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What Are the Benefits of Telemedicine for Myeloma Patients?

What Are the Benefits of Telemedicine for Myeloma Patients? from Patient Empowerment Network on Vimeo

How will myeloma patients benefit from telehealth visits? Myeloma expert Dr. Sarah Holstein shares benefits she has seen while caring for her myeloma patients including broadening access and the ease of seeking a second opinion.

See More From the Myeloma TelemEDucation Empowerment Resource Center

Related Resources:

 

Is Telemedicine Here to Stay for Multiple Myeloma Care?

Will Telemedicine Mitigate Financial Toxicity for Myeloma Patients?

How Will the Pandemic Impact Multiple Myeloma Trials? 

 

Transcript:

Dr. Sarah Holstein

So, I think telemedicine has been one of the few silver linings of this entire pandemic, I had personally never utilized telemedicine previously in my career, and now I’m using it almost extensively these days to care for my myeloma patients.

I’ve always had patients who tell me that they wish they didn’t have to take a half day off to come to a clinic appointment, and sometimes the clinic appointments are only 20 minutes, but they’re driving an hour and a half or two hours or more to come to those clinic appointments. So, some of it has just been the freedom that allows patients to go about their lives and not have to take time off of work or time off from other things that they’re doing to physically travel to come and see me. Telemedicine though, has also really broadened the access to me in my cancer center, again, based on where I’m at in Nebraska, patients would sometimes have to travel a very far distance to see me, and these days it’s just a matter of logging on via Zoom to access me, and it’s allowed me to see patients for second opinions in not only different parts in Nebraska that otherwise would have been difficult to reach, but also really across the country.

So, telemedicine in general, has allowed patients much more flexibility in seeing me and has also allowed the ability for me to do second opinions without making patients travel quite a distance.

Step-By-Step Guide to Using Telemedicine

Step-By-Step Guide to Using Telemedicine from Patient Empowerment Network on Vimeo.

The ultimate guide for a successful and safe telemedicine visit with your doctor that includes practical and actionable tips to help you utilize telemedicine to your advantage.


Transcript:

Andrea Conners

Hi, I’m Andrea Conners the Executive Director of Patient Empowerment Network. It’s my pleasure to talk with you about telemedicine and offer some practical and actionable tips to help you utilize telemedicine to your advantage, both now and the foreseeable future due to COVID. As well as, throughout your healthcare journey.

So, let’s start at the beginning with what exactly is telemedicine? Whether it is an appointment with your nurse, doctor, or mental health provider, there are times when it could make more sense to meet with a member of your healthcare team virtually using your computer or mobile device.

This approach may offer more flexibility and cut down on your time in the car or in the waiting room and, of course, decrease your exposure to illnesses such as COVID. If telemedicine is available to you through your doctor’s office or hospital you can see your health care provider for an appointment without leaving your home using a few simple steps which I’ll walk you through now.

The first step is scheduling your appointment, step two is preparing for your appointment, and step three is understanding what to expect on the day of your appointment. Utilizing these three steps will ensure you have a stress free and successful telemedicine visit.

It’s important to keep in mind that every provider’s technology is slightly different. The platforms and instructions you receive for your telemedicine visit may vary for each healthcare system. That being said, there are a few things you will need. The first is a strong Internet connection like a home Wi-Fi network. The other requirement is a computer or mobile device like a tablet or your smartphone. The device should have a webcam so that your provider can see you and a microphone so that you can communicate with the provider. Both of these are standard on most mobile devices.

Once you have confirmed that you have the necessary equipment and tech requirements, the next step is to ensure your physician or clinic has options for telemedicine. You can do this by calling the appointment staff. You may be able to see the options for virtual appointments when you log on to your patient portal that your provider has once the appointment is scheduled.

It’s important to ask how you will receive instructions for the appointment. Providers might send information to your email address or through your patient portal messaging system. Be sure to ask for telephone number in case you have technical difficulties.

After you’ve scheduled your appointment, it’s time to get prepared here’s a pro tip for you, don’t use a public Wi-Fi connection to access personal information as it can be easily compromised. If you’re going to use Wi-Fi, it’s best to do it from home on a secure connection. It’s important to also note that because you will be sharing health information during the virtual visit, your provider will use the technology that protects your information.

Here are some tips for preparing for your telemedicine appointment:

First, review the instructions that you received from your provider. Then, log on to the portal to familiarize yourself with the process and the software. Once again, every health care system is set up a bit differently so follow the provided instructions closely.

Be sure to test your system. Most software offers this option, and you can test well in advance of your appointment.

Lastly, ensure that your audio and video are working properly. If not, refer to the instructions or call the designated number to get assistance.

On the day of your appointment, login at least 10 minutes early. You may have to fill out an intake form just like you do at a regular visit or sign a consent form for care, this will all be done online. Also, and this is really important, make sure your device is fully charged. Just like an in-person appointment, there may be some time that you spend in your virtual waiting room so you’re going to want to make sure that your computer or your smartphone has enough battery to last the entire visit.

A few more things to keep in mind: make sure the sound, camera, and microphone on your device are turned on and check the levels are up and not muted. This is another really important one, be patient. As with most video calls, it takes some time, even a few minutes, for everyone to be able to hear and see each other.

Be prepared. Write down questions and topics you would like to address with your provider in advance, and just know, that there may be follow up you need to complete following the appointment, such as lab work. If that’s the case, your doctor will provide specific instructions on how best to handle this.

One important thing to note when deciding between a telemedicine versus an in-person appointment is that telemedicine is not for emergency situations. And although it might not replace an in-person appointment, some types of non-emergency follow up and monitoring appointments might be possible to conduct virtually.

Mental health resources, such as online counseling, are also often available through telemedicine. When in doubt, your health care provider can help you determine if a virtual appointment is an option for you and the best option for you.

So, all of this might leave you wondering is telemedicine just a passing trend that will go away after the pandemic is over? 54% of physicians surveyed said that they will continue to utilize telemedicine to serve their patients after the pandemic has ended. So, it appears that telemedicine is here to stay.

I know I’ve covered a lot of information in a very short period of time so if you would like to learn more I invite you to visit PEN’s website and take the full Digitally Empowered™ course where you’ll learn all sorts of digital skills that will help you become more tech-savvy and empower your health care journey. The courses free self-paced and available to you at anytime you can access it using the URL (iamdigitallyempowered.org) in the green box on this slide.

Before I let you go, I’d like to tell you more about my organization Patient Empowerment Network, also known as PEN, in case you’re not familiar with us. PEN is a pan-cancer advocacy organization that focuses on increasing health and digital literacy for patients and care partners. We provide free online programs and resources designed to educate and help activate patients and care partners to share in decision making with their care team. We do this because we know that empowered patients like all of you typically achieve better health outcomes. Please join our network of empowered patients. Thank you for your time.

February 2021 Digital Health Roundup

Over the past year, with Covid-19 shutdowns keeping people home and out of their doctors’ offices, technology has taken an even more important role in healthcare. From virtual doctor appointments to navigating patient portals, now more than ever, patients need to understand how technology can benefit their health. Each month, Patient Empowerment Network (PEN) will round up some of the most notable digital health news pertinent to empowered patients and their caregivers.

Digital Health

So, what exactly is digital health? According to the U.S. Food and Drug Administration (FDA) at fda.gov, digital health includes a broad list of categories, such as health information technology, wearable devices, telehealth and telemedicine, and personalized medicine. The influence of digital technology in healthcare is almost infinite and is revolutionizing the healthcare industry, improving the ability to diagnose and treat disease and to improve the way healthcare is delivered to each individual. In addition, digital tools help to empower patients by giving them more control over their health. Patients can use digital technologies to make more-informed decisions and manage their healthcare. Providers use digital health to make healthcare more affordable, more personal, more efficient, and higher quality. The coming together of technology, patients, providers, information, and connectivity lead to overall improvements in healthcare and better health outcomes. Find more information about digital health and how the FDA is focusing on it here.

How Will Technology Influence Healthcare in 2021?

You may be wondering where you are most likely to see technological influence in your healthcare in 2021. There are several areas. Artificial Intelligence (AI) saw a lot of advancements in 2020, and it is expected to be further used to advance healthcare in 2021, says medcitynews.com. In the oncology field, technology advances are changing the way disease is being diagnosed through pathology, which traditionally is a manual process. In 2021, the trend is moving more and more toward digital pathology, which saves times and labor costs. AI advancements are also being used in areas of triage, diagnosis, and analysis. Digital technology can be used to collect and share patient data from a variety of sources so that doctors can determine the best diagnosis and treatment.

Technology is also expected to continue to expand patient access to medical care through telehealth, increasing personalization of care, quality control, and screening protocols. Get more information about the ways AI is predicted to advance healthcare in 2021 here.

Another area that continues to be widely used in healthcare is Virtual Reality (VR), technology that simulates an experience, according to a recently updated article by news-medical.net. Medical training is one of the most prevalent ways VR is used in healthcare. Students can learn how to manage any type of medical situation through VR simulation giving instructors the opportunity to see how the student would respond in real life. VR is also used to simulate surgeries and give medical professionals visual access to the inside of the human body, without having to dissect cadavers. In some cases, VR training is believed to be superior to more conventional forms of medical training. Learn how VR is being used to treat mental health and addiction, manage pain, shorten physical therapy recovery times, and educate patients here.

Patient Access to Care

One of the most important aspects of digital healthcare is access. Patient portals are being used more and more, but not all patients have access to them, reports healthcareitnews.com. A study involving kidney patients found that many patients aren’t actively engaged in their care and that interventions are needed to make sure all patients have access to patient tools. Patient portals provide access to personal records and educational resources, but studies show that black patients, older patients, and patients who use Medicaid as their primary insurance were not as likely to use patient portals as white patients, younger patients, and patients with other types of insurance. Researchers found that patients who used the portals had more knowledge and better health status, and that they had less disease-related stress. While the use of portals is promoted by health systems, they may actually be widening health disparities for patients who aren’t using or don’t have access to the portals. The study suggests that more effort needs to be made to ensure that all patients have access to the digital tools that can help improve their patient outcomes. Learn more here.

Recognizing that technology is advancing care for many, but that it can also further expand the digital divide, a new group to address the disparities in access to healthcare has been launched, reports healthcareitnews.com. The Telehealth Equity Commission, made up of groups who attended the American Telemedicine Association’s EDGE policy conference, plans to use a data-driven approach to help improve telehealth policy. Learn more here.

One thing is certain: digital technology is here to stay, and its influence on patient health is expanding. To ensure that you have access to all the latest digital healthcare, become a Digitally Empowered patient through Patient Empowerment Network’s free Digitally Empowered™ Course. The course will help you to become more tech-savvy so you can research your condition, ask informed questions, and take an active role in shared decision making with your care team. Access the course here.

5 Ways a Patient Portal Can Improve Your Health Care Experience

A patient portal is an online application which gives patients access to personal health information stored in a health care organization’s electronic health records (EHR). If your doctor’s office offers a patient portal, consider these reasons why you should take advantage of the service.

Schedule Appointments

Use the portal to request or schedule appointments with your health care providers.

Request Refills

Giving you a convenient way to request refills should make it easier for you to keep up with refills and avoid lapses in the medication regimen. One study found that patients who use the portal to request refills of cholesterol medications took the medications more consistently and had better cholesterol levels (compared to patients who didn’t request the refills online).

View your Records

With a patient portal, you gain access to critical health information that was previously locked up in the EHR. A typical portal allows you to view your test results, medications, immunizations, and allergies. A summary of your doctor visits and educational materials may also be available. You have the right to view this information and use it to participate more fully in your health care.

Improve the Accuracy of Your Records

Keeping a list of your medications may seem like a straightforward task for a health care provider using an EHR. However, there are several reasons why your medication list may not be current and accurate, reflecting the name and dose of all the medications you are taking:

  • Human error in entering the medications into the EHR
  • Incomplete information at time of medication entry. For example, in your first visit to a doctor, maybe you remembered the names but not the doses of your medications.
  • Over-the-counter medications are frequently overlooked
  • Providers from multiple health organizations are prescribing medications for you
  • You stopped taking a medication

Fortunately, some portals give you the opportunity to submit corrections to your medication list and other parts of your record. This type of feedback loop is designed to improve the quality and safety of your care. In small pilot study in the Geisinger Health System in Pennsylvania, patients used the portal to submit corrections such as:

  • Add over-the-counter medications, vitamins, and supplements
  • Add medications prescribed by providers outside the Geisinger system
  • Remove medications they had stopped taking
  • Make corrections in the frequency and doses of medications

Communicate with Healthcare Team

A patient portal allows you to exchange secure messages with your healthcare provider. Rather than wait on hold or play phone tag, you can submit a question at your convenience. The response time may depend on the triage system used by the medical office for electronic messages, the content of your message, and the frequency with which your provider checks messages. A systematic review showed that patients who communicate electronically with their health care team can enjoy improvements in the following health dimensions:

  • Knowledge about their health condition
  • Ability to cope with and manage chronic health issues
  • Blood sugar, blood pressure, cholesterol, and weight (for patients with diabetes)
  • Control of asthma and quality of life (for patients with asthma)
  • Chronic back pain
  • Self-esteem and empowerment
  • Stress, depression, and loneliness

Note that electronic messaging isn’t appropriate in all medical situations.

When You Should (and Shouldn’t) Email Your Doctor

If you don’t already do so, you probably wish you could communicate with your doctor by email. It would align your health care experience with the rest of your increasingly digital life. Who wants to play phone tag or be put on hold when dealing with health issues?

Emailing your doctor is best done through a patient portal linked to your electronic health record (EHR). This allows your doctor to view your medical history, medications, and test results when responding to your email.

Patient-doctor email will likely increase as patient portals become more widespread and federal incentives for email are rolled out. Someday, emailing your doctor may become part of standard medical care.

However, email is not suitable for all health-related situations. Just as there are rules of etiquette for work-related emails, there are a few guidelines for emailing with your doctor. This article will outline a few scenarios where it is appropriate and not appropriate to email your doctor.

Email your Doctor if . . .

You have a straightforward question which can be answered in one or two exchanges.

You can save yourself an office visit by taking care of the issue by email. For example, if you just need a refill of a medication you have been taking for a long time, and you’re otherwise doing well, then an email may save you and the doctor some time. Depending on the nature of the request, the doctor may forward the message to another member of the medical team or office staff. Some offices designate a nurse or assistant to screen all the messages and assign them to the appropriate recipient.

Note that the email exchange may not be free, because doctors can bill for the time they spend responding to your email.

You have been waiting longer than expected to hear about test results or other pending issues. Doctors can easily get bogged down with their responsibilities. A timely reminder from you is helpful.

You forgot or needed some clarification of what your doctor said during a recent visit. It can be tough to remember or process everything that you and your doctor discussed. Sometimes it’s best to tie up the loose ends by email.

You can supply information that your doctor requested, such as home blood pressure readings, or results of a test you had at another health care facility.

Don’t Email Your Doctor if . . .

You are reporting sudden or severe symptoms which could indicate a medical emergency. You may not get an immediate response, and your condition could deteriorate as you wait for a reply. Email in a medical setting is only appropriate for non-emergencies.

You want to discuss a complex issue that would require a lengthy back-and-forth discussion. These issues are best discussed on the phone or in person.

You want to discuss an emotionally-sensitive topic which can’t fully be addressed by email. Facial expressions and body language are important in communication. Sometimes an old-fashioned office visit is best.

You are unsure of the security of the email transmission. Patient portals are designed to be secure. But if you’re emailing your doctor at “Doctor@mail.com”, the message could be intercepted.

Once your email becomes a part of your medical record, other people who have legitimate access to your record may see it.

Steps to Improve Patient Access to Online Services

The telehealth market is expected to experience an 80% year on year growth in 2020 as a result of the pandemic, with telehealth services easing the burden on traditional healthcare systems by urging patients with mild or moderate ailments to use web-based applications for treatment or management. Telemedicine also takes the lead in the cancer care strategy during the coronavirus outbreak and will continue to play a role in the future to support symptom management, lifestyle changes, and medication protocols. Therefore, access to online services to support patients with cancer is crucial to coordinate care from availing of financial aid and medical services to legal and psychological support. Empowering the patient to take control of their overall care using internet-based technologies can improve care coordination with medical and legal professionals and may also reduce the burden on the health care system.

Learn to Navigate the Web

Of vital importance to accessing online services is knowing how to use the internet to search for resources that you may need. In addition to the basics of having an email that you use to communicate, you must familiarize yourself with the main features of browsers such as clearing cache, bookmarking, and viewing history as well as the practicality of tabbed browsing.

Another important aspect of being internet savvy is to learn to use search engines such as Google, Bing, or Duck Duck Go effectively that will enable you to find answers to queries on all types of subjects. Know that you can also filter and refine your search to yield results that are suitable to your queries. Hence, if you are looking for lawyers that can help you find financial assistance for your cancer treatment, it will save you time since most professional websites are optimized for search engines nowadays. Professional sites do this by providing relevant and authoritative content that are useful to website visitors ranking them high whenever a query is typed in the search engine and results are displayed. Keywords that are often used by surfers are also incorporated in the text and articles of sites, making these portals easy to find by search engines.

Retrieve Information and Benefit From Online Access

Now that you are confident about using internet technology, there are many things that you can do online to assist in your cancer care management. One of the constraints in cancer care is health insurance. Access to government portals and organization websites such as the Social Security Administration (SSA) for disability insurance benefits or the Cancer Financial Assistance Coalition (CFAC) which offers a data base of financial resources can already give you leads on where to get financial aid.

Although many people are benefiting from treatment outside of hospitals due to mounting medical costs, declining number of doctors, and an older cohort of patients who are living longer, outpatient care can lead to a decrease in support delivered by health care staff. The good news is internet-based tech including patient portals, websites, and apps can tip the scale to balance the perceived support deficiency.

The ability to access health records, choose health providers and place of treatment, book and cancel appointments online, find psychological support, and order prescription refills virtually are major steps in cancer care management. Telephony is also another feature of the internet offering free phone calls if a patient needs to talk to a healthcare provider or specialist urgently. Other forms of communication with doctors and hospitals include forums such as message boards and instant messaging. Mobile applications to track and fight cancer also make it easy for patients to sign up for trials and access research results and other information on the go.

Improved access to online services by learning to navigate the web efficiently and effectively can open up an entire virtual world to a person with cancer. It also empowers a patient by managing the coordination of their condition with different actors such as oncologists, lawyers, therapists, and psychologists.

A Complete Breakdown of Telemedicine

Interview with Joe Kvedar, MD, President, American Telemedicine Association (ATA) Professor of Dermatology, Harvard Medical School Physician Scientist, Author. As the only organization completely focused on advancing telehealth, the ATA is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people.


Honora Miller:

Dr. Kvedar, thank you for joining us.

Dr. Kvedar:

I’m delighted to be with you.

Honora Miller:

Can you tell us what telemedicine is?

Dr. Kvedar:

Well, it’s not a new concept, but since the late 1960s, people have been talking and working towards this idea that care doesn’t necessarily have to be two people in the same room at the same time — that we can use technology to connect people. Like we’re doing now with this video interview, that’s the most common type of telehealth visit, but we can also connect with patients via telephone calls.

There are various remote monitoring devices that are able to monitor an individual’s vital signs or other health measures in their homes.

Finally, in the same way we exchange emails and text messages, we can do that securely with patients, what we call e-visits, which can be very helpful, as well. So there are a variety of forms, but it’s really all about care where the patient is, when the patient needs it, and not having an individual travel to visit a doctor in person.

Honora Miller:

Can you break down the differences between the terms telehealth, virtual visits, e-visits, and virtual health?

Dr. Kvedar:

I’ll go back to the beginning when there were visionary clinicians who believed medicine could be delivered this way and were doing this kind of work. They called it telemedicine. A few years into that journey, there were a number of clinicians who felt that the same technologies could be used in other ways, including education, and so they started using the term telehealth to make it broader and more inclusive. To this day, telehealth the term that everyone is mostly comfortable with.

A few years ago, some people started to say that we needed to be able distinguish between real-time and asynchronous interactions, the same way that we have video or phone calls and emails, and that we also needed to distinguish between direct-to-patient interactions and interactions between clinicians

If it is an interaction between patient and doctor, it’s a virtual visit; if it’s between clinicians, it’s a virtual consult. For example, if a physician is caring for a stroke patient in another hospital, we call that a virtual consult. An e-visit is considered an asynchronous interaction. For instance, I’m a dermatologist, so if my patient takes a picture of a rash or skin disorder, and sends it to me via a secure portal, I could respond with a message back to the patient. That would be an e-visit.

Likewise, if the primary care doctor caring for a patient decided that she wanted a picture of something looked at and sent it to me electronically, then we call that an e-consult.

Telehealth generally encompasses four areas: virtual visits, virtual consults, e-visits and e-consults. Digital Health has become a term of art because that includes everything from robotic process automation, to artificial intelligence, and so on.

Honora Miller:

What is telemedicine remote monitoring?

Dr. Kvedar:

Well, remote monitoring is best suited for certain conditions, mostly chronic illness — conditions like congestive heart failure or high blood pressure or diabetes, particularly type 2 diabetes, when it’s helpful to have more data from the patient about their condition.

For example, if you were starting out on blood pressure medication, we could give you a blood pressure cuff to take home, so that you could take your blood pressure for a week. The cuff, connected by Bluetooth, would automatically share your BP readings with your healthcare provider.

That would be an example of home-monitoring. For people with heart failure, we might give them a wireless blood pressure cuff, weight scale and a device to measure oxygen levels in the blood, so that we can remotely monitor their vital signs.

There are a variety of opportunities to monitor all types of health measures using wearable devices like an Apple Watch, and sensors, that can remotely monitor things like an EKG, sleep patterns, daily activity and other functions.

Honora Miller:

Is the monitoring done in real-time? Or do patients supply the data as it becomes available by entering it into a portal?

Dr. Kvedar:

A lot of remote monitor is done in an asynchronous way. For example, you might step on a scale every morning, take your blood pressure and heart rate, and that personal health data is securely transmitted to your healthcare provider and winds up in your electronic health record. Then a nurse or other provider could look at your data and put in a call to you if something was not quite right, and you’d have a dialogue. Again, it could be a video call or an audio call, but you’d have a dialogue with your provider about what was going on — maybe your diet was off, or maybe you need to increase your medicine dose, but that’s typically how it’s done. It’s not usually done with real-time readings.

Honora Miller:

Can you speak to what telemedicine care looks like in the era of COVID-19?

Dr. Kvedar:

I’ll start with statistics from my own large delivery system in Boston to give you a flavor, and by the way, our numbers are not unique. February of 2020, across two academic hospitals, we did about 1600 virtual encounters. In March, we did 89,000 and in April we did 242,000. We are not unique because I’ve been talking to my colleagues around the country and everyone’s having that kind of accelerated demand for telehealth services, what we would call hockey stick growth, partly because, to help stop the spread of the virus, people need to stay at home, yet we still have to take care of our patients. The technology that you and I are using for this interview is common now, whether it be Zoom or Skype or FaceTime.

People are, for the most part, comfortable with video calls, and likewise, patients have really taken to it. Patients generally have been very, very positive. Doctors are warming to it. Many doctors are saying Gosh, there’s so many things I can do this way that I hadn’t thought about, and I’m going to continue to practice this way. So telehealth services have grown a like wildfire. Before the pandemic, mental health was the biggest user and for sure now mental health providers are still the biggest users of telehealth. In mental health care, providers are talking to the patient, so it’s very easy to make that transition. And then we mentioned chronic illness before, but it turns out that the screening questions used to decide if someone needs a COVID test can easily be asked via telehealth.

if someone is sick at home with only mild symptoms, that individual can be monitored quite well using this kind of virtual care tool set because it’s all about asking questions.

Honora Miller:

So those are the main things that we’re seeing — the use of telehealth for follow-up visits for all kinds of conditions and health concerns, mental health, as well as respiratory symptom questions to determine if individuals need additional testing for coronavirus.

I’m wondering if you can speak to whether or not health insurance coverage has kept up with the pace of change in this arena?

Dr. Kvedar:

So great question and any time you ask about insurance coverage, it is always a long answer with a lot of caveats. I’ll start with Medicare, the Centers for Medicare and Medicaid Services, the biggest payer in the country for the elderly and disabled, and they said very early on they would pay for telehealth at the same level they would pay us for seeing you in the office, so that was a big boom. They’ve since refined that to pay for telephone calls at that rate, as well. That, by the way, is really a nod to addressing disparities because there are people who can’t afford a smartphone or have broadband and we want to make sure that we get to them.

I credit the Medicare folks for seeing that. Medicare is doing very well. Medicaid is state-by-state. Reimbursement will depend upon where you live. But most states, most governors, during this State of Emergency, said that they should pay and most private payers are paying for telehealth as well, so it’s pretty rosy right now, in terms of reimbursement.

One of the things that we’re doing at the ATA is trying to make sure that enough of that reimbursement culture sticks when we move out of this health crisis so that people can continue to enjoy the benefits of this type of care delivery.

Honora Miller:

Do you think that there will be legislation required in order to have that level of coverage continue or is there going to be another mechanism to advocate for that to be the case?

Dr. Kvedar:

Again, great question. I would say that if we look at history as a guide, when Medicare decides to pay for something, private payers typically follow, and there was no need for legislation because it was something that just rippled through the medical economy. So that’s what we’re hoping will happen again. In every state Medicaid is a little bit different. Patients have found that they can get care and there’s this what I call the magic of access, quality and convenience. And when you get that kind of care delivery, everyone feels great about it.

Patients have experienced that and doctors have experienced that. I would just suggest that you listeners and readers talk to their company’s human resources person, and tell them how much they’ve enjoyed their telehealth benefit; if you are insured by the government, take the time to write your senator or representative, and tell them that you don’t want to go back to in-person only care. I think we will have to advocate some but there’s such an overwhelming positive response that I’m quite optimistic that it will stick.

Honora Miller:

Having recently experienced four or five different medical professionals interacting with me through telemedicine, I’ve noticed that there’s a different cadence to each of the visits depending on the person’s communication style and their comfort level with the medium.

How patients can prepare themselves in order to get the best possible experience out of telemedicine?

Dr. Kvedar:

Sure, but before I get to that, I would just quickly say that we’re working on doctors, too, on what we’re calling “website manner.” It used to be something that we sort of said with a chuckle, but we’re very serious about it now. And it’s things like looking directly at the camera, and dressing up so that your patient takes you seriously.

But back to your question about how patients can prepare for a telehealth visit. I’d suggest everyone think about being more conscious of the information that your doctor needs to help you, either in making a diagnosis or by helping you with a care plan. For example, when we were able to have office visits back in the day — that was only several weeks ago — the doctor was asking questions, they listened to your lungs, your heart, even indicators such as your speech pattern or if you look your doctor in the eye. They were collecting information constantly during that office visit. So, let’s say, you’re a patient with diabetes. You should make sure you have your blood sugar readings handy.

Let’s say you’ve been following your blood pressure, make sure you have your blood pressure readings handy.

For me, as a dermatologist, it’s so important that we have good images of whatever it is on your skin that you need looked at. So it’s really thinking through what information your provider needs, and sometimes a doctor will help you. In our case, in advance of a telehealth interaction, we send patients information about how to take good quality pictures of their skin condition. So we’re learning, too.

Also, make sure you have your questions ready in advance, which is always good advice, both for an in-person or virtual visit, so that you get all your questions answered.

Make sure you have all the information about your condition that you can gather and make sure you have your questions prepared.

Honora Miller:

In relation to lab tests that a patient may need to get, how does that work in the telemedicine context?

Dr. Kvedar:

Well, that’s a wonderful question. Notwithstanding home pregnancy tests and the like, there are a number of companies making great strides towards taking a drop or two of blood and having a test done in the home, so we can look forward to that in the future.

In the meantime, the answer is, you need to go to a lab, hospital or clinic for testing, which is in most cases what happens currently. Things like genetic tests can be done with saliva, so some samples can be packaged from the home and shipped to a lab to be evaluated.

So it depends on the test, but unfortunately, for a lot of these tests, we still have to send people to a lab to get a blood specimen drawn or to leave a urine or stool specimen.

Honora Miller:

How can patients best identify whether their doctors provide a telemedicine option?

Dr. Kvedar:

Well, these days, I think most doctors are being very proactive, because we have this dilemma, where we want to take care of you but we’re discouraging you from coming to healthcare facilities because of the risk of contracting the virus.

If your doctor hasn’t reached out to you and you feel like you need a consultation or some care, reach out to your doctor and ask them what telehealth platform they’re using.

The government also said in the middle of March, when they relaxed the reimbursement rules, that providers could use any technology right now that we wanted during this crisis, including FaceTime, Skype, Google Hangouts, Zoom et cetera.

I’ve been telling patients, if you’re comfortable, there’s no harm in asking your doctor’s office if they will talk with you via FaceTime or another platform. I would say the first step is to ask your provider. Most people can also get access to basic telehealth services through large pharmacy chains. If you happen to have a CVS app on your phone or a Walgreens app, you can get a telehealth visit that way as well.

Most health plans, even before this health crisis, would offer an option for you to get a telehealth visit. I hope your doctor is responsive and he/she should be, but in the event that your provider isn’t offering telehealth visits, other options exist.

Honora Miller:

Can you speak to what tools a patient will need to adequately engage with patient portals?

Dr. Kvedar:

Patient portals have been around for a long time. However, I would give us a bit of a black eye on making them user-friendly. I don’t think we’ve done a very good job of that. And again, this is a patient empowerment conversation, and I don’t know that we’ve done a very good job of empowering people to interact with us through those tools.

That said, all of a sudden now patient portals have become a primary way you’re interacting with your healthcare providers, so we’re upping our game. It’s too bad it takes a crisis but there it is, and I think we’ll get much, much better.

I often say, every service you consume other than healthcare has a digital front end that has a way of interacting with software to get things done easily. For example, you take a picture of your check and deposit in your bank account with just a few taps on your smartphone. There’s millions of examples now, and health care is just getting going in that regard.

The patient portal story is really mostly about security, that is to say, it’s a very secure electronic environment for you to interact with your healthcare provider. The basic things that you can do there, apart from doing a virtual visit, is to do billing information, usually there’s a way to get a list of your medications, ask for prescription refills, schedule appointments, get letters for things like school physicals, and that the like. Nowadays, those things can be handled electronically.

There’s a little bit of, I would say, activation energy for some people, because signing up can be complicated.

It is so secure you are sometimes required to submit a letter or do something extra than you would to sign up for a normal website, all in good intent. I would urge people to put up with whatever barrier hits you in the beginning. Once you get involved with a patient portal, and we’re working very hard now to make it a really a good experience for you, patients will be able to not only interact with us as providers, but you will be able to access all kinds of information and services offered by your healthcare system, access lots of information from your record and so forth.

Honora Miller:

As a cancer patient, and for others living with chronic conditions, how might telemedicine impact the future of survivorship?

Dr. Kvedar:

It’s a great question. One aspect of survivorship is things like living wills which, if it isn’t done electronically, we will have to move in that direction, to enable that. There is a lot of interest in interactivity with palliative care and hospice around how to better care for patients, particularly around medication management. Patients can be afraid of opiates and sometimes they’re in terrible pain, so we need to get this right. So those are a couple of examples.

Honora Miller:

Is a potential for telemedicine to be used in lieu of in-person visits to such an extent that the medical provider doesn’t get to see the patient enough to pick up on subtleties that are crucial? Can you share any insights about this concern?

Dr. Kvedar:

I think that’s wonderful insight and we are definitely grappling with that for sure, especially now that telehealth use has surged. Before this pandemic hit, we had only one channel healthcare delivery to come to the hospital or doctor’s office. Now of course the answer is, let’s do a telehealth visit.

But the truth is somewhere in the middle, and I trust clinicians to have good instincts about that.

For instance, patients that we’re treating for a chronic illness, maybe we do every other visit in the office so that we can have that face time and actual interactivity. There’s something about in-person interactions with patients that’s very special. I take care of patients with acne, for example, and arguably that can be done online. But I would say we’ll probably end up doing every other visit in the office, because you want to get to know the patient, their family, etcetera. It’s just that right now where we don’t really have a choice.

Honora Miller:

Can you speak to privacy concerns around telemedicine?

Dr. Kvedar:

Forty-eight states have temporarily loosened their licensure restrictions in response to the pandemic. As, a patient, that may or may not hit your radar, depending upon where you live. Here in Eastern Massachusetts, I have a medical license in Massachusetts, but regularly take care of patients who live in New Hampshire and Rhode Island, because they often had come in for office visits. So now if we’re doing follow-up care, there’s a mechanism where I can still take care of them, even though I don’t have a medical license in those two other states.

Waiving restrictions on state licensure is important to point out because it’s really enabling us to again deliver better care to more people. The question then becomes, after this crisis is over, will we have to go back to the very old-fashioned, state-by-state geographic border-based care delivery model? This is something that the ATA is working on, as well as the need to maintain patient privacy, especially for providers using telehealth for the first time, who may not be familiar with these new procedures.

I would also point out that the biggest part of health data security is how we record that visit in the medical record, and that hasn’t changed. We do that in a very secure way. It’s something we take very seriously. And I don’t mean to say that you’d never get hacked. It’s part of reality that anyone can get hacked any time, but I don’t believe it’s something that should get in the way of delivering care.

Honora Miller:

Thank you, these are interesting times and we are moving at an amazing speed, and just the incredible growth that you described it really is a testament to how there can be interesting unintended consequences of a pandemic. Thank you very much for joining us and for you sharing your expertise.

Dr. Kvedar:

It’s been a real honor and pleasure.

How to Make the Most of a Virtual Visit

“Well, we need to check your titer,” the doctor explained as he went over my lab results via a recent Zoom call. “Titer?” I thought. I know I’ve heard that term before, but I wasn’t really sure what it meant. The doctor reappeared the word a few more times, exacerbating my confusion. I was too embarrassed to ask what he meant; he was talking quickly. When he eventually said, “The titer is the strength of the antibodies in your blood,” I finally understood and felt more at ease.

As we face this pandemic, chronic and/or rare disease patients like myself are facing an extension of the “new normal” that everyone is experiencing firsthand. Our doctor’s appointments are critical times when we’re able to explain how we’re feeling, how our medication may or may not be working, and what the next steps are. But our visits become different when our face to face sessions turn virtual. I believe we become more vulnerable, as we invite the doctors into our home lives.

While healthcare has certainly come a long way and telemedicine has been on the horizon, virtual visits are now the norm. We have been placed, both as patient and healthcare professionals, in a position that allows us to take advantage of the technology we have and still provide and receive great care. In my opinion, these visits should not be considered a hassle, but rather an encounter that continues to focus on patient education as we face unprecedented times.

A part of patient education is health literacy. Health literacy can be defined in many ways, but the short, paraphrased version is that health literacy is the ability of patients to understand health information (verbal, visual, etc.) in order to make the best decisions about their health. This includes understanding the messages that are being conveyed to them by health professionals, including symptoms to look for and how to take medication. The case remains the same whether visits are in-person or virtual, perhaps with greater emphasis on the latter, in my opinion.

Below, I will highlight things that patients can do to make the most of their health appointment, with a focus on health literacy.

Tips for Patients

  1. Discuss any information you have questions about during your appointment, especially if it has jargon you don’t understand
  2. If a doctor speaks too quickly, tell them to slow down or repeat what they said
  3. Take notes during your appointment if having something visual helps you remember
  4. If your doctor mentions a word you’ve never heard of, ask them to define it
  5. Share your understanding of how a certain medication or treatment is helping you and/or if you think something could work better
  6. If you’re unsure of how to take a medication, show the label to your doctor to have them explain
  7. If you are provided with test results, ask your doctor to review them carefully with clear language

What is Telehealth? How Can It Benefit Patients?

According to the Center for Connected Health Policy, telehealth can be defined as encompassing a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education. For example, telehealth could be as simple as two healthcare professionals discussing a case over the phone or as sophisticated as doing robotic surgery between facilities at different ends of the globe. Common examples that are being used today include teleradiology, in which test results are forwarded to another facility for a diagnosis, continuing education for healthcare professionals, and supplements to home/hospital visits, which is especially useful for elderly patients. Frequently used applications and services include video conferencing, email, smart phones, streaming media, and mobile apps. So, what does that all mean for patients? It means patients can more easily integrate their healthcare into their daily life, instead of infrequent doctor’s visits. Thus, giving them a more efficient way to manage their ongoing care. Telehealth shows great potential for advancing preventative medicine and the treatment of chronic conditions.

Patient Benefits

Costs
  • Lower travel costs and miss work income savings to patients who would otherwise need to commute to an urban location
  • Home monitoring programs can reduce high cost hospital visits
  •  Specialists “team up” with local healthcare providers to improve disease management and improved disease management reduces complications and hospitalizations
  • Less time is spent by the patient in waiting rooms
  • Some doctors charge less for a telehealth consultation than they would for an average in-person visit
  • Telehealth has also been shown to reduce the need for hospital re-admissions, which can be an inconvenience for patients and are a significant expense to healthcare facilities
OutcomesTelehealth
  • Patients can be diagnosed and treated more quickly in distant locations
  • Hospitalized patients whose care is supervised by a specialist via telehealth have the advantage of staying in their home community where family and friends can easily visit. Studies have shown that recovery is faster when patients are close to home
  • In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction
  • Test results can be quickly sent to specialists for second opinions
Access
  • School based telehealth allows school nurses and other healthcare providers to serve more students at more locations
  • Can bring previously unavailable levels of care to remote or rural areas of the country and the world
  • Through Telehealth consults, patients are often able to participate in clinical trials unavailable in many rural areas.
Empowering
  • Empowers patients to take an active role in their health care
  • Increases their confidence to stay independent and at home

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http://www.setrc.us/index.php/what-is-telehealth/benefits-of-telehealth-telemedicine/

http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.V2BM0-YrKmE

http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/howcantelehealth.html

http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatistelehealth.html

https://www.globalmed.com/press-room/press-releases/2013/the-benefits-of-telemedicine

https://www.cardiocom.com/benefits_telehealth.asp

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