_WELLNESS / TELEHEALTH
Your Quick and Easy Guide to the Pros and Cons of Telehealth
Everything you need to know
If you haven’t used it, telemedicine can sound like the stuff of a dystopian sci-fi movie. That describes about half of us. In March, 42% of Americans were unfamiliar with what telemedicine is, according to one survey. But within weeks, 60% (in the same survey) said they would consider using it. What happened? COVID-19
Who is this 60% and what was their first experience like? According to a very informal JUNIPER survey on Facebook, only 3 out of the 25 comments was ‘meh’. People said:
- “Had a video appointment with my new cardiologist. It was great, easy, stress free”—(man in his 50s)
- “My husband had one in early April that I sat in on. It was fantastic. No driving over there, frantically circling for a half hour for a semi-legal parking space, waiting in the packed outer waiting room for 45 minutes and then waiting another 20
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is telehealth right for you?
minutes in the inner room. She called, we talked for about 15 minutes and were set. (40s woman)
- “A 15-minute appointment took 15 actual minutes, not an hour and a half of aggravation. LOVE telemedicine!”— (couple in their late 40s)
- ”Phone shrink….almost as good as in person.” (woman in her 60s)
- Many people had made appointments with their vet for telehealth appointments and said they also went really well and saved time.
In a pandemic, connecting via live video on your computer or smartphone keeps far from potentially deadly exposure to coronavirus in doctor’s offices and emergency rooms. Still, critics warn, don’t underestimate the healing power of human touch and examination and face-to-face conversation. So who’s right?
Both views are valid, says Kimberly Noel, MD, MPH, telehealth director and deputy chief medical information officer at Stony Brook University Hospital in New York. Dr. Noel has been part of a multi-department team that used Microsoft Teams to create training for top-down training of department specialists to medical students giving free lectures on telehealth in the community.
Dr. Noel, who incidentally had COVID-19, is happy to be fully recovered and back at Stony Brook treating older patients and people with disabilities using telehealth. She gave us some quick and easy to understand guidance:
WHAT IS TELEMEDICINE? IS IT SAFE? The World Health Organization (WHO) defines telemedicine as “healing from a distance” or in other words, the ability to get medical help remotely. Patients use telemedicine in three basic ways:
- Live medicine Doctors, caregivers and patients interact in real time via teleconferencing (on a computer or tablet) or using a smartphone (usually by downloading a secure app, similar to Zoom.)
- Patient monitoring Caregivers and physicians can check in regularly using mobile monitoring devices, such as a blue tooth blood pressure cuff or stethoscope. This is helpful for people with chronic illness, says Noel, and will change the home care industry dramatically in coming years.
- Electronic records sharing Hospitals, pharmacies and EMS can share your records confidentially, eliminating the hassle of transferring paper documents via fax or mail. “During the pandemic, many states and providers loosened or changed laws so that patients could better navigate what were common hurdles—such as billing, and getting reimbursement,” says Dr. Noel.
There are still a lot of kinks to be worked out. But the Centers for Medicare and Medicaid Services expanded Medicare coverage of telehealth services. That funding is targeted at helping older Americans to opt for virtual care from the safety of their homes during the pandemic. “Policy is now being forced to adapt to technology,” said Dr. Noel, who has been using telehealth to work with patients who have multiple disabilities and limited mobility. More than half of employers have at least temporarily waived telehealth costs during the pandemic. Still, many Americans view telehealth with at least one eyebrow raised, wondering where their data is being shared and how to protect their privacy if they opt into using electronic records. The standard answer during the pandemic is this: health companies can protect patients’ privacy while still profiting from presumably aggregated, anonymous data. “Post-pandemic tech companies will need to step in to provide the best security and maintain HIPAA confidentiality,” says Dr. Noel.
IS TELEHEALTH RIGHT FOR YOU?First, let’s dispel the myth that you need to be a tech wizard or even vaguely interested in computers to use telemedicine. It’s much easier to use than many might expect. That’s welcome news particularly because in the next 10 years, more than 1 in 5 Americans will be over age 60 and more than 1.3 billion Americans will have some type of disability. Many will want the option of at-home monitoring and welcome offers of virtual care. The top three drivers of telehealth will sound pretty familiar. People who need monitoring, or who have some vision, mobility or transportation issues are big supporters of telehealth
If you have ever waited 50 minutes for a five-minute appointment with a doctor or filled out the same basic health form three times in the same day, you can see the upside of electronic records. Patients in a J.D. Power study valued how easy it was to enroll and the ability to resolve their questions over a smartphone or computer. If you have a chronic condition, such as pulmonary disease and sat in the car most of the day crisscrossing the city to see specialists, you will also welcome home monitoring.
IS TELEHEALTH SAFE? In a pandemic, not visiting the doctor’s office in person could be the safest way to get care, particularly for groups considered to be at high risk for COVID-19. This includes people with underlying or chronic conditions, people with disabilities and anyone over the age of 60. If you chafe at the suggestion that being a certain age or having a disability means you are ‘weak’—don’t. It’s not a judgment, it’s a fact: tangling with an unpredictable, gnarly virus like COVID-19 is riskier for you. Period.
Patients with addiction-abuse problems and depression have also found that making regular appointments and getting the medication they need is easier. That’s mostly because the government has made certain practices, such as medication evaluation via Facetime or another video app and electronic (versus paper) transmission of prescriptions possible. These would have both been illegal months ago
The electronic record-keeping used in telemedicine can also save valuable time in an emergency. Telehealth consultations can be used by EMS and remote urgent care doctors. In a review of 22 EMS and 19 ER studies, emergency telehealth consultations telehealth decreased the time it took to make decisions, transport and treat patients, according to the Agency for Healthcare and Quality. “Healthcare workers want to ensure that everyone has access to safe, effective and appropriate care when and where they need it,” said Dr. Noel.
HOW IS TELEHEALTH HELPING THE DISABILITY AND AGING COMMUNITIES? The American Telemedicine Association will hold its upcoming virtual ummit amid the chaos of the pandemic and they are approaching it with a new sense of purposefulness, prioritizing patients with disabilities and seniors living at home. Where speed and convenience were once top of the list, now relationship-building and autonomy are the focus of inclusive innovation, says Dr. Noel.
“Coronavirus did more for advancing the need for innovation in helping people with disabilities and preparing older Americans to be in control of their care than anything in the past decade,” says Dr. Noel. Americans don’t need to look much farther than the news on nursing and adult day care facilities to see the system is broken. “At Stony Brook we had already been trained using Microsoft Teams to collaborate, quickly coordinate and give leadership a strong voice,” says Dr. Noel. “The idea was to be ready for a crisis that could span across several departments and locations—and we were.”
To imagine how remote medicine still fosters human to human interaction, Dr. Noel offered some detail on the tools that patients and caregivers are using successfully. “It’s common now to use tooth blood pressure cuffs and electronic stethoscopes that can record lung and heart capacity,” says Dr. Noel. “Instead of underestimating what we think people high-risk patients can do, we are approaching this pandemic as a way to reset habits and learn new things using technology,” says Dr. Noel. “While telehealth will not replace clinical care, because human touch and interaction is so important, telehealth, whether for caregiver check-ins and therapy or chronic conditions is a potent tool in the right hands at the right time.”