Over the past year, the COVID-19 pandemic has forced some big changes in the world of medicine, making telehealth much more widely available than ever before. Although the pandemic is beginning to fade, it looks like the telehealth expansion is here to stay. Read on for a detailed overview of telehealth and what to expect from a virtual doctor’s visit.
What Is Telehealth?
Though it may feel very 21st century, telehealth is not a new concept. With the advent of the telephone, the idea of telehealth soon emerged. An article in the Lancet medical journal describes the history of the telephone in medicine, starting with Alexendar Graham Bell’s momentous invention in 1876, and the rapid awareness of telephone’s potential to reduce unnecessary office or home visits.
As technology has continually developed since, the push to offer more services remotely has increased, and today, telehealth is exploding in popularity.
You may be seeing multiple terms related to the delivery of health services in a remote way. Telehealth is the more common term, but telemedicine is also used sometimes. Though they’re technically different terms, these days they’re used largely interchangeably by most health organizations, says Dr. Megan M. Chiarelli, a psychiatrist and medical director of behavioral health integration with the Facey Medical Group in Mission Hills, California.
A virtual visit is another term that typically connotes “live, two-way audiovisual communication,” Chiarelli says, “but there are many other ways we use technology to provide the right care at the right place and right time.”
Remote Patient Monitoring
Remote patient monitoring uses digital tools to collect medical and other health data and transmit it to a health care provider.
MHealth refers specifically to health care services delivered via a mobile device.
EHealth is a catch-all term related to electronic-based health information and services.
William England, a former director of the Office for the Advancement of Telehealth in the Federal Office of Rural Health Policy at Health Resources & Services Administration, an agency of the U.S. Department of Health and Human Services, says that while many of these terms are still in use, “somewhere in the mid-2000s, we started to call it all telehealth,” which has become sort of an overarching term for all health care services that are delivered remotely.
What Services Can Be Provided Via Telehealth?
“Almost anything can be conducted” via a virtual visit, England says.
But certain types of visits may be more amenable to a telehealth model, says Dr. David R. Stukus, associate professor of pediatrics in the division of allergy and immunology at Nationwide Children’s Hospital in Columbus, Ohio. “Visits that don’t rely heavily on detailed physical exams or in-office diagnostic testing are optimal for telemedicine. This includes behavioral health, follow-up visits for many chronic medical conditions and new patient visits where a detailed clinical history can provide sufficient information to offer an informed diagnosis and treatment plan.”
Chiarelli adds that “the history the patient provides is always one of the most important pieces of a medical visit. With telemedicine, we can still gather all of the history and many important pieces of the examination.” Labs, studies, a referral to a specialist or a face-to-face visit may still be necessary later, but that can come after the remote gathering of that important medical history.
Some situations where telehealth can be especially useful include:
— Follow-up appointments. Primary care and urgent care where the provider is following up a previous visit or checking in with the patient to determine whether more direct care is necessary. If medications are needed, the prescriber may be able to send a prescription directly to your pharmacy.
— Medication management. For people with chronic conditions that require prescription medication, such as diabetes or high blood pressure, a routine check-in is often necessary.
— Behavioral health services. Mental health services and counseling are usually talk-based and typically require no hands-on care from the provider, making these services especially well-suited to remote delivery.
— Health screening. In the current crisis, a virtual doctor’s visit is a smart way to reduce the potential for transmission of infection. Many doctors and health care centers are offering remote screening options for COVID-19, says Dr. Joseph C. Kvedar, vice president of connected health at Partners HealthCare and a professor of dermatology at Harvard Medical School. “Checking if someone needs the test and following people who are quarantining with mild symptoms is mostly about asking questions,” which lends itself well to a telehealth approach, he says. Other health screenings, such as hearing tests for kids and cognitive testing in older adults, may also be offered remotely.
— Rural specialty care. England says that in some cases, which may be more common in rural settings, the patient will go into the office of their primary care provider and from there will connect via an audio-visual connection with a specialist provider — who may be in another hospital or health care center hundreds of miles away. This approach can extend the reach of providers who can’t physically get to more rural locations and enable rural patients to more easily access specialist care at a larger, urban institution.
Dr. Alan H. Beyer, executive medical director of the Hoag Orthopedic Institute in Newport Beach, California, says that in light of the current pandemic, telehealth has been a good option for his practice. “Just because you are at home, injuries and falls can still occur. I’ve really enjoyed introducing telemedicine into our practice as we try to help patients that may not have a lot of options. It keeps many patients with minor orthopedic injuries out of the ER or urgent care.”
It’s still possible to collect important information regarding vital signs and other basic health indicators remotely, Stukus says. “A current weight using a typical scale is helpful. We can counsel patients on how to check their heart rate and can count respirations through video. Home blood pressure cuffs have been used for decades, and many adults with chronic conditions already have these available to use, or they can obtain if necessary,” he says.
Even dentistry has some partial telehealth options, England says. There are some services that a hygienist can perform “with simple portable equipment that can be taken anywhere,” and then a dentist can be patched in to meet with the patient via a video monitor.
Though telehealth is naturally devised for services that don’t require a physical examination, there are still options for remote monitoring of patients.
How Devices Can Help
Particularly with diabetes care and monitoring, telehealth can be a good option for many patients, says Kellie Antinori-Lent, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center – Shadyside Hospital and immediate past president of the Association of Diabetes Care & Education Specialists. “Many blood glucose monitors have the capability to upload to the internet,” she says, which allows your doctor or diabetes care specialist to keep an eye on your sugar levels remotely.
Other devices such as blood pressure cuffs, digital thermometers and even spirometers (devices that measure air flow for those with asthma, COPD or other lung diseases) “are all relatively inexpensive at the consumer level and can be connected to transmit data electronically,” England says. These peripherals can help your doctor get nearly the same amount and quality of information regarding basic health markers as could be gleaned in an office visit.
Who Is Telehealth For?
Telehealth has long been an option for some patients who live in rural areas who would have to travel long distances to be seen in person by a provider. Because of the current COVID-19 pandemic, providers are now able to offer this type of delivery method to many more patients regardless of where they’re located. For example, Beyer says that “as an orthopedic surgeon who is limiting practice hours and postponing all elective surgeries due to the virus, we are now seeing some patients via telemedicine.” This is primarily being reserved for patients who need a check-up and some post-op visits.
It’s not an option for all patients, he says. “New patient visits and certain joint movement problems, for example, are not well done by telemedicine as a physical examination is required. For those patients, we ask them to come into the office,” Beyer says.
Is Telehealth Covered by Insurance?
This varies based on where you live and the kind of insurance you have, but during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services has expanded virtual services. Many private insurers have also expanded what they’ll cover, and many states have relaxed restrictions on reimbursing providers for delivery of remote services.
What Equipment Do I Need?
To get the most out of a remote visit with your doctor or health care provider, ideally you should have the following:
— A telephone line.
— A high-speed internet connection.
— Video access through a smart phone, tablet or computer.
— Any app used by your provider to connect, which should be downloaded beforehand.
To connect with a doctor for a virtual visit, at a minimum you need a telephone line. These days, most providers are also looking to connect with you visually. This will require the internet, and a high-speed connection tends to work a lot better than a slower link. “Ideally a faster broadband connection provides a clearer picture without lag,” Chiarelli says, “but we can get by with anything that doesn’t drop the call.”
Stukus agrees. “The connection should be strong enough to stream video, but it doesn’t have to be the highest quality or speed available. If you can watch movies through your Wi-Fi connection, you have more than enough to get through a telemedicine visit.”
“If you don’t have that technology, you can still use the phone” to conduct a telehealth visit, Antinori-Lent says. A phone line can be a good backup option if the video call drops or the technology otherwise doesn’t work.
In addition to connecting via the phone or a video platform, “there are dozens of apps that are currently in use for telemedicine,” Stukus says. “It’s important for each patient to use the one that their personal medical provider is using on their system. They can all be easily accessed and downloaded onto any device.”
Before your appointment, check with your provider about their preferred platform and for specific instructions for when and how to access that service. Most medical offices have someone on staff who can walk you through any technical issues you may be having.
How Can I Prepare for a Telehealth Visit?
Here are some tips and suggestions for things you can do ahead of time to help make your virtual visit the best it can be:
— Make sure your paperwork is filled out. “We still need the same information regarding insurance and any forms normally filled out while sitting in the waiting room,” Stukus says. Check with your doctor’s office to be sure your paperwork is up-to-date and accurate beforehand.
— Make sure your doctor has the information they need. Antinori-Lent says it’s helpful to make sure that if you’re going to be meeting with a provider for routine care, such as diabetes management, you forward your blood sugars and other information the doctor needs prior to the call. That way, the provider can have it in hand and can review it prior to the visit, she says. This saves time and helps focus the call on the most important aspects of managing your chronic condition.
— Check with your insurance company. Because many rules surrounding telehealth have changed rapidly, it’s best to double-check ahead of time with your health insurance provider that the service you’re seeking to receive via a telehealth visit will be covered.
— Prepare like you would for any other appointment. Chiarelli says you should prepare for a virtual visit just like you would any health care appointment by taking a moment to jot down questions you have or symptoms you want to discuss. She also recommends having “any recent home monitoring you have done, such as glucometer readings and blood pressure readings” on hand. It’s also important to have a list of medications ready, or better yet, the medicines themselves, Antinori-Lent says. “That way, if you have the video aspect, you can actually show the provider the medication bottles,” so that there’s no mistaking what you’re taking and at what dose.
— Double-check your equipment. Check to make sure that your equipment is optimized. Check that the volume is up and camera access has been granted to the appropriate application before the call starts. “Make sure you’re prepared a couple minutes before the visit so that technological issues don’t delay your appointment,” Chiarelli says.
— Have a pen and paper ready. This is “to jot down recommendations the provider might have,” Chiarelli says. Though some providers will email you a summary note after the visit, it’s also helpful if you have taken your own notes during the call.
— Think about the setting. Do your best to find a quiet, well-lit corner to have your visit. Don’t sit outside, as there’s always extra noise and potentially wind noise that will interfere with the call. Sitting outside or in a busy location also compromises the privacy of your visit. Avoid positioning yourself in front of a bright window, as that obscures the view the provider will have of your face. Position your device so that your face is centered in the middle of the screen and the webcam is at eye level, so that your doctor can see your eyes. Use a stand to keep the device still.
— Consider having someone else join you. Depending on the type of visit you’ll be having and what will be discussed, it might be helpful to have a family member sit in on the call with you to help take notes or to raise other concerns with the provider if you forget something.
— Focus on the session. Just as you would during an office visit, eliminate distractions and interruptions during the virtual visit and give your provider your undivided attention. Shut off notifications on your cell phone and shut down apps that might create distractions or noise.
Stukus says that while it might seem daunting at first or a bit unusual, “once people get past the easy technological hurdles and participate in their first visit, many will prefer these types of visits moving forward.”
Antinori-Lent agrees. “I would encourage people to try it. I was a little hesitant too,” she says, while adding that telehealth can be a good complement to in-person support. “I have a dietitian colleague who asks to see the box of rice or whatever the patient is talking about. The patient can just walk into the kitchen, and then they look at the label together,” she says.
What Happens If I Need More Direct Care?
For visits such as check-ups and post-op care, Beyer says that “if we suspect something is seriously wrong, we will ask the patient to come into the office for an appointment.”
Kvedar, a dermatologist, says that for many common skin complaints, he can conduct the necessary visual check via a remote link up. But sometimes there’s a question about whether a particular lesion or rash needs to be investigated further. “If they were in front of me, I’d take a skin biopsy right there because that’s prudent.” But that can’t be done in a remote environment. Therefore, he’ll set up an in-office appointment for that biopsy.
In other instances, some doctors may refer you to a local urgent care center or emergency department or tell you to call 911. “We want to ensure you stay safe and healthy, so please don’t ignore or delay symptoms for which you otherwise would seek care,” Chiarelli says.
Concerns about what happens if you end up needing more intensive care than can be provided remotely is “one of the slight challenges” of telehealth, England says. And it’s important that the doctor offering the services have “a good handle on local resources where they can send patients,” he says. It’s a good idea for you to familiarize yourself with local emergency and urgent care resources, too.
What About Privacy and Security?
Despite the urgency of the pandemic that has loosened some restrictions around telehealth services, privacy and protecting your medical information is still a major concern. Your health information is private and should remain so. “We care a lot about privacy,” Kvedar says.
“We’re not using TikTok or Facebook,” Antinori-Lent notes, but platforms like FaceTime, Zoom and Skype are in wide use currently by many providers. “During this crisis, providers are using all kind of modalities,” Kvedar says. Your provider, who may be using a platform designed specifically for telehealth — such as Doxy.me or Teledoc — will let you know which platform they use, and you’ll be sent a link and instructions to connect via that system.
“Depending on your relationship with your doctor, you could ask her, ‘I like FaceTime. Is that OK with you?'” Kvedar says. The key is to find a means of connection that works for both patient and provider.
Is Telehealth Here to Stay?
It’s good to get comfortable with telehealth, as recent findings suggest that virtual visits are indeed here to stay:
— Only 43% of health centers were capable of providing telemedicine in 2019, compared with the 95% of health centers that used telemedicine during the pandemic, according to the Feb. 19, 2021 Morbidity and Mortality Weekly Report.
— With employee health plans, 53% of large employers expect to implement more virtual care options in 2021, with telehealth as their top initiative.
— Among hospitals and health care systems, the vast majority — nearly 95% — say that telehealth is a long-term strategy beyond COVID-19, according to the 2020 Telehealth Benchmark Survey.
For her part, Antinori-Lent says that she feels “very strongly about relationship-based care. Human interaction is powerful.” She feels there’s a certain something that’s gained by meeting with someone in person. “The cornerstone of good care is having a relationship with your provider,” she adds.
However, telehealth can be a helpful addition to a regular in-person practice and can provide strong continuity of care, particularly in the midst of this pandemic. Meeting with a provider remotely certainly beats not meeting at all.
“It’s the next best thing to being there,” Antinori-Lent acknowledges. And what’s more, “it does allow a level of efficiency — if you need to talk to your doctor about something simple, with telemedicine you can connect a lot more quickly and efficiently. There’s also a lot of cost savings and a reduced carbon footprint” associated with not traveling for every doctor’s visit.
Some inpatient care is being phased back in as COVID-19 is getting under control. Still, it seems likely that some of these more routine visits will continue to be offered remotely even after the pandemic subsides.
“It’ll be interesting to see what happens,” England says. “Now that we know that doctors can easily do electronic health calls, what will we expect in the future? It’s an exciting time for telehealth and good that we have the technology to do this.”
For the time being, Kvedar urges some patience among patients. “Every single software platform and doctor and health service is getting a huge spike in demand, and we’re bringing people on these platforms who weren’t planning on it.” It’s a process, and it’s going to take a little time until all the kinks get worked out. “I would say, be patient with us. We have your best interests and best care at heart.”
Stukus adds that “telemedicine is a fantastic way to provide high level care to patients who live far away, cannot be seen in person for whatever reason. COVID-19 may have accelerated our wide-scale adoption of telemedicine services, but this will not go away once we resume normal activities — it’s here to stay.”
Where Can I Get More Information?
The National Consortium of Telehealth Resource Centers has created a page of additional information and resources specific to the COVID-19 pandemic to help guide you through any additional questions or concerns you may have regarding telehealth services.
The Hawaii State Department of Health has also created an informative video about telehealth for patients. It provides a thorough overview of what patients can expect from a telehealth visit.
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Update 03/17/21: This story was previously published and has been updated with new information.