How to Use Telemedicine for Different Populations Fighting COVID-19

Updated: Apr 29, 2020

Tweetchat Summary

#TelemedNow Twitter Chat Wednesday, April 15 – 8 PM ET Introduction & Welcome: Ritu Thamman (@iamritu) – Moderator Implementing strategies for vulnerable populations

Q1 How can #Telemedicine help the Rural population? What about the urban population?

A1 Notable Responses: Jackie Lee (@jacki3lee) Telemedicine can bring consults that were not accessible previously to rural communities. Important consults such as stroke consults requiring a time-sensitive diagnosis can be done virtually for better outcomes. Tulsi (@tulsim19) Those living in rural settings may live far away from a doctor’s office or hospital. #telemednow allows them to access healthcare in their home without the stress of traveling. Jamey Edwards (@jameyedwards) Geriatric populations are net gainers from #Telemedicine. #Telehealth brings the care to them & given various challenges our elderly face in #mobility, saving travel time, cost, etc…brings a ton of value. #RPM tools can help with #ChronicConditions as well. Helen Burstin (@helenburstin) Really strong evidence that telehealth makes a big difference in rural communities, especially for care that requires specialties that are in short supply. Provider-to-provider telehealth makes a big difference too. Michael Arcieri (@ArcieriMichael) Worked with a child psychiatrist at WPIC who connected to clinics in Central PA, where child psych is desperately needed. BP and Pulse taken by nurse there, interview was seamless. Safe (and timely!) prescribing for ADHD, Depression, Anxiety. Jagdish Patel, MD (@jpkca) The biggest obstacle I learned in last year for #rural telemedicine is connection. There is a lack of enough bandwidth and most patients don't have access to network. Andrew Watson (@arwmd) #TelemedNow started with rural healthcare, it has been urbanized but must go back in full force. Especially with cell technology and smart phones. Andrew Watson (@arwmd) And many real hospitals don’t have a lot of redundancy in their medical staff office, a retirement or illness or vacation can cause a gap. This is where #Telemedicine #TelemedNow could really help. Andrew Watson (@arwmd) We calculated a savings of $135 for each Telemedicine visit for the elderly living in rural Pennsylvania. Emily Kosinski (@kosinski_emily) Telemedicine allows rural patients to access follow up visits after being discharged from the hospital, eliminating the need for extra travel Carly Heck (@HeckCarly) Coming from a rural community, telemedicine could help those connect to specialties they sometimes have to drive hours to see. To see a dermatologist, psychiatrist, or even ob-gyn provider in my community is a minimum 45 minute drive. Janice Tufte (@Hassanah2017) #telemedicine can benefit rural and urban populations both, can save #patientstime, taking into consideration travel, caregiving and parking. Follow up for many chronic conditions can be addressed through #telemednow Evan Kirstel (@evankirstel) People who live in rural areas in US more likely to die prematurely from all of the leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke!

Jagdish Patel, MD (@jpkca) Agree with @HeckCarly. I have limited success in providing cardio service to rural spots. We can be instrumental if Primary care service in the rural area connect with specialists and have joint effort to provide services #TelemedNow Jamey Edwards (@jameyedwards) Medical deserts exist in some of nation’s biggest cities, so rural & urban healthcare face many of same access challenges. #Telemedicine addresses these disparities through ensuring access to high quality #healthcare even if it doesn’t reside in community. Andrew Watson (@arwmd) The @CMSGov @SeemaCMS @chrissyfarr waiver 1135 on 20 March really opened up the landscape for new platforms, ones that rural Americans can afford and more easily used. Stacy Hurt (@stacy_hurt) I am excited for all the #cancer patients in rural areas nowhere near an NCI cancer center who contact me about seeking a second opinions on treatment or surgery-This option can cost effectively give them a chance they may have not had otherwise Ami Bhatt (AmiBhattMD) For those who don't have access to transportation, rural areas are especially challenging, #TelemedNow brings us to them. Helen Burstin (@helenburstin) Appreciate big changes from @CMSGov, but we still need temporary payment parity for telephone calls to get us through the current crisis. It also gives us time to make video work for ALL clinicians and patients #TelemedNow Jennifer Co-Vu (@DrJenniferCo_Vu) #Telemedicine can help the Rural population have access to all types of subspecialty/expert care that would otherwise not be available to them unless they travel. This is of great benefit for patients with rare diseases. Rafa Ifthikhar (@rafaifhikhar) #Telemed literally meets patients where they are in both rural & urban areas where transportation can be barrier in regards to access & cost Q2 Do older folks gain or lose from telemedicine? How about the younger population? Younger <29yrs ~30% asymptomatic carriers of #COVID19 A2 Notable Responses: Ami Bhatt (AmiBhattMD) #TelemedNow is not a replacement for in person visits. It is only a gain. If it doesn’t fit a relationship or healthcare need there is always the clinic. Ritu Thamman (@iamritu) Older adults use #TelemedNow. A study showed 85+ yo use EPIC MyChart access @AGSJournal #CovidPittClass Adults, aged 85 years & older, and their caregivers utilize personal portals tethered to EHRs Evan Kirstel (@evankirstel) he elder care market is so complex that it's hard for #telemedicine companies to break in Ami Bhatt (AmiBhattMD) one place to start is nursing homes. oversight models could really help, especially when the next pandemic wave occurs #TelemedNow Sarah Minney (@minneymed) Do we have any data re: uptake of telemedicine in older folks? Ex how can we capture those who are offered telemedicine but choose not to engage or are unable due to lack of smartphone or internet access and end up lost to "virtual" follow-up? Andrew Watson (@arwmd) #telemedNow. We do not have a specific data right now, but it does appear to be a drop off after the age of 70 in the ability to use technology independently. James Legan MD (@jimmie_vanagon) I am fairly new at #TelemedNow but being in Montana which is rural, but the town I live in is 50 K, Internet or 4G access is not the issue but rather not having a computer with a camera&mic/smart phone ie. iPhone 6 or later,is more of an issue in the elderly population. Janice Tufte (Hassanah2017) I believe there are benefits and challenges to #telemedicine for older adults as there can be to any #healthrelated #treatment or #prescription. Risks and benefits must be weighed individually. Kevin J. Fowler (@gratefull080504) The #covid19 pamdemic has forced nephrology to rapidly implement #telemedicine and the response has been very positive In my opinion I think you will rapid growth in nephrology Jagdish Patel MD (@jpkca) Elderly homebound > 85 y/o are happy with A/V visits if there is home health service assisting them. They preferred tele visit as part of transition care program ( TCM ) to prevent readmission Mikaela Fenn (@mfenn22) As much as technology can be a hassle for geriatric patients, so can transportation, mobility, and finances, which definitely interfere w/ accessing health care. With efforts to improve the technology I believe #telemednow can be a total gain for these pts Ryan Louie MD, PhD (@ryanlouie) Also with #telemedicine, there is a greater opportunity to get foreign language interpretation for non-native speakers. Katie Fuentes (@KatielFuentes) In cases of adolescents seeking care for things they are able to consent for it helps meet them where they are at, eases burden of transportation. But does require phones/pcs/tablets/phone signal, not available to all, esp most vulnerable. Vivianne Oyefusi (@viv_oyefusi) Ultimately, I believe the elderly will gain. Many elderly patients struggle with mobility and access and this should help those with internet capability access care. This will also help young people who are used to tech improve efficiency. Q3 How do we use #telemedicine to help insured verus uninsured with #Covid19? A3 Notable Responses: Jamey Edwards (@jameyedwards) #Healthsystems can still utilize their medical staffs to treat underserved #patients. Reduced need to maintain #hospital #physicalplants can be passed on as savings to drive down cost of care for #telemedicine patients & leave high cost venues to acute situations. Evan Kirstel (@evankirstel) #virtualcare providers like @HealthTap offering a free US primary care doctor consult to anyone in the US with flu-like symptoms including millions who have no healthcare insurance Jagdish Patel MD, PhD (@jpkca) With the #COVID19 outbreak, so many people are out of work. Most health systems don't even test people unless admission is warranted. It is challenge for uninsured to care for as an outpatient Michael Arcieri (@ArcieriMichael) Much easier to give everyone internet access than everyone health insurance. Telemedicine is a good first step towards universal access, especially if hotspots developed at Libraries/Community Centers/etc replace need for individual mobile device. Janice Tufte (@Hassanah2017) #HealthCarefortheHomeless #PublicHealth could benefit greatly from having access to #telemedicine. Visits to the office can be a challenge, with #telemedNOW we should look at access to affordable smart phones, data, texts and talk. Ritu Thamman (@iamritu) One of the biggest systemic healthcare changes #COVID19 will cause. Mass unemployment & recognition that employer-based insurancemay not be a good way to make sure people are covered. Anna Leone (@Anna_M_Leone) One thing to consider is how to spread info to the uninsured population about access to telemedicine if they're not being alerted through their insurance plan. Has anyone had any success with this in the past? Ami Bhatt (@AmiBhattMD) Low cost, easily accessible healthcare will prevail with the rising unemployment rates. It’s important that we preserve continuity of care by offering telemedicine within existing practices not just standalone companies #TelemedNow Andrew Watson (@arwmd) Good point, and using standard social areas such as a supermarket or VFW. #TelemedNow. Many people are trying pharmacies, but in rule areas I think it have to be more basic than that. Kevin J. Fowler (@gratefull080504) #Telemedicine would address some of the major challenges in nephrology: 1) low #patientengagment 2) workforce shortage 3) growing #kidneydisease population 4) new models of care Jackie Lee (@jacki3lee) Definitely would need to consider public dissemination of information instead of insurance-based information. Could be more of a public policy change. Arthi Narayanan (@arthi_nar) I'm also wondering, fundamentally, if patients don't have insurance, will they be able to afford #telemedicine? I worry that #Telemedicine might not be easily incorporated into free clinics because free clinics are already under great financial stress Rafa Ifthikhar (@rafaifhikhar) How do uninsured pts plug into telemedicine if they don't have access via insurance? The expansion of telemedicine needs to include systems and structures to make sure we don't leave these pts and others who are marginalized/vulnerable behind Q4 Do females Squared vs males use #Telemedicine differently ? If so what strategies should we use to have best outcomes for both?

A4 Notable Responses: Jamey Edwards (@jameyedwards) We have a use case in market for #pregnant mothers who want to check in with a clinician but avoid risk of exposure. #Telemedicine enables such encounters & helps settle down anxious & questioning minds through trusted communication. Jamey Edwards (@jameyedwards) #Telemedicine has helped people seek care of conditions they may consider #embarassing or #ashamed about. While not warranted, #telehealth gives people a voice. @GetRoman and others have built big businesses here solving a need. Ryan K. Louie MD, PhD (@ryanlouie) Victims of domestic violence or victims of human trafficking might benefit from #telemedicine if they are not able to receive medical care with physical visits #TelemedNow cc: @FBI

AmiBhatt (@AmiBhattMD) According to FairHealth study Nearly two-thirds of all telehealth claim lines (65%) were associated with female patients. But for telehealth visits related to a hospital discharge, women had only a slight majority, with 53% of such claim lines. AmiBhatt (@AmiBhattMD) Research in the BA population reveals that women veterans use telecommunication for medical care more than men. Has been a rationale for promoting gender specific virtual visits. Janice Tufte (@Hassanah2017) #Quarantined and #socialdistanced #COVID19 patients are benefiting from #telemedicine now! Ritu Thamman (@iamritu) I’ve thought the same - just like women medicine clinics or pregnancy clinics ; I wonder if substance abuse clinics see more of one gender or not especially during a pandemic Q5 How can Telemedicine help burnout? With Interrupted care of chronic conditions, Psychic trauma, mental illness, PTSD, economic injury, burnout Upwards arrowin #COVID19

A5 Notable Responses: Kevin J. Fowler (@gratefull080504) In nephrology it would develop patient self-care skills which were one the foundation of #kidneydisease patients Industry consolidation reduced self-care Another benefit of #telemedicine to nephrology. Evan Kirstel (@evankirstel) Some #doctors can designate specific days of the week as “#telemedicine days” where they can see patients from home, eliminating the dreaded commute Jamey Edwards (@jameyedwards) #Telemedicine allows #Clinicians to: 1) Practice on their terms where & when they want 2) Create connections & build rapport (especially with video) 3) Makes routine follow-ups easier. 4) Use tech in a healthy way where both sides benefit James Legan MD (@jimmie_vanagon) I have noticed with #TeleMednow, that the schedule in my primary care office is much more malleable&easier to fit in acute/semi acute appointments at a moments notice rather than a fully loaded face-to-face schedule before the pandemic Ying Liu (@YigLiu40146323) as a medical student with no telemed experiences, I am curious to know from the providers' perspective, is the workload of a tele visit the same as an in-person appointment? Kevin J. Fowler (@gratefull080504) One other benefit: Enable #nephrologists to spend time coaching people living with #kidneydiseases Since I was diagnosed with #adpkd my nephrologists are my coaches + teachers who have empowered me to maximize my gift

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