What You Need to Know About Telemedicine During The Coronavirus Pandemic

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As our medical personnel continue to deal with the current situation, and with our country at Level 4, with the prospect of Level 3 just a few weeks away, people are still being warned to stay at home. Unless your patient is experiencing signs of an emergency, it is still best  advice to stay at home, rather than to expose yourself, and your office staff.  

I had first hand  experience of  this, no more  than a week ago, when I was first advised to consult with my doctor via a telemedicine platform. After the consultation, I had no choice but to visit him in his office. I don’t mind admitting feeling rather uneasy in his waiting room, as all the waiting patients sat, with a seat between them, their faces covered with a mask. This has become the new norm, and things will never again be the same. I keep hearing that people cant wait until things are “back to normal”. Im not sure that we will see normal again. As the well known band, R.E.M said..”its the end of the world as we know it…”

 Just this morning, I read an article about  Twitter CEO Jack Dorsey, who  told his employees that many of them will be allowed to work from home in perpetuity, even after the coronavirus pandemic ends, adding that their decision will be when to open their office, however, it would be the employees decision if and when they would return. Google announced that they don’t expect their staff back until 2021, and Facebook has announced a remote work programme going forward. You can now buy BMW’s and Harley Davidson’s from a virtual showroom and more and more  people ask questioning the need for a physical office, the daily commute there and back and the wasted hours chatting with colleagues, when they are just as effective, sometimes more so,  from home… Full service online retail has has opened before physical retail stores. This has become a world of remote, online, non physical consumerism…and people are loving it.

Its the End of The World As We Know It.

I, as many others, have used  telehealth, for years, rather than book an in person consultation.  I rely on technology to get the care that my family needs, and I don’t mind admitting that I have actively sought out doctors, who have adopted this technology, foregoing those who have not. During Covid 19, not only does it make it possible for doctors to continue taking care of patients while minimising risk to everyone involved, but it also allows them to screen patients for  symptoms, and assists in directing them to appropriate testing sites. This certainly gives peace of mind to the doctors and to their staff, not to mention the patients in the waiting room.

While Covid 19, takes precedence right now, we must remember that people are still needing care for general everyday needs, as I did a week ago.Since my in office visit, I have effectively used telemedicine to get follow up advice, obtain a new script, been guided on removing a stitch, all  while following social distancing guidelines….and my doctor was able to get paid for his time and expertise.

 I often get asked..”What exactly is telemedicine and is telemedicine and telehealth the same thing”?One would think they are one and the same, since they are used interchangeably. Actually they are different….

Here, once and for all is the explanation:Telehealth is a broad term, used to describe a variety of health service, that are delivered from a distance. These could include patient monitoring for diabetes, high blood pressure and asthma, to name just a few. It is basically the term used to describe all forms of remote care.Telemedicine is the actual delivery of care. It is the process, as I connect with my doctor via text, or video, in order to get care, follow up advice  or a script. It could be seen as a subsection of Telehealth.

How To Use Telemedicine During The Pandemic.The good news for  patients is that many doctors have incorporated some form of telemedicine into their practices, since the outbreak of Covid 19. The good news for doctors is that technology has grown in leaps and bounds around telemedicine, leaving a number of choices, which can also be a little confusing. Some are charged for, some are free, some are just existing business platforms disguised as telemedicine in another form, but the reality is, a doctor is spoilt for choice right now.

Telemedicine has become a necessity, and is no more just a “ nice to have.” Should a patient experience symptoms that they suspect may be Covid 19 related, they are able to utilise remote telehealth and get advice before seeing their doctor.What we have seen of late, is that patient demand for this facility has skyrocketed, as consumers  actively seek out doctors who are available online. Patients who approach a doctor for care relating to Covid 19 symptoms are being actively moved into a telemedicine platform, before testing, thereby protecting both the doctor and their staff. This is borne out by the fact that South Africa probably had 5 or 6 platforms at the end of Feb. Today this has grown to well over 20. Ive seen doctors provide ongoing  care during this pandemic without much interruption to their revenue flows at all, and a dramatic decrease in running costs.

Even patients without regular doctors are turning to telemedicine platforms that provide online doctors, who are available to give advice around Covid 19 and related issues. In this is a warning….get left behind at your own peril!Platforms, such as Medici  facilitate an in app billing functionality, allowing for easy and seamless billing and invoicing  of the patient..something that has been an obstacle  for awhile, amongst practitioners, who spend a lot of time giving remote care, for little or no remuneration.

How Much Should I Charge?

We typically see virtual care delivered at a rate of around 30% less than an in office visit. Many will say that this is unsatisfactory, since 30% less revenue is quite undesirable…and I would agree. The point is that remote care frees the doctor up to see patients who need to be physically examined , while telemedicine still allows him to offer care to less urgent, low intervention patients…..and keep that patient in the practice. The revenue generated by telemedicine is, for the most part, additive.Having said all of this, there is no real right or wrong answer to this and doctors set their rates, based on time, geographic location and expertise.

Does Telemedicine Actually Happen Outside of the Pandemic?

While telemedicine is very topical and relevant right now, telemedicine was happening long before the pandemic, and will continue to do so.  Its a convenience tool, and consumers like convenience. Also consider those who live in rural settings,  where telemedicine  is especially valuable to  patients, who gain  access to doctors and specialists who  they would only be able to see if they traveled long distances. In a country such as ours, where access to basic healthcare is often limited by geography and transport costs, telemedicine is an obvious gateway to care.The answer to this is, “Absolutely, yes!”. Any doctor who has cared for a patient via email, telephone, WhatsApp or SMS has provided telemedicine. Its dangerous, since there often no records, no indemnity cover and questionable data security, but be that as it may, telemedicine was born  the day the telephone was invented and doctors have been providing telemedicine, long before this pandemic, albeit it unintentionally.Many have chosen to adopt telemedicine into their practices as a value add, long before this pandemic took hold.  For them, telemedicine is just another day at the office.

When is it Appropriate to use Telemedicine? 

I get this question a lot and my answer is often…don’t make this more complicated than it needs to be. Your own ethics and clinical experience should guide you to the answer. It has to be said, telemedicine will never replace a face to face visit, of this there is no doubt, and face to face visits will always be preferable, maybe not always necessary, or possible.There is a very clear place for telemedicine within a practice.Telemedicine is not appropriate for life threatening conditions, nor is it appropriate where a physical examination is essential.

I always advise to introduce virtual care into a practice by way of follow ups, giving clinical advice, which very often is just about peace of mind for the patient and reinventing the doctor/patient relationship.I have found that even where the initial consultation results in a necessary office visit, that initial virtual consultation was  not a waste of time, and becomes an integral part of the in office visit. My my doctor had valuable insight into my medical concerns before I even got there, hence cutting down on valuable time for both of us.

I have seen practices incorporate telemedicine as an extremely valuable triage tool.
I think we are now well beyond the question as to whether telemedicine is here to stay or not. There is now too much evidence and usage to confirm  that it will become a part of our daily lives. The question now is how to incorporate it in a safe and efficient  way, what pitfalls to look for and how to seek out the best solution for your practice. My advice is not to jump into the first solution you come across, understand your needs, the needs of your patients, regulatory and data storage concerns and seek out a robust, data secure, long term solution for your practice. 
There are some really exciting offerings on the horizon, that will simply change the way you deliver care, that will simply free you up to do what you were born to do….to take care of your patents.

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