GLMS EVENTS
TELEHEALTH IS HERE ! IS MEDICINE CHANGING ?
On Tuesday , Dec . 8 , 2020 , the Senior Physicians Committee
met to listen to Dr . Mary Barry speak on telehealth and the way it is changing medicine . Dr . Barry is a retired internal medicine physician , formerly with Norton Healthcare .
Dr . Barry opened her talk to the Senior Physicians Committee with a line that resonated throughout her presentation : the eyes tell the story . Of course you can see a patient ’ s eyes during an in-person visit , but you can also look into their eyes through a computer screen . Sometimes , the eyes can give you a clear diagnosis ( earlier this year , Dr . Barry was able to diagnose a patient with COVID-19 just based on the appearance of his eyes ). Sometimes the eyes can simply hint that there is more lurking below the surface .
In all of her “ maybe has COVID-19 ” appointments , Dr . Barry has her patients walk 200 feet quickly or walk up and down the stairs two times . Unconventional methods like this allowed her to examine a patient ’ s breathing without actually being able to hear their lungs . This has been especially important with diagnosis of COVID-19 , other chest infections and asthma .
There are three usual types of televisits , she said : clinician to patient at a health facility , clinician to patient at home or other private setting , and clinician to clinician .
Clinician to a patient at a health facility involves bringing in a specialist on video chat . For example , if a practitioner needs a consult from someone at another institution , they might have an interview and specialist-guided exam with the patient to determine a diagnosis . This is similar to the clinician to clinician form of telehealth where one physician might use a phone call or video to ask advice of another . Both of these methods have been used for years and many physicians are familiar with them .
The onset of COVID-19 , however , shed light on the second form of telehealth , what is being called “ telemedicine .” Telemedicine occurs when physicians or other practitioners ( counselors , APRNs ) are in their home or office , video conferencing with a patient somewhere else , often in their own home . This has proven to be beneficial for many reasons , Dr . Barry says . Patients typically enjoy these visits as they do not have to leave home ; they ’ re in a space that ’ s more comfortable emotionally and physically .
Physicians have found benefits to telemedicine as well . According to a report from the American Medical Association on Dec . 3 , 2020 , more than 75 % of respondents to their Telehealth Impact Physician Survey said that telehealth has enabled them to provide quality care for COVID-19 related care , acute care , chronic disease management , hospital or emergency department follow-up , care coordination , preventive care and mental or behavioral health . Sixty percent reported that telehealth has improved the health of their patients .
However , all of these visits are now allowable under Medicare rules only because of the national Public Health Emergency / Section 1135 Social Security Act Waiver . That expires on Jan . 22 , unless renewed by both the President and the Secretary for Health and
20 LOUISVILLE MEDICINE
AUTHOR Kathryn Vance
Human Services . If allowed to expire , payment for nearly all such visits stops at midnight , Jan . 21 .
While telehealth does have its benefits , there are also drawbacks , she says . “ Getting to yes ,” that is , getting connected for the appointment , sometimes filling out multiple screens for informed consents , etc ., can be difficult . Hearing and seeing each other on video , language barriers and speech problems all interfere with getting the e-visit opened . If the patient is unable to access video , they can switch to a phone call , but then we lose the ever-important eyes . Dr . Barry also says that it ’ s more crucial than ever for patients to remember care instructions given by their provider . This means that if a responsible family member attends regular doctors ’ appointments with the patient , then they should do so during telemedicine appointments , as well .
Dr . Barry also discussed the technology involved in “ robo-docs .” These machines allow for a consult from a specialist anywhere in the country to be a part of the patient ’ s care . Especially in rural Kentucky hospital emergency rooms and intensive care units , the distant doctors fill a vital role in acute stroke consultation with Dr . Kerri Remmel ’ s teams at the University of Louisville , for instance . Small , rural hospitals across the country are struggling to keep any doctors on staff - out West , the nearest family doctor might be 150 miles away . But the virtual ER / ICU doctor is able to talk nurses through emergency procedures such as intubating a patient , running a code , triaging a patient , setting a bone , stabilizing the spine , urgent burn care , etc . The nurses end up taking on advanced medical duties with the help of additional monitors , ultrasound wands , insertable cameras , etc ., all with minute-to-minute guidance from the live-video experts . Without the virtual doctors , the people of these communities would likely die on the long , long ride to the referral hospital .
With all of the benefits and obstacles concerning telehealth and telemedicine , it ultimately comes down to what has always been a top priority : making sure that you are providing the best care possible for the patient . When determining if a patient should come into the office for a visit or if they can use telehealth , ask yourself : is it worth the risk for COVID-19 infection for either your patient or your staff ? Use telehealth opportunities for safety - for yourself and your staff , as well as your patients . But make sure to remember first , what the patient needs , and what matters to them .
“ The connection is really what it ’ s all about , medicine has always been about connections ,” said Dr . Barry . “ Whether it ’ s in person or it ’ s through a screen , if you don ’ t connect with somebody , you ’ re not taking good care of them at all .”
The next Senior Physicians Committee meeting will take place on Tuesday , Jan . 19 , 2021 at 12:00 p . m . via Zoom . The speaker will be Dr . Mary Helen Davis on the topic of " Communication in Good Times and Bad Times ." For more information , email Mary Hess at mary . hess @ glms . org .
Kathryn Vance is the Communication Specialist at the Greater Louisville Medical Society .