As of yesterday, about half of all U.S. states had issued orders for their residents to stay at home other than essential trips. Another 14 or so had regional shutdowns. So what can patients who have non-coronavirus problems do in the next two months? There are a couple of options including Telemedicine. What’s that? How does it work?
State Orders and Doctor’s Visits
First, all state orders that I have seen allow physician clinic visits. That just makes good public policy sense. In addition, who better than physician offices to come up with solid viral spread mitigation plans?
So should you go to the doctor’s office if you have a problem? First, if you suspect you have coronavirus which is a high fever, aches/pains, a dry cough, and oftentimes stomach upset, then you should call your family doctor first. Most family physician offices would rather deal with this first step over the phone. Why? They want to avoid turning their offices into a concentrator for the virus.
However, the vast majority of us don’t have coronavirus, or if we get it, it will be mild. Yet we still have medical issues that need to be managed or treated. How about all of the common stuff or even new things that would cause you to see a doctor?
Clinic Visits in the Time of Coronavirus
So if you have a problem, should you see your doctor in the clinic? The answer in the time of corona is yes, but that’s up to you. Listen, you go to the grocery store and if you’re in Colorado, our marijuana dispensaries are open (which is a state joke, but true), so who’s going to do a better job of protecting you? Your local Publix, Kroger, Safeway, Vaughn’s, or Piggy Wiggly? Or your doctor’s office?
I would also personally use some common sense. For example, if you have a family doctor’s office that is overrun with sick people who may have coronavirus and the office is not doing a good job of managing things (i.e. no social distancing and a full waiting room), then you may want to request a telemedicine visit (more on that below). On the other hand, if you have a specialist’s office who has limited their patient flow during this time and has sent you an email describing how they’re handling and mitigating the spread of coronavirus, I wouldn’t hesitate to go and get what you need to have treated handled.
As you’ll see below, I think the new standard during this time is offering patients both options. That means in clinic visits for those who are comfortable with that approach or who really need to be seen or treated in the clinic or a telemedicine option for those who can’t or don’t want to leave the house. The bottom line? You should have BOTH options.
Telemedicine is defined as using technology to visit with a patient that’s not able to come to the office. While there are many different systems out there, just about any video conferencing tool can be used. All are secure platforms and many have medical versions. In addition, medical doctors during this crisis are now licensed for the purpose of telemedicine across state lines, so a doctor licensed in state X can now see a patient in state Y.
How It Works
These visits are usually scheduled just like any other visit. However, rather than coming to the office, you’re usually sent a link to click that downloads the telemedicine “room”. Oftentimes you’re greeted by a medical assistant who will take some basic history. When the doctor enters the virtual room, he or she can see you and vice versa. They should be able to share the screen to show you films or lab results. The doctor can prescribe medications, imaging, procedures, physical therapy, or whatever needs to be done.
Another exciting thing right now is that Telemedicine visits are now covered by insurance for routine care! That means that major health carriers cover these visits right now just like a regular office visit. This is new and was pushed through to allow telemedicine visits during the crisis.
Our Case Example
Regenexx as a national clinic system helps patients avoid invasive surgeries for orthopedic problems by using state of the art and precise image-guided, platelet, stem cell, and regenerative medicine procedures. Given that what we do is to help painful knees, backs, neck, hips, shoulders, etc…, we needed a telemedicine system that was geared more toward the musculoskeletal system than adjusting someone’s blood pressure medication. Above is my video introducing our telemedicine platform to our patients.
Given that many telemedicine systems are designed to layer in many extra steps to comply with HIPPA and these rules have been relaxed during the crisis, in looking for a video conferencing system, we wanted one that was as easy and familiar for patients as possible. Hence, we chose a medical version of the world’s most popular video conferencing system called Zoom. If you work in business and have remote meetings, you already know Zoom.
Our system begins when the patient calls a local Regenexx provider or the national call center. He or she is then booked an appointment just as if they were being seen in the office. The only difference is that the scheduler sends out a reminder email with a link that the patient clicks to see the doctor.
History means what happened, any prior problems a patient has had diagnosed, and what the patient experiences. The patient fills out a form no different than if they were seen in the clinic.
The Physical Exam
One of the problems we’ve solved is how an orthopedic focused doctor can perform an examination on a new patient over a telemedicine system. In our case, the patient is directed to a secure webpage where they click on their problem body area. They can then watch a short video that walks them through a self-exam, which is a great way for them to understand their condition at a much higher level than an exam in the office. They record their findings for the doctor and send those to the clinic.
On the date/time of the visit, rather than traveling to the office, the patient stays home, fires up a phone, tablet, or laptop or desktop and clicks the link. The software downloads and they enter a virtual room. The doctor has the physical exam info in front of him and shares his screen to review the results of any imaging studies, showing the patient what’s wrong on the images. He or she then refines the history and exam over the video link. Finally, a game plan for treatment is formulated.
If you’re in an area where elective procedures are shut down for the moment, then most physicians are putting together what’s called a “priority schedule”. That means that when elective procedures are opened back up, patients will be on a priority list for the clinic. For example, a patient who was seen earlier will get booked earlier on startup.
Patients in these areas who have more urgent needs can still get the types of procedures we offer. What’s allowed varies from state to state, but for example in Colorado, if the doctor believes that not treating the patient now will worsen their overall condition on a go-forward basis, a procedure is permitted.
Other parts of the country are still offering more routine procedures.
The Advantages of Telemedicine
The advantages are many:
- You get to stay home
- If you have kids to watch, no reason to get a babysitter
- No travel time
- If you have a condition that doesn’t travel well, you can still be evaluated even if you’re in another part of the country
- Our self-exam modules teach you about your condition
The upshot? Telemedicine may sound daunting or scary, but it’s actually pretty cool. You get to stay home and be seen by your doctor! In addition, at Regenexx, we’ve solved the problems of how an orthopedic focused doctor can get the information he or she needs to make a decision. So if you’re new to telemedicine, don’t hesitate to schedule a visit today!