it “very safe and much safer than the typical Zoom meeting,” Bochsler said. Recording in this version of Zoom is not possible.

Video visits can be done with any device (smartphone, tablet, computer) that has a video camera and microphone and can connect to the internet.

A support person can be invited after the start of the video visit. They cannot just call in on behalf of the patient, as this would create a security issue, Bochsler said.

Video visits are charged as a clinical visit and the charge varies depending on the complexity of the visit.

As of now, there is charge equity based on state and federal guidelines. Outside of the COVID time, these are billed similarly to a face-to-face office visit but may not be exactly the same.

Convenience, security

Insurers are paying for video visits just as they do for traditional visits, according to Dr. Miriam Shapiro, a family practice physician at Family Care Network.

At Family Care Network, telemed visits are great for situations in which the history, careful questioning about symptoms and associated conditions, and medical counseling about treatment and next steps are what is needed to diagnose or follow up on a medical situation, Shapiro said.

“They are also fabulous for people who live remotely, can’t take routine transportation, or are homebound. In this time of COVID, it reduces the need to leave home if you don’t have to,” Shapiro said. “Or if you have a reason that you can’t come to the office easily, such as having several small children or not driving, it can be really convenient.”

Telemed visits are great for a re-check on medical conditions that may not require a physical exam, mental health follow-ups, lab or imaging follow-up visits, problem review and medication renewal visits, counseling about medical concerns, and some prevention and wellness visits. It’s also very helpful for visiting seniors with their families to check on the home situation or end-of-life care. They are very useful for evaluations of minor illnesses and injuries as well, Shapiro said.

It has been used for the evaluation of symptoms that might be concerning for COVID-19, without the risk to patients, healthcare workers, and the use of scarce personal protective equipment resources, Shapiro said.

“We were able to reassure a lot of patients, and send others for in-car lab testing without them having to come in.” Shapiro said.

“As well, we have been able to see a lot of our patients for their routine prevention, follow-up, and acute care needs,” she said.

Shapiro said she thinks Family Care Network will see many people continue to use telemed visits because of the convenience and safety they offer — as long as the insurance companies continue to pay for them.

“We have been interested in this way of providing care for quite a while before COVID-19, and were in the process of rolling this out one clinic at a time, but when COVID-19 hit, our amazing technology committees and leadership fast-tracked it — what was expected to be an 18-month process was mobilized for our entire network in a week, and we were the first medical group in the area to offer telemed services, starting in the first week of March,” Shapiro said. “We also have a great patient portal system which has been improved even further during this pandemic — you can schedule an appointment, review your lab results, receive certain documents and imaging orders, and communicate with your provider in a more direct and convenient way.”

Personally, Shapiro said, she could not be prouder of the leadership, technology and all the support staff for their innovation and responsiveness during this pandemic.

“It has been an incredibly hard time for all of us in health care, and they all went the extra mile to enable us to take care of our patients in new and better ways,” Shapiro said.