Are you one of the millions of Americans who used telehealth services – possibly for the first time – last year? Will you continue to do so post-pandemic? Many patients (and healthcare providers) discovered the benefits this type of appointment can bring when COVID kept us at home, and began using it for conditions and visit types unheard of in the past.
Doing so meant eliminating the stress and expense of traveling to a doctor’s office, reducing the chance of infection, time and fuel savings, adding patient convenience, improving access to doctors for those unable to drive (and reduced dependence on others for transport), and access to out-of-area providers.
Telehealth vs. Telemedicine
The American Academy of Family Physicians defines telehealth as referring “broadly to electronic and telecommunications technologies and services used to provide care and services at a distance” and telemedicine as “the practice of medicine using technology to deliver care at a distance.” The distinction between the two is scope. “Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.”
Augusta, Georgia-based Rafael Salazar II provides patient rehabilitation services remotely and worked on the state’s telehealth guidelines last year. He says that this capability allows clinicians to deliver quality, high value care across a wider geographic area, noting, “The addition of virtual health services can decrease the cost of care in many ways, such as early detection, prevention, decreasing lengths of stay or courses of traditional in-person care.”
Expanding Services
SreyRam Kuy, a board-certified Houston, Texas-based surgeon, notes that while these services have existed for years, their use is expanding to new practice areas. “About a year ago, I’d never done a video appointment to see a surgical patient; aside from telephone calls, all were seen in the clinic.”
The belief in her field was that you needed to lay hands on a patient to determine if they were surgical candidates, or check to make sure the patient didn’t have a postoperative complication. “In the surgical community, we just didn’t routinely think we could do those things by video.”
COVID changed this mindset, she shares, with its imperative to provide services and reduce exposure to the virus. “As it turned out, our concerns about challenges of adopting telehealth were rapidly relieved. Yes, we can do a post op wound check by video. Yes, we can preoperatively examine a patient by video and assess them as candidates for surgery. And yes, we can protect our patients from risks of unnecessary travel during the COVID-19 pandemic.” This was particularly beneficial to Kuy’s older patient population, which accounted for about half of her telehealth appointments, she says. “The adoption of telehealth in our general surgery clinic has been phenomenally rapid.”
Mental health visits – called teletherapy when done virtually – are another increasingly popular form of telehealth, Roseann Capanna-Hodge, author of the Teletherapy Toolkit and a Ridgefield, Connecticut-based educational psychologist, says. Her virtual visits have grown from 15% of her practice to 50%, she reports. “Compared to adults, kids can do as well or better in a virtual appointment,” Hodge comments.
Board-certified internal medicine doctor Alexandra Sowa of New York City created an at-home lab test to check for insulin resistance and metabolic health, pairing it with telehealth services for her largely tech-savvy Millennial patient base. Home-based diagnostics and devices support telehealth services by allowing patients to facilitate some of the testing on their own that was previously only available in doctors’ offices. “Several telehealth appointments will be ahead of, or following, some at-home diagnostics,” Sowa shares.
“Blood pressure checks, blood sugar checks, heart rate checks can all be easily done at home, and the information quickly sent to your physician for telehealth follow up,” Kuy says.
Safety and Security
The common element of all of these disparate services is care in your home. That means your living space needs to be set up in a way that facilitates your service needs. “First, pick a room that’s quiet and secure,” Kuy suggests. “It needs to be quiet enough that you can hear your doctor easily, and your doctor can hear you. Second, the location needs to be secure, so that unauthorized people won’t be able to overhear your private healthcare information. It also needs to be secure so that if you are being examined as part of the visit, someone doesn’t walk in on you.”
The surgeon suggests a room that can be locked from the inside. She also recommends having access to a phone and providing that number, along with your location, to the doctor in case of an emergency during your appointment. The phone can double as a backup means of communication if your technology fails during the visit, as can certainly happen.
“Privacy is very important for a telehealth or teletherapy appointment because without it, a patient won’t feel comfortable to speak truthfully,” Capanna-Hodge points out. “Creating a physical space that has privacy and audio and video capabilities for a telehealth or teletherapy appointment is ideal. You want to make sure that you won’t be interrupted or distracted, so you can make the most of your time with your provider, as well as respecting the time your provider has created for you.”
She suggests setting boundaries for your household before an appointment, so that everyone knows when you can’t be disturbed. “Having a schedule on the door to let everyone know this is your time can go a long way in improving communication and reducing friction.”
Efficiency and Comfort Planning
Within your selected area, you also want to have everything you need handy, Sowa suggests. “Ensure you have any relevant medical devices, medications, or required items in an accessible area.” Having these stored close to where you’ll be participating in these sessions will be essential for as many sessions as the clinician schedules with you. The internal medicine specialist also recommends having your insurance cards close at hand in case your physician’s office requests the information before or after the consultation.
If you’re going to participate in a series of teletherapy sessions, Capanna-Hodge suggests adding to your feeling of safety by creating a supportive space for your visits. “Adding in sensory items can soothe nerves and make for better experiences,” the psychologist notes. “Creating a comfortable environment could be sitting in a big comfy chair, having a soft blanket or pillow, using a weighted blanket, diffusing essential oils, lavender or scented candles, or dimmed lights. Accessing one’s senses to reduce stress can support the subconscious to calm enough for one to have better mental control and thinking to do therapeutic work.”
“Design for telehealth from the home may be similar to the set-up for home offices, but should provide adequate support to access any health-monitoring equipment used by the patient,” recommends Susan Chung, vice president of research for the American Society of Interior Designers. For ongoing needs, she suggests, “Homeowners could consider having a wellness room that functions as a telehealth space, can be transformed for in-home care when needed, but used as a refuge area overall.”
Technology Needs
“Both parties need to have a device with a screen (smartphone, tablet, or computer),” rehab specialist Salazar comments. “Make sure that they’re charged, plugged in, or that you have a power supply at the ready, as some devices deplete battery at a faster rate when they’re used for video conferencing.”
Ryan Herd, a Pompton Plains, New Jersey-based technology integrator who specializes in caregiving for seniors via smart home systems, works with both family members and patients in making telehealth work well. “Internet service provider quality and speed are paramount, followed by Wi-Fi in the loved ones’ home,” he advises. “Depending on how many Wi-Fi devices the person has, the size of their home, and where they would like to do the telehealth appointments, the client might need to update their ISP speed; I would suggest a package of 100 megabits per second or greater.” He also points to the age of a client’s router, noting, “We have seen routers that are 10 years old in clients’ homes. That is old technology that has issues connecting with the new smart devices used by telehealth.”
His older clients typically don’t want all of the bells and whistles available in a full-scale smart home or wellness space, he says. “As an industry, we need to do a better job of explaining the benefits of using technology to support or enhance their lifestyle, independence, and dignity.” In the wellness realm, the potential is tremendous.
Final Thoughts
“Telehealth is so much more than ‘Zoom calls’ with your doctor,” Salazar comments, “but is a tool to address whatever the condition is.” He predicts a hybrid healthcare model where in-person and remote services work seamlessly together. “Telehealth, and all that it encompasses, has the ability to radically transform the way healthcare is delivered.”