Features January 2019 Issue

Bringing Healthcare Home

Doctor visits via video chat are a tech-enhanced version of a house call.

When Lynn Whitley, who lives in North Carolina, needed a complicated surgical procedure on her shoulder, she turned to Joseph Iannotti, MD, PhD, Chairman of Cleveland Clinic's Orthopedic & Rheumatologic Institute. Living so far from Ohio, Lynn and her husband, Steve, were concerned about follow-up care.

"Dr. Iannotti put us at ease," says Steve Whitley. "He told us, "We'll do the surgery on a Thursday and you'll go home on Monday and then we're going to have periodic office visits virtually through the internet.'"

Virtual Office Visits

Virtual doctor's office visits are part of the growing trend of telemedicine, which utilizes telecommunications and other technology to exchange health information from one site to another. Telemedicine is a broad term that might include remote monitoring of a patient's heart function, long distance observation of a patient in the intensive care unit, applications and devices that transmit data (such as blood pressure), or consultation between two doctors in different locations.

Telemedicine also includes a standard doctor's office visit, with the notable difference being that the doctor is in his or her office and the patient is at home. Using a computer, smartphone or tablet, the patient signs in on a website at the time of the appointment. Doctor and patient can then see and hear each other on their screens. It's like having a chat on FaceTime or Skype. In the case of virtual office visits, the software used for the video conferencing must comply with strict standards of security and confidentiality.

Remote Examinations

telemedecine

Image courtesy of Cleveland Clinic

After her shoulder surgery, Lynn Whitley had all of her follow-up appointments with her surgeon, Dr. Joseph Iannotti, via videochat.

Virtual office visits are used in a number of medical specialties, including orthopaedics. "A virtual visit works only if I don't need to have physical contact with the patient," says Dr. Iannotti. But he notes that quite a lot can be done remotely.

"Typically, I get X-rays or other imaging studies of the patient and review the medical record to determine whether the patient might benefit from a surgical procedure," says Dr. Iannotti, who specializes in complex shoulder surgery. In some cases, he can then perform the examination remotely.

"It won't be a full exam," he says. "But you can watch somebody walk or move their arm and instruct them in ways to move to demonstrate their function." Just like when someone visits the office in person, a doctor can get a thorough medical history and ask and answer questions.

"I can show them their X-rays and the models I use to demonstrate what shoulder replacement looks like and how it works, just like I would if someone was sitting next to me," says Dr. Iannotti.

Post surgical appointments can also be done remotely as long as there are no major complications or other problems that require in-person care. "You can watch them do their exercises, check their function, and look at their wound," says Dr. Iannotti.

After her surgery, Lynn Whitley's follow-up appointments were all done virtually. "Dr. Iannotti was able to look at my incision and see how well I could move my shoulder," she says. "It was so easy. I never felt that I was giving up anything. He could see and examine everything he needed to, and I felt comfortable with that."

Wide Application

Telemedicine was originally intended to help provide medical services to people living in rural areas not well served by healthcare providers. It's still used for these types of patients. But it's become more widely used for all kinds of nonemergency care.

Telemedicine can be used to diagnose acute medical problems, such as infections, sprains, strains, colds and rashes. If necessary, prescriptions can be sent electronically to a local pharmacy. Telemedicine can also be used to help manage chronic conditions, including arthritis.

Initial visits may need to be done in person, but follow-ups and check-ins often can be accomplished via video chat. A growing number of gadgets and devices allow doctors to remotely measure and monitor vital signs, such as blood pressure, heart rate and weight.

Major benefits are the convenience and time saving. With a traditional doctor appointment, you may spend half the day getting to and from the office and sitting in the waiting room, just for a 10-minute follow-up visit.

Telemedicine also expands access to specialists who are a long distance from your home. You can eliminate much of the travel time and still get treated by the physician of your choice. And virtual visits are a good option for people with mobility problems who have difficulty getting to a doctor's office.

Telemedicine also has the potential to save costs. While Lynn Whitley ultimately had a successful outcome of her shoulder surgery, she experienced what turned out to be a minor issue with the wound. She went to a local emergency department and was told she had a wound infection and had to be quickly admitted to the hospital for more surgery.

She contacted Dr. Iannotti and the two had a virtual visit. He concluded that it was a hematoma (a collection of blood) and not an infection, and she did not need surgery. She then made an appointment with a local physician who confirmed the diagnosis. "If I hadn't done the virtual visit, she might have had unnecessary surgery," says Dr. Iannotti.

Limitations

There are some limitations to virtual office visits. For example, the doctor can't physically examine the patient and the patient must be comfortable using the technology. For a virtual video conference with your doctor, you need a computer or other electronic device with a camera and microphone, as well as a connection to the internet.

There may be technical problems as well. If the quality of the image and the audio are poor, it may not work well enough.

Insurance Coverage

Not all insurance companies cover telemedicine, but this is constantly changing. Some states require insurance companies to reimburse the same for virtual doctor visits as they do for in-person visits. In other states, you may have to pay for the service. Many people find the convenience of the virtual visits worth the extra cost. It may even save money when you factor in the expenses of taking time off work, traveling and parking.

Medicare has just begun covering some telemedicine services. Starting in January 2019, Medicare will reimburse doctors for brief check-ins with patients via communication technology, but only for established patients.

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