We’re all witnessing how telemedicine is changing healthcare. Telehealth encounters have become more common in the last few years, despite regulatory and reimbursement challenges. It got a bit of a boost in 2019 with new Medicare reimbursement codes for remote consults and virtual check-ins.
During the first half of 2020, the growth has been spectacular, with COVID-19 leading to dramatic increases in telemedicine visits. That trend will likely continue even after the pandemic subsides. If you don’t currently incorporate telehealth service in your practice, chances are you will soon. AudioDigest includes an array of lectures, across specialties, to bring you up to date while earning CME credits.
Telemedicine for Preoperative Assessment and Remote Monitoring for the Perioperative Anesthesiologist
Nirav V. Kamdar, MD, September 2019 (28 minutes; 1 credit)
“In the era of digital native, the home will be the next hospital.” That’s the premise of this lecture, which focuses on virtual preoperative assessment and, to a lesser extent, remote monitoring. Dr. Kamdar draws on his firsthand experience at UCLA’s David Geffen School of Medicine. He starts with the business case, pointing out that healthcare is associated with high administrative costs, and physical spaces for clinics are expensive to operate and maintain. At the same time, most of the population uses cell phones, and most employers offer an option for telemedicine.
The demand is there, given that roughly 90% of individuals aged 18-49 own smartphones. These consumers want instant delivery of goods and services. And the research suggests that they want — or even prefer — remote assessments. Satisfaction is high, and there’s no increase in cancellation rates compared to in-person evaluations.
Remote monitoring holds tremendous potential: Bluetooth-enabled peripherals can push data — say, from a pacemaker — into the electronic medical record. But the key is to obtain clinically valid and useful data while adequately addressing all the compliance issues.
Linda D. Meloy, MD, October 2019 (26 minutes; .75 credit)
Parents want virtual visits, and offering them the option through their own pediatric practices preserves continuity of care. That’s one of the takeaways of Dr. Meloy’s presentation.
Virtual visits enhance access not only by improving convenience for families but also by freeing up more exam rooms and reducing wait time. Patients and their families report high satisfaction, and providers benefit through lower readmission and no-show rates and reduced overhead costs.
Potential disadvantages of virtual visits include the lack of a physical examination and — related to that — higher rates of antibiotic prescribing. Dr. Meloy adds that the American Academy of Pediatrics has warned that telemedicine visits through a third party can lead to visits occurring outside the medical home, interfering with the continuity of care.
Dr. Meloy goes on to share her experiences and lessons learned at the Children’s Hospital of Richmond at VCU, providing insights into how telemedicine is changing healthcare, even for the youngest patients.
Mobile Apps for People With Diabetes
Addie L. Fortmann, PhD, June 2018 (57 minutes; 2 credits)
Telehealth doesn’t always require direct contact with the physician. This lecture offers insights on how physicians and other care team members can understand and leverage smartphone apps for their patients with diabetes. Dr. Fortmann warns that most apps on the market haven’t been rigorously tested and many aren’t accurate.
She provides guidance not only into the apps themselves but into how to predict which patients are most likely to benefit from using an app for diabetes self-management. Factors to consider include the user’s age, comorbidities, treatment regimen and duration of disease.
So who are good candidates for an app? Patients who are engaged and proficient in technology and are open to using new tools or those who have family members who will help. Some studies indicate that younger patients benefit more from apps than older ones, as do those with a shorter duration of disease.
Telemedicine in Ophthalmology: Creating a Comprehensive E-Health Eye Care System
Donald S. Fong, MD, MPH, Jan. 2019 (29 minutes; 1 credit)
Dr. Fong, director of the Kaiser Permanente Southern California Eye Monitoring Center, makes the case for remote eye screenings and monitoring and, as the title of his talk suggests, describes how Kaiser built a comprehensive teleophthalmology system. The model involves cameras placed in primary care offices so screening can be done during a regular office visit without an appointment with a specialist.
Among the lessons he shares:
- Remote screening isn’t optimal for all situations, such as high-risk conditions or work-ups of unexplained visual loss, but it’s ideal for low-risk conditions.
- Patients who require periodic testing can be monitored remotely (again, this is ideal for low-risk disease).
Nutritional Counseling in the Digital Age: Telemedicine and Mobile Apps
Ryan William Stidham, MD, March 2018 (31 minutes; 1.25 credits)
Don’t worry about the “nutritional” in the name of this lecture. Dr. Stidham offers a primer for anyone dipping their toe into e-health. He starts with a basic overview of telehealth, explaining that the terms “telehealth” and “telemedicine” are now used interchangeably.
He moves on to the challenges of implementing telemedicine in a practice. He provides some tips for setting up a program, including critical questions to ask before getting started. He also identifies some of the key hurdles, such as payment.
Some of the details related to reimbursement and regulatory and legal issues have changed since the lecture was recorded, but if you’re not sure where to begin with telemedicine, this is a good place to start.