Tag Archives: Telehealth

Dr. C "Comments", Men's Health, TELEMEDICINE, Videos, Women's Health

TELEMEDICINE BENEFITS: PATIENT’S “CONVENIENCE & SAFETY” TOP THE LIST

Leave a comment

From a Permanente.org online article (May 11, 2020):

“Our patients are glad we offer telehealth options because they don’t want to come to the medical centers. This allows them to stay home and stay safe,” Dr. Lee says. “Before, telehealth was a choice and convenience, but now it’s one of the ways patients remain healthy with social distancing.”

The majority of telehealth visits are phone appointments, but Dr. Lee says video usage is increasing as more patients become comfortable with the platform.

Telehealth can also include services such as remote patient monitoring, which allows patients to take blood pressure measurements and blood sugar readings at home so that their care teams can monitor ongoing health conditions. In the case of the Kaiser Permanente Mid-Atlantic States region, doctors also use telehealth to do rounds virtually for patients who have suspected or confirmed COVID-19.

Patients at higher risk for complications are given pulse oximeters so their doctor can monitor for signs of severe respiratory infection before other symptoms might indicate a need for additional care, including hospitalization.

COMMENTARY

TELEHEALTH is HERE TO STAY. It came in with the telephone, and has been gaining in recent decades. The distancing and Patient convenience so characteristic of Telehealth made it a natural fit for Covid 19, which has accelerated its’ adoption.

Your CLINICAL HISTORY, led by the Story of your Present Illness, has since time immemorial been the MOST IMPORTANT ELEMENT leading to accurate  DIAGNOSIS. During a TELEMEDICINE VISIT, your doctor must make the MOST out of your clinical history. She can’t do a proper Physical Exam, although she can usually see you, and maybe direct a SELF exam. Teledata, such as EKG,B.P., and blood sugar will become increasingly available.

Your Doctor can usually get enough information to order Lab work and Imaging; and prolix ordering can be tempered, since a good HISTORY of the PRESENT ILLNESS, systems review, past and family history can narrow the diagnostic possibilities considerably. The pressure of time and demanding computer Records may lead the overworked Doctor to use Lab Tests to make up for insufficient Medical History.

Integrated medical systems, such as Kaiser, can also easily access your past medical information, one of the advantages of having everything under one roof.

Informed Patients, SELF-EDUCATING themselves from the vast trove of medical information on the internet (and maybe DWWR) can author their own MEDICAL NARRATIVE, or at least make the Doctors job easier.

—Dr. C.

Read full article

Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE “LANGUAGE” SKILLS WILL CONTINUE TO INCREASE AT A RAPID RATE

Leave a comment

From a New York Times article (May 5, 2020):

“Calling my patients at home, with or without video, has become my new normal. After 25 years of being a pediatrician, telemedicine is teaching me new ways to communicate with families.“

“I try to hear the mother above the babbling of her baby. And then to listen to the babbling of the baby. Is it joyful? Are there big breaths between the babbling?“

A federal government waiver, issued early in March, expanded the use of federally funded health insurance — Medicaid, Medicare and the Children’s Health Insurance Program — to pay for telemedicine visits. The goal was to allow more people with symptoms of illness to be heard, and sometimes also seen, by a health care provider without the risk of exposure to coronavirus at a doctor’s office or hospital.

The federal government has been expanding the use of telemedicine for years — but like so many changes in this pandemic, what used to take years to transform, we are now doing within weeks.

Read more

Prevention, TELEMEDICINE, Women's Health

TELEMEDICINE: Obstetrics & Gynecology Services

1 Comment

The following list contains preventive services that may be done via telehealth (from ACOG.org):

General Health

  • Alcohol screening and counseling regarding alcohol use
  • Anxiety Screening and referral*
  • Counseling regarding aspirin to prevent CVD and CRC
  • Blood pressure screening (if patient has appropriate resources available such as a blood pressure cuff)
  • Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants*
  • Depression screening and referral
  • Fall Prevention counseling
  • Counseling regarding folic acid supplementation
  • Healthy diet and activity counseling
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Obesity screening (if patient has appropriate resources available such as a scale)
  • Substance use assessment (drug use)
  • Tobacco screening and cessation counseling
  • Urinary incontinence screening*
     

Infectious disease

  • HIV risk assessment*
  • Sexually Transmitted Infection prevention counseling*

Cancer

  • Counseling and possible prescribing of medications to reduce breast cancer risk 
  • Risk assessment for BRCA testing
  • Skin cancer counseling

Pregnancy and postpartum

  • Breastfeeding services and supplies*
  • Postpartum contraceptive counseling, discussion of methods, and  prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants
  • Depression screening and referral
  • Counseling regarding folic acid supplementation
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Preeclampsia prevention with low-dose aspirin
  • Preeclampsia screening (if patient has appropriate resources available)
  • Tobacco screening and cessation counseling

*WPSI recommendation. For more information about each recommendation, please see our WPSI Recommendation page.

Download Well-Woman Care Chart

ACOG.org website

Read this May 4, 2020 “Women’sHealth” article for information about what a Telemedicine Visit is like

Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE: CHECKLIST – DERMATOLOGIST SESSIONS

Leave a comment

According to the American Academy of Dermatology, “The technology has reached a point where, in many situations, health care providers can use IT to offer quality health care services remotely,” and they support telemedicine as an additional treatment tool to supplement in-person services.

To get the most from your telemedicine appointment, board-certified dermatologists offer these tips:

  1. Contact your insurance provider to find out if your plan covers telemedicine appointments. Many insurance providers are updating their plans to cover telemedicine visits during the coronavirus pandemic. Find out what type of telemedicine visits are covered by your insurance.
  2. Gather essential information. This is especially important if you have a telemedicine appointment with a dermatologist you haven’t seen before. Knowing your medical history will help your dermatologist make a diagnosis, decide treatment options, and prescribe medicine, if necessary. Ask your dermatologist’s office if they have any forms you need to fill out before your appointment.Before your appointment, make a list of the following:
    • Medications you take
    • Major illnesses or surgeries you have had
    • Previous skin problems
    • When your current symptoms began
    • Your allergies
    • Illnesses that your family members have had, such as cancer, heart disease, or diabetes
  3. Find out how to reach your dermatologist. Talk to your dermatologist’s office to make sure you know what type of telemedicine appointment you will have, and how your dermatologist will reach out to you. Ask when and how to send the pictures and information you gather.
    • For video visits, you will be sent a website link you can use to connect with your dermatologist at the time of your appointment.
    • For telephone visits, you may be given instructions on when to expect a call from your dermatologist.
    • undefined
  4. Write down all your questions. Doing this helps you remember everything you plan to talk to your dermatologist about and make the most of your appointment.
  5. Take pictures. To help your dermatologist examine your concern, take clear pictures of the areas you need examined. Follow these tips to make sure the pictures are the highest-possible quality:
    • Make sure your pictures are well-lit. Take your pictures in natural light, if possible. Use another light source, like a book light or flashlight, if needed. Make sure that there aren’t any shadows or glares on the area you are taking pictures of.
    • Take multiple pictures, including one of each side of the area you need examined. Make sure to show the entire area around your spot or rash. If your spot is hard to see, you may want circle it or draw an arrow pointing toward it with a marker.
    • Take pictures to compare. For example, if you have a spot on your hand, take pictures of both hands so your dermatologist can see how that area usually looks. Make sure you also take a close-up and a far-away picture of the areas you are concerned about so your dermatologist can compare.
    • Just like an in-person dermatologist appointment, do not wear makeup. If you need your nails examined, take off any nail polish you have on before taking any pictures.
    • Get help. If you live with someone, ask them to take pictures of hard-to-reach areas, such as your back. If you live alone, use a mirror to make sure you are taking pictures of the right spot.
    • If your picture turns out blurry, delete it and replace it with one that is clearer.
  6. Avoid irritating your skin before your appointment. Try to avoid doing things that could change the appearance of your skin before you begin your telemedicine appointment or take your pictures. Some examples of things to avoid are taking a hot shower, rubbing or picking at your skin, or applying skin care products.
  7. Find a private space. Find a quiet and private space without distractions to have your appointment. Make sure you can connect to the internet in that space and it has the best-possible lighting.

For more information

Men's Health, TELEMEDICINE, Videos, Women's Health

GERIATRIC TELEMEDICINE: NEW CONNECTIVITY AND CONVENIENCE AT HOME

1 Comment

From Becker’s Hospital Review (May 1, 2020):

Connectivity in combination with mobile devices is making home-based services like telepharmacy and telemedicine a reality. These are great options if patients feel too sick to leave their home or they want a second opinion. It’s also possible to connect people in rural areas with academic medical centers. During the pandemic, the use of telemedicine has risen dramatically.

“Technology is enabling access to healthcare in many ways,” Holcomb said. “You no longer need to live in certain places to get access to great care, and you no longer have to go to your physician in person, for many aspects of a visit – this is helping people get care, even as they stay at home.”

Against the backdrop of the aging population and ongoing pandemic, technology is likely to continue to influence healthcare consumer expectations. Almost every aspect of life has been transformed by the emergence of digital conveniences. Digital technology is transforming industries, including shopping, communications and entertainment. Healthcare is no exception.

Read full article

Howard Fillit, MD: The Positives of Telemedicine Adoption for Geriatric Patients

Medicine, TELEMEDICINE

TELEMEDICINE: 80% OF PEDIATRIC PATIENTS SEEN REMOTELY AT JOHNS HOPKINS CHILDREN’S CENTER

Leave a comment

From Johns Hopkins Medicine (April 30, 2020):

“A lot of our pediatric divisions are now seeing 80% or more of their patients by video or telephone,” says Hughes.

The Children’s Center’s preparations for the virus and the disease it causes, COVID-19, were unwittingly sparked by pediatrician Helen Hughes and her early work in telemedicine outreach for pediatric subspecialists. In 2018, she spearheaded development of a telemedicine collaboration with the Talbot County Health Department on Maryland’s Eastern Shore.

Pediatrician Helen Hughes during a video visit with a young patient and mom.. Johns Hopkins Medicine

The goal was to ease the burden of long treks to Johns Hopkins’ Baltimore campus for young patients — especially medically complex patients — for follow-up visits. At the time, she said, “This is where the future of health care is headed. Video technologies can allow us to do so many things for our patients without having to see them in person every time.”

The Children’s Center, notes Hughes, had been conducting between zero and eight video visits per month for the past two years. In the second half of March, after the coronavirus had clearly arrived, Johns Hopkins pediatricians and pediatric subspecialists saw 800 patients via telemedicine. That number increased to 1,400 telemedicine visits in the first half of April. Additionally, MyChart users in April jumped to 71%.

Read full article

Men's Health, PODCASTS, TELEMEDICINE, Women's Health

TELEMEDICINE: “FORWARD TRIAGE” FOR SCREENING PATIENTS DURING COVID-19

Audio 1 Comment

 Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.

Interview with Dr. Judd Hollander on how health systems can use telemedicine services during the Covid-19 pandemic.

It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. 

Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.

Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients. Payment and regulatory structures, state licensing, credentialing across hospitals, and program implementation all take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need. In this instance, it may be a virtually perfect solution.

Read full article at NEJM

Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE: “THE MOST COMMON USES AND HIGHEST VALUE FOR PATIENTS”

1 Comment

Telehealth had been gaining momentum in recent years, but the COVID-19 pandemic is propelling physician practices to quickly figure out how they can best use the technology to provide patients with care while practicing physical distancing.

(From an AMA article -April 29, 2020)

COMMON USES FOR TELEHEALTH INCLUDE:

TELEMEDICINE

TELEMEDICINE: STANFORD MEDICINE UTILIZES IPADS IN EMERGENCY DEPARTMENT

Leave a comment

From a Stanford Medicine article (April 27, 2020):

“Far from separating us from our patients, it is actually expanding on what we can do,” said Ryan Ribeira, MD, clinical assistant professor of emergency medicine at the Stanford School.

An iPad in a patient room at Stanford Health Care’s emergency department. Photo by Susan Coppa

Caring for patients remotely greatly reduces the use of protective equipment — an estimated 80-120 sets per day. The risk of exposure has also been minimized for physicians, nurses and other caregivers, particularly those who are pregnant, immune-compromised or otherwise at high risk of complications from COVID-19. 

When the staff at Stanford Health Care’s Marc and Laura Andreessen Emergency Department started connecting with patients in isolation via iPad, they found an unexpected benefit: The approach offered a more personal, human-centered experience. 

The iPad project moved from conception to implementation in just eight days, starting with a drive-through program in a Stanford Health Care garage: Patients remained in their cars while a physician assessed them by video from inside the emergency department. 

To bring the program into patient rooms, technology specialists at Stanford Health Care ensured the tablets had necessary features, such as the ability to auto-answer calls. When a caregiver calls to check in, the patient receives a few rings as advance notice, then the iPad answers itself. 

The iPad has also been paired with portable handheld ultrasound scanners that quickly plug in, eliminating the need for a bulky ultrasound cart that requires decontamination after every use. And patients participating in clinical research can consent via iPad.

Read full article

Men's Health, TELEMEDICINE, Women's Health

ENDOCRINOLOGY: BENEFITS OF TELEMEDICINE IN DIABETES MANAGEMENT

Leave a comment

From an EndocrinologyAdvisor online article (April 27, 2020):

“In the diabetes world where data from meter, pump, and sensor downloads are critical to management, telemedicine is an ideal way to interact with patients. The missing pieces are vital signs, especially blood pressure and weight, but often the patient can monitor these at home and provide trends. Diabetes experts can manage the majority of patients using the HbA1c test and other data the patient has recorded and downloaded to a website. These are easily accessible. I have had patients write down their glucose readings and fax the results as well.” Mark H. Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center

In perhaps one of the most significant changes to occur in health care as a result of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has suddenly reached the widespread adoption many proponents have championed for years. Recognizing the necessity of telemedicine in light of the current crisis — both to address increased treatment needs and to prevent unnecessary in-person contact — some payors and state legislators have loosened certain restrictions regarding its use across clinical specialties.

Read full article