When the doctor’s office becomes a no-go zone, patients and physicians do the next best thing—meet online. Welcome to the new world of health care
In the blink of an eye, the coronavirus pandemic has changed how doctors in America treat everyday illnesses and handle routine checkups. Gone are trips to the office or clinic. Video visits and phone consultations are suddenly the norm—and will be for at least the foreseeable future.
“Telemedicine’s 15 minutes of fame is here,” says Ryan Spaulding, Ph.D., acting director of the University of Kansas Center for Telemedicine and Telehealth.
Sparked by the onslaught of COVID-19, the respiratory illness caused by the new coronavirus, health care providers have quickly turned on their virtual open-for-business signs.
At the same time, Medicare, private health insurers, and state and federal regulatory agencies have all relaxed their rules surrounding telehealth tools, so that people can limit their trips outside the home and cut exposure to the highly contagious virus.
“We are rapidly deploying telehealth technology at scale during this public health emergency,” says Steven E. Waldren, M.D., vice president and chief medical informatics officer for the American Academy of Family Physicians.
But just because the roll out is happening on the fly, doesn’t mean you’re entering unknown territory. “Some patients think, ‘Oh, gosh, we’re going to be doing this thing that’s experimental or not really proven yet,’ and that’s not the case,” says Spaulding.
“Telemedicine has been around since at least the 1960s,” he continues, “and in some health fields it’s become commonplace. So, it’s not experimental. It’s documented. It’s secure. It’s private. Telemedicine is a good way for providers to connect with patients.”
Before you and your doctor make your first online connection, here are answers to your most pressing questions about telemedicine in the age of COVID-19.
What, exactly, is telemedicine?
Simply put, it’s the care you receive from your doctor or other health care provider when you can’t be in the same room together. It can be a video chat, or you can use an app or online portal. In some cases, even a phone call with your doctor can count as an exam. (More on that later.)
As Spaulding noted, telemedicine dates back as far as 1959, when the Nebraska Psychiatric Institute started using video conferencing to provide therapy to hospitalized patients.
You may also hear the term telehealth, which is the umbrella term for the many interactive technologies that doctors use to provide care from a distance. Think of telehealth as the toolbox that holds, among other things, telemedicine.
So, you can have a telemedicine appointment with your doctor, who will use telehealth tools.
If telemedicine is not new, why am I only now hearing about it?
One word: coronavirus. To prevent the further spread of the virus, doctors need to meet people in the safest place possible, which right now many times happens to be your own home, says Dr. Waldren.
“Telemedicine isn’t best for every type of medical situation,” explains Dr. Waldren. “But because of where we’re at in this outbreak, if you feel the need to see your doctor about something that’s going on with your health, we encourage you to call your doctor, explain what your issues are, and consider a telemedicine appointment.”
He notes that doctors across the country—even in communities that aren’t so-called “hot spots” for the coronavirus—are doing risk assessments: Is the risk to my patient greater if I see them in the office, or greater if I see them during a video visit?
“In the current environment, and especially if the patient has underlying lung or heart problems, or is of an advanced age, the risk may be worse to actually have them come to the practice,” says Dr. Waldren.
Does this mean being seen in person is out of the question?
Not at all. Obviously, chest pain, breathing problems, broken bones, and severe wounds require emergency care. But if you have a sore throat or a mysterious rash, if you are due for a routine checkup for an ongoing health issue, or even if you suspect COVID-19, a telemedicine call is the best first step.
Can a doctor provide good care and give an accurate diagnosis this way?
While the hands-on aspects of a doctor visit can’t be met if you’re at home, virtual visits are surprisingly wide-reaching and thorough. “Many routine appointments, across all conditions, can be transferred to telemedicine,” says Spaulding.
Post-surgical follow-up? Check. Dementia care? Check. Diabetes and cardiology appointments? Check and check.
“We even do a block of telemedicine appointments for ALS patients,” he says, referring to amyotrophic lateral sclerosis (aka Lou Gehrig’s disease).
Mental health has a long track record with telemedicine, especially in the treatment of post-traumatic stress disorder, depression, anxiety disorders, and ADHD, according to the American Psychiatric Association.
A doctor’s first preference is always going to be to see their patients in person, admits Dr. Waldren. But a lot can be accomplished even through a simple FaceTime call.
“A doctor can ask you to get close to the camera,” he explains, “and they’ll be able to see if your lips are not pursed and if your color is good. They can also ask to see the area underneath your collarbone and check to see that it’s not sinking in, so you’re not having labored breathing.
“There are a lot of things physicians can see straight away,” Dr. Waldren continues, “and know that you’re generally okay, you’re not likely in respiratory distress, and be less concerned that you’re in an emergency situation.”
Two examples that may warrant an in-person visit include keeping your infant and toddler up-to-date on their vaccinations and having a new or changing lump checked out.
“Nineteen years ago, when I started in telehealth, people were really surprised that a doctor visit could be done this way,” says Spaulding. “Today, what surprises people the most is how routine a video visit can be.”
Do health plans or Medicare cover telemedicine?
Yes, on both fronts. The federal government recently expanded access to telehealth services—approving more than 80 different services that can be handled remotely—for people with Medicare, according to the Center for Connected Health Policy.
That means that Medicare is now treating a video or phone visit the same as it would an in-person office visit. During this public health emergency, Medicare is even covering telemedicine visits for physical, occupational, and speech therapy, as well as behavioral health counseling.
This is huge news for older Americans, who are at a higher risk of experiencing bad outcomes if they develop COVID-19. “The whole idea is to help people avoid crowded waiting rooms, where they might pick up an infection, as well as protect other patients and the staff at the office from catching the virus,” says Spaulding.
Many private health plans are also moving to classify telemedicine appointments as regular office visits. “Odds are that your video visit will be covered by your insurer as a way to support physical distancing and stay-at-home orders,” says Dr. Waldren. “But it’s best to call first or go to your insurer’s website to see exactly what they’re covering now.”
He notes that every plan is going to have slightly different rules and procedures in place during the COVID-19 outbreak. For example, “some are waiving co-pays and others aren’t, and some may not be covering audio-only appointments, while others allow them, so it’s always best to check first.”
Will I be able to get prescription refills or new medicine if I have a telemedicine appointment?
Yes. Even if you’re not seeing your regular doctor, a provider in the practice will be able to access your electronic records and prescribe necessary medicines.
In fact, the Drug Enforcement Agency, or DEA, has loosened some of its rules surrounding the prescribing of certain powerful pain medications and other controlled substances.
Normally, these medications cannot be prescribed without an in-person visit (and in some cases testing), Dr. Waldren explains. Now, however, a telemedicine appointment with a video component will satisfy that face-to-face requirement. (Different state regulations may still apply.)
He adds that there are some opioids and medicines used to treat ADHD (attention deficit hyperactivity disorder) that still require testing and an in-person visit.
Do I need to do anything special before my first telemedicine visit?
Turning your home into an exam room requires a little prep. Start here:
1. Make the call. Schedule your visit as you normally would, either by calling your doctor’s office or going to your online patient portal. Pay attention to any instructions you’re given regarding steps to take prior to the video visit.
2. Do a technology check. Some doctors and clinics will have specially designed telehealth software built into their patient portals, making video visits as easy as clicking on a button once you’ve logged in.
For others, you may need to download an app, while still others will simply need you to have access to video chat services such as FaceTime, Skype, Google Duo, or Zoom. (Note: Once the COVID-19 emergency is over, such mainstream video services may not be allowed, for privacy reasons.)
3. Gather your background material. Jot down your symptoms, including details such as when they started, how often they occur, and so on.
4. Draft an agenda. “Know what questions and concerns you want to cover with the doctor—anything you think is important,” says Dr. Waldren. “Make sure you have these thoughts written down and in front of you before the visit begins.”
4. Set the stage. While a smartphone may suffice, Spaulding recommends using a computer, laptop, or tablet. “The bigger screen will be a plus,” he says.
Set yourself up in a quiet room with good lighting. Ideally, the light source should be behind the camera, so you’re illuminated.
5. Test your equipment. Make sure you know how to operate the camera feature on your phone, tablet, or computer. During the appointment, your doctor may ask you to pull the camera closer, or zoom in on a body part—say, to look at a rash or an injury.
If you’re not comfortable with technology, you can ask a trusted family member or caregiver to help you during the appointment—just be sure to let the doctor know that they’re there.
6. Take your temperature. If you’re calling about COVID-19 symptoms, record your temperature a few minutes before the visit begins.
If you have things like a blood pressure cuff or scale at home, you may also want to take those measurements. Doctors Waldren and Spaulding both emphasize that owning these items isn’t necessary for a telemedicine appointment.
7. Be on time. When your appointment time arrives, follow the instructions you were given to connect with your doctor. In some cases, the doctor may be calling you, or you may be given a phone number or web link to join a video conference line.
“Have patience,” says Dr. Waldren. “Doctors may be running late, so have a spare thing to do while you’re virtually waiting.”
The information in this story is accurate as of press time and posting. Because the situation surrounding COVID-19 continues to evolve, we encourage readers to follow the news and recommendations for their own communities by using the resources from the CDC, WHO, and their local public health department.