Patients

“Take care with telehealth” – it’s an urging not a warning. Unless you have been a caregiver of a loved one, you may not appreciate the potential mental, physical, quality of life and financial impacts. My sister bore the burden of caring for our mother when Alzheimer dementia stole her sharp mind. On the rare occasions when my mother stayed with me for weeks at a time, I was overcome with anxiety, feeling like there were tight bands around my chest, and my normally low blood pressure shot up. This tracks with evidence that female caregivers experience more psychological distress than males (Families Caring for an Aging America. 2016).

Over the past year, many individuals have been staying home to help support public safety measures and reduce the impact of COVID-19 on our communities. This was challenging, but current technological advances have allowed most of us to continue to stay healthy.

Part of this technology is telemedicine, which is also referred to as telehealth, telecare, telewellness, and more.

Can you imagine the opportunity to receive some of your prenatal care without leaving your home? The stress of pregnancy is certainly exacerbated by the eight to fourteen recommended prenatal visits, particularly if the woman has full-time work, lives far from the clinician, has other children at home, or lives in a part of the country with weather or other factors than makes it difficult to drive safely.

Published data show that these visits are safe, with the same outcomes as women who had traditional prenatal care visits. Patient satisfaction is high, particularly among women for which the pregnancy is not her first.

Telemedicine is when technology is used to deliver care at a distance. A physician or some other healthcare provider is in a different location than the patient, delivering care virtually, over video or phone. Since the spread of the Covid-19 virus in 2020 telehealth and telemedicine coverage has been expanded, which was previously covered only in a limited fashion. Therefore, there has been a large increase in Medicare recipients seeing physicians using telemedicine. Many types of visits in most specialties can be handled through a virtual or telemedicine visit. This is especially important for the Medicare population, since it is mitigating their risk by not going to an office with exposure to others. In some circumstances it may still be necessary to do an in-person visit, for example to get an x-ray exam, get labs done or have a procedure done. Here are five helpful tips to help you best prepare for a Medicare telemedicine appointment.

Well… not quite; but it may not be what you think. I’m not here to make the case about the importance of good oral health, the impacts of poor oral health on overall health and chronic disease, the potential to lower health care costs and our countless opportunities to integrate oral health into health care services. Rather I ask that you join me to learn just a bit more about what teledentistry is and how it can be used to expand access, provide education and elevate team-based care.

Utah has a population of over 3 million people spread across 82,144 square miles. Rural communities make up a little more than 10% of Utah's population. The details of Utah’s population raise a challenging question for healthcare: How to provide quality and timely care to the 10% of the population living in rural communities? At Intermountain Healthcare, telehealth is a crucial part of our solution. The Intermountain telehealth journey began when clinical leadership recognized that Park City Hospital was transferring many critically ill patients to Salt Lake City. The distance is not far, but potentially unnecessary transfers were taking place on mountain roads, during bad weather conditions typical of high-elevation, mountainous regions.

Snow birds. Not the kind that fly (certainly not now with COVID) but the human kind. For those of you who never heard the term before, snow birds are typically retirees who travel south in the winter to states like Arizona, New Mexico and Florida to get away from the snow and cold up north than go back up north in the summer when the heat hits the south. What does this have to do with telemedicine? A lot actually and not just with snow birds. We are a mobile population. People don’t stay in one place their entire lives anymore – we move around, we travel but when we move from one place to another we don’t get to leave our health conditions behind us. They stay with us and sometimes we just get sick when we travel. Being creatures of habit, however, most people like to have consistency in their health providers. We like to think that our PCP and specialists that we see know us and our problems, that we have a relationship. Back to the snow birds – if my cardiologist lives in Chicago and I see her during the summer I want to see her during the winter as well when I’m relaxing by the pool in Tucson staying warm. Problem is she’s back in Chicago shoveling snow so how can I see her? Telemedicine of course but it’s not that easy.

Empanelment. Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment is a foundational component of primary care and is essential in population health management. In 2019, the People-Centered Integrated Care collaborative, participants from 10 countries developed an overview of empanelment and a comprehensive definition:

When it comes to platforms and technology for virtual care, when do you buy and when should you build? Building is certain to cost more up front, but it offers the option of lower costs of ongoing support. In addition, if you build it, you own it and can do what you like without interference. Buying it leverages the experience and expertise of vendors, while alleviating programming and some internal support needs. When it comes to creating a telemedicine offering, the struggle is real. There are countless vendors and options. Large companies have merged into larger major market brands. Many companies, including startups, do one or a few things very well as targeted solutions. Getting information on product decisions can be difficult as vendors do not always provide actual use cases. They often leave that up to the customer to define then say how their system could fulfill those needs. Searching for something like ‘TeleICU’ returns more articles and vendors than one could reasonably read.

I spend many hours every week in meetings regarding telehealth. I lead one on proving the value of telehealth. I participate in others focused on mental health, pediatrics, ocular care, the business of telehealth, the associated technology, etc. etc. etc. Over time I’ve realized that, in most cases, the focus is totally on video visits. Having spent many years leading virtual care for Kaiser Permanente in Colorado, in my humble opinion, telehealth encompasses MUCH MORE than video visits. My definition of telehealth is any care process that does not have the clinician and the patient in the same room at the same time. This includes care provided via secure text, e-mail, telephone, video, remote patient monitoring, social media, mobile apps, even sources of information for self-care.