Implementing Telemedicine

Updated: Apr 29, 2020

Tweetchat Summary

#TelemedNow Twitter Chat Wednesday, March 18 – 8 PM ET Introduction & Welcome: Dr. Andrew Watson (@arwmd)

Q1: #telemedNow technology - What type do you need? * Video visits / live direct to patient video * Remote patient monitoring asynchronous work * Use of patient portals / EHRs A1 Notable Responses: Dr. Annette Ansong (@kiddiehearts) seeking to embark on videoconferencing/synchronous telemedicine for pediatric cardiology practice. For the cardiologists in the group, would be interested in knowing what use cases you are seeing for telemedicine. Dr. Nina Browner (@ninabrowner) We just started to use phone outreach visits as part of teleneurology here at UNC but waiting for video visits on larding from healthcare. Interested to know challenges and how to during video encounter. Dr. Raj Janardhanan (@rajdoc2005) I think we now have a Live video option using the Zoom platform - made HIPPA compliant. I have not used it yet since I am on vacation this week. Planning to try next week. Dr. Purvi Parwani (@purviparwani) We are doing all of them. But seriously some patients (particularly in blue zone) get overwhelmed with technology and video visit on epic. Have to keep that in mind. Q2: Best practices #telemedicine - scheduling can be hard! How best to schedule visits: * Integrated platforms with EHRs * 3rd party vendors + integrated sched. * If manual, don’t sched. back to back A2 Notable Reponses: Dr. Nina Browner (@ninabrowner) oh “video-peek” into patient’s home is something that would be invaluable for us - to see whether there are limitations for walking, risk falls, how poll box is set up. I wonder whether that something that you can document or bill for ? Stacy Hurt (@stacy_hurt) My onc makes his own schedule because he knows the acuity of his patients-in addition to automation, we need provider input to prioritize the sickest patients for care. Dr. Ami Bhatt (@AmiBhattMD) at this time, using what we have (phone, stand-alone) is fine. But longer term, integrated platforms allow for easier scheduling and tracking. Jamey Edwards (@jameyedwards) Treat #telehealth calls like an in-office visit w/ similar pacing & breaks. Maintain openings for the “real-time” needs of #patients in more of an on-call model so you can tackle urgent situations as they arise. Julie Reisetter (@juliereisetter) LOTS of opportunity to improve here! Right now - more manual than integrated Face with rolling eyes. We need to worry about getting the job to done - right NOW!

Q3: Documentation for #telemedicine is key - how, when where do you document? *EHRs *Separate *3rd party vendor What tricks do you have? Do you need interop? Templates? A3 Notable Responses: Dr. Ami Bhatt (@AmiBhattMD) ALWAYS Document in the EMR. No matter if it’s a phone, stand-alone or integrated system. So important for continuity of care and #patientsafety #TelemedNow Jamey Edwards (@jameyedwards) #Interoperability can take many shapes and forms. You can use a video camera to read a monitor locally. Expensive integrations can sometimes be avoided with simple solution.

Q4/A4 – HIPPA Compliance – Notable Responses: Jamey Edwards (@jameyedwards) Just because we are disregarding #HIPAA during this crisis, doesn’t mean we will forever. While you can use that advantage to deploy quickly, make sure your solution can be compliant within a short time thereafter. #TelemedNow #Telemedicine #CyberSec #InfoSec

Q5: Billing, the ongoing curse for E&M based #telemedicine. What can you do now? * What codes? * CMS changes in Medicare? * What do we expect in the near future? * 3rd party payers A5 Notable Responses: Dr. Nina Browner (@ninabrowner) Yes! Saw it yesterday and was very impressed how thorough that was with all the codes posted ! Dr. John Erwin (@@HeartOTXHeartMD) The Blues were proactive in Illinois. Few commercial payers have tipped their hand down here in TX. @bswhealth Plan is covering, however. Helen Burstein (@helenburstein) On public side -- need CMS to include coverage for telephone calls. Extend payment changes to Medicaid. Q6 What is your “Web-side” manner for #telemedicine? * Watch out for backlight and noise? * Look at camera * Be more verbose * Watch out what is behind you * Use humor ! A6 Notable Responses: Jamey Edwards (@jameyedwards) Make sure your environment is conducive with good lighting, enough bandwidth and a neutral background. Still dress the part and look professional. Invest in a good headset and at least dual monitors.

Q7: Using #telemedicine to examine someone has nuances, what are they? * Be verbose about your needs? * Have them show you * Have someone help them * Have them hold camera close to lesions / wounds… A7 Notables Responses Jamey Edwards (@jameyedwards) Connection and rapport can be built via #telemedicine. Empathy can be felt in a phone call or video conference. Tone of voice, eye contact can be felt on the far end. Some patients prefer video to in-person & feel more comfortable sharing deeper. Dr. Ami Bhatt (@amibhattmd) Speaking of non-verbal, integrated systems (Intouch/Epic for us) allow for a third party to conference in. I have done this for our hearing impaired patients with sign language interpreters @ACCinTouch #congenitalheart often runs with congenital #deafness Stacy Hurt (@stacy_hurt) My oncologist once told me “I can tell 90% about a patient by how they look and asking how they feel” this is where we appreciate the art as well as the science of medicine. Ritu Thamman (@iamritu) Lots of tweets saying physical exam is unnecessary for many types of cardiology f/u

Q8: For a #telemedicine visit, try to get info ahead of time. * Look at your HER * Some platforms enable ptx to enter data in advance If you are coming at the visit “cold” it is okay to tell them. A8 Notable Responses Jamey Edwards (@jameyedwards) Episodic visits can have #workflow that prepopulates information for treating physician that can be reviewed in advance of visit to make most of time in front of patient. Dr. Ritu Thamman (@iamritu) Would be great to have a voice activated “Siri” to tell you the patient summary before you saw the patient Dr. Ami Bhatt (@amibhattmd) When you book the #Telemedicine visit, use the appointment notes to write what the visit is for, you will usually have a reason when you book. It will jog your memory on a busy day

Q9 During this time we must screen all for #Covid19. So scary on multiple levels. Ask your patients and use local health resources and advice as this evolves. (No responses)

Q10 = end. HAVE FUN and do it. Go and help our patients. We welcome feedback and topics for next week. A10 Notable Responses Jamey Edwards (@jameyedwards ) #Telemedicine can allow patients to receive care where they are most satisfied (home or work) with minimal wait time (if any), no travel time or costs and on their terms. Can also reduce #carbonfootprint significantly while saving system billions. Other comments in the chat: Dr. Annette Ansong (@kiddiehearts) #TelemedNow For your non-English speaking patients, what interpreter services do you use if doing a videoconference, especially if doing from your home?

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