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In the Midst of the Coronavirus Pandemic, Now Is the Time to Ramp Up Telemedicine

by Jennifer Fink •

  • Telehealth: real-time, audio/video communication that connects physician and patient in different locations.
  • E-visits: synchronous (real-time) or asynchronous (delayed response) virtual visits completed via a patient portal.
  • Virtual check-ins: audio-only communications with patients over the phone.

“For otolaryngologists trying to meet patient needs in the short-term, I think FaceTime and Skype are reasonable, given CMS’ relaxation of the HIPAA requirements,” said Dr. Sale, noting that TUKHS accelerated a two-year implementation timeline to just two weeks, and went from 10 weekly telehealth visits to more than 1,000 across 20 departments in one week. “The biggest issue really is speed to market. Our patients want and need telehealth. Our providers are ready and need less than an hour of training.

“We have this golden window now, where some of the rules and regulations around telehealth have been relaxed. This is a great time to experiment and figure out what the next version of healthcare should look like.”

Getting Started

For providers starting from scratch, the American Medical Association (ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice) and the American Association of Family Physicians (aafp.org/patient-care/emergency/2019-coronavirus/telehealth.html) offer comprehensive startup guides and resources. HIPAA-compliant vendors like GoTo Meeting, Updox, and Vsee offer various product levels, demonstrations, and expedited implementation.

Keith A. Sale, MDWe have this golden window now, where some of the rules and regulations around telehealth have been relaxed. This is a great time to experiment and figure out what the next version of healthcare should look like. —Keith A. Sale, MD

Dr. Pynonnen said her department is using the “Lombardy, Italy” model, named after the region in Italy where telemedicine has been used to great effect for a number of digital services for public hospitals, including monitoring patients affected by respiratory insufficiencies and those who are mechanically ventilated. Dr. Pynonnen’s department uses a three-week rotation: Providers are in their offices one week for urgent care and then provide telehealth from home the other two weeks. She added that Michigan Medicine is using its EMR (via laptop or smartphone app), but that some physicians and departments were given permission to use Zoom or other platforms during the crisis. Dr. Sale said that the ideal setup for video telehealth is two devices: one connected to the patient (KUMC uses Zoom for Healthcare) and a second device for the EMR.

“Once somebody shows you how telehealth works, you can very quickly become facile with it,” Dr. Pynnonen said. “It’s helpful to have some formal training or education, even if that’s just a well-written tip or FAQ sheet.”

Although some patients will require an in-person examination, Dr. Pynnonen said telehealth will work well for many situations. “Even in this crisis, we can still help many patients who contact us with symptom concerns by providing reassuring information, despite the inability to look inside their ear or nose,” she said.

Ménière’s disease and vestibular migraine patients who have already had audiograms should be considered for telehealth, said James Lin, MD, associate professor of otolaryngology, head and neck surgery at KUMC. “If they show classic symptoms for Meniere’s, it’s highly unlikely I would see anything different during the physical exam on the day of the office visit,” he said. “Those are perfect patients for telehealth. I can see them, review their audiograms, order an MRI, and start them on Dyazide. I can follow them that way if they’re three or four hours from the office. If they have worsening symptoms, we can telehealth again, or, if it really worsens, we can discuss surgery. We can save a number of in-person visits before it gets to that.”

The AMA recommends using a tele-triage program to ensure that patients seeking appointments are put on the right path through discussing the patient’s condition and symptoms. Some telemedicine services offer this on an after-hours basis, and physicians or staff can be redeployed to manage this during the day. Dr. Pynonnen said administrators and call center staff have been contacting all nonurgent patients based on a priority system TUKHS developed.