Use of telemedicine soars during pandemic

'Different way to reach patients' proving to be popular

Telemedicine theme with person using a laptop computer
Telemedicine theme with person using a laptop computer

Telehealth has become the norm for health care visits during the novel coronavirus pandemic. And patients are getting used to virtual rather than in-person visits with a doctor.

“In March (of 2020), telehealth became our go-to, especially early on,” said Dr. Tim Sagers, a primary care provider with Mercy Cedar Rapids.

Technology use by consumers had matured, and people had developed a comfort level with on-demand services, Sagers said. The time was right for telehealth to take off.

“The consumer was prepared, the technology was prepared, and health care finally realized that we have to have different ways to reach patients,” Sagers said.

Telehealth, also called telemedicine, is a virtual visit with your health care provider. Rather than meeting in person, the provider and the patient communicate through video conferencing, a smartphone app or phone call.

About 2,500 telehealth visits occurred with Mercy providers in 2019. Between March and December, Mercy providers connected with patients through telehealth about 40,000 times.

All providers are using telehealth to some extent, Sagers said. After the Aug. 10 derecho damaged all of Mercy Cedar Rapids’ clinics, telehealth allowed providers to meet with patients.

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“It became a lifesaver,” Sagers said. “It was the only way we could safely connect with patients.”

BEFORE COVID-19

Health care has been moving towards telehealth for about 20 years, said Sagers, who’s been seeing patients via telehealth technology for half of his 20-year career as a physician.

Sagers is one of the physicians who provide care through Collins Aerospace Telehealth Clinic. The clinic is a blended model, with nurses and other staff on-site. The nurse sees the patient in person, then calls the physician who interacts with patients through high-definition diagnostic technology tools.

Like many other providers, Mercy Cedar Rapids already had the technology in place to expand telehealth. Videoconferencing is built into the electronic health records system that a nurse or doctor use to type in information during an inoffice visit.

If you have a MyChart account through Mercy Cedar Rapids, UnityPoint Health, University of Iowa Hospitals and Clinics or another health care system, you’ve been ready for telehealth visits. MyChart is part of the electronic health records software many health care providers use from Epic Systems, which includes a videoconferencing option.

Are you registered for a MyChart account? If so, before the pandemic, you could use it to access appointment information, view test results, and to message your health care team. You also were ready to meet with your provider virtually through a cellphone app or internet site.

UIHC also uses Epic and MyChart. But Dr. Katie Imborek, director of Offsite Primary Care for UIHC and University of Iowa associate professor of family medicine, had never done a telehealth visit before the pandemic. She had used Epic for e-consults with other providers but not with any of her patients. With the new focus on telehealth visits, Imborek has noticed that many of her patients who live a distance from Iowa City really appreciate telehealth as an option.

DURING COVID-19

Although telehealth systems were in place, the transition to mostly virtual visits brought some challenges.

Health care systems scrambled to put together tech teams to train staff and make sure they had the hardware they needed to interact with patients.

Imborek found it remarkable how fast IT was able to get telehealth up and running for UIHC providers.

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In order to make the transition to telehealth visits easier for patients, many providers quickly set up help desks to talk patients through setting up MyChart and to work through any computer, tablet or cellphone issues. Often, though, it was the doctor or nurse who helped troubleshoot audio and video issues.

“Some providers are more comfortable with that than others,” Imborek said.

Health care providers always can pick up the phone “and do it the oldfashioned way,” she said. When a patient doesn’t use MyChart or doesn’t have access to high-speed internet needed for video, a traditional phone call is still a good option.

Video calls are the preference for telehealth. The internet connection and hardware on the patient’s end determines how clearly the provider can see the patient. For example, a webcam mounted on a computer often provides a clearer picture than using an older cellphone or a laptop’s builtin camera.

“Adding the video really gives you the ability to be able to assess a patient a little more, not giving us as much information as we could get in person, but potentially giving us what we need,” Imborek said.

“You click the button, and the screen pops up on your phone in the app,” Imborek said. And just like that, provider and patient can see and hear each other. “It’s super slick.”

Starting with a telehealth visit can answer Imborek’s first question: Can I complete this visit via telehealth, or do I need to see them in person?

There is always the option to schedule an in-person visit — if, for example, the telehealth visit is with a feverish child whose ears need to be checked for infection.

For family medical practice, most visits are scheduled wellness checks or follow-ups to manage chronic illnesses which can be handled well by a telehealth appointment.

MENTAL HEALTH CARE

Imborek said telehealth also works for follow-up care for ADHD or mental illnesses such as anxiety and depression.

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Drew Martel, director of crisis services with Foundation 2, was familiar with telehealth services through his private practice. During the pandemic, clients became familiar with telehealth visits and began to request seeing him virtually.

“I never had a client request it before the pandemic,” Martel said.

Before the COVID outbreak, Foundation 2, a nonprofit agency whose services include counseling and crisis mental health care, did have a crisis line where providers could talk to clients via telephone, chat or text. Its mobile crisis team, which serves 11 counties, can do in-person visits within an hour of a crisis call.

However, Foundation 2 wasn’t doing any video telehealth.

Within a week of Gov. Kim Reynolds closing schools in March, Foundation 2 was ready to interact with clients virtually. The nonprofit uses the same free online service that Martel uses in private practice. The service doesn’t require clients to download an app or require individual subscriptions for each staff member.

As infection rates went up, and the risk of infection became greater for both clients and staff, Foundation 2 used telehealth intermittently. It was a struggle to identify when to go 100 percent to telehealth, Martel said.

Foundation 2 now makes decisions about when to use telehealth based on what’s best for the client and staff, rather than looking at infection rates county by county.

After the derecho tore off the roof of the Cedar Rapids crisis center, telehealth became the only option even as calls for assistance picked up. Martel would like telehealth to continue to be an option moving forward. However, a lot depends on whether insurance carriers will continue to pay for it.

Still, there are times when inperson is the best option, including when clients are an imminent threat to themselves or others, Martel said. Kids also can find it difficult to sit in front of a screen for a 45-minute visit. The younger the client, the more challenging telehealth visits are, he said.

Overall, he encourages people not to delay treatment.

“There’s never a wrong time to reach out,” Martel said. “We will work with a client to identify the patient’s needs, whether that’s telehealth or inperson. We’ll figure it out.

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Tips for getting the most out of telehealth

BEFORE YOUR APPOINTMENT

• Enroll in your healthcare provider’s telehealth system – before you need it. Call your provider or check online to find out how to get connected.

• If you don’t have an internet connection but can use your cellphone, be aware the call will use your cellular data.

• At least an hour before your scheduled appointment, test your technology. If you are having issues connecting, seeing or hearing your healthcare provider, call their office. Most have a tech or help desk available to resolve telehealth issues.

• E-check-in, if that is an option.

• Clean the camera on your phone, tablet or computer.

• Prepare any questions in advance, including a list of medications and supplements, etc., just like you would for an in-person visit.

DURING YOUR APPOINTMENT

• Find a private, quiet space: Think of it as an exam room.

- If you’ll be discussing your child’s health, you should both be sitting in a room with minimal distractions. Turn off the TV or any games.

- Sitting in your vehicle may be a good option if you don’t have a private space at home or work.

- Wear headphones or a headset to provide an extra level of privacy.

• Be comfortable and wear appropriate clothes. Remove personal items from the space. Your provider may ask you to stand or move about to assess your condition.

• Sit down and focus.

• Keep your device stable on a desk or table.

• A nurse may speak with you before your primary care provider, just as they would during an office visit.

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• Ask others to leave if you don’t want someone to be involved in the appointment. Your provider should ask if it’s OK to talk about confidential matters.

WHEN TELEHEALTH IS NOT APPROPRIATE

• A broken bone or any critical injury

• A possible heart attack, stroke or other serious condition or illness

• When additional testing or labs are needed to assess your condition

HEALTHY YOU ARTICLES

09:00AM | Thu, February 04, 2021

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