Telemedicine (and me)

Telemedicine and telehealth have been with us for decades, but with the onset of the pandemic, it has become a vital tool, catapulting to the forefront of medicine. With the continued requirement for social distance, its use and acceptability are expanding at unprecedented rate. The availability of electronic equipment and reliable broadband, along with our ability to use them, are also contributing to increase. Long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions are now possible.

Before this recent acceleration, telehealth/telemedicine had provided treatment to offset costs in rural settings, in situations where sufficient staff wasn’t available, or where transportation or immobility made in person treatment untenable. Now, NYU Langone books an average of 4000 telemedicine appointments a day.

Some organizations and countries distinguish between telehealth and telemedicine; Telemedicine specifically focuses on diagnosis and treatment; whereas telehealth includes communication between clinicians, and between facilities, home monitoring of patients through the transmission of health data as well as non-clinical applications like administration and provider education.

Practically every specialty can now partake in remote medicine, including surgery with the help of robotic assistants. It has proved useful for post-operative monitoring and care as well as telerehabilitation. (Of course, telemedicine’s limitations become obvious when a hands-on examination is necessary, like a yearly physical or a gynecological exam.)

Telenursing is also growing in many countries to treat the increasing number of aging and chronically ill population, to help with the nursing shortage, save time and costs and keep patients out of the hospital. As a result, nurses have reported greater job satisfaction. 

Telehealth facilitates medical disciplines to merge and improve the level of care. The everyday medical and psychological visits as well as those that extent beyond the quotidian. Trauma specialists can interact with personnel on the scene of a mass casualty or disaster via the internet to provide clinical assessments and determine the severity of injuries, and whether injuries warrant evacuation. Remote trauma specialists provide the same quality of clinical assessment and care as a clinician on-site.

Telemedicine is being used in some ICU’s to reduce the spread of infection and is especially useful in communicating among caretakers to relay information for patients’ care between day and night shifts.

The team of attending, residents, fellows, nurses, nurse practitioners and pharmacists are able to watch live video from a patient’s bedside, see the patient’s vital signs on the monitor, view settings on a ventilator, and assess a patient’s wounds. Video-conferencing allow the remote practitioners two-way communication with clinicians at the bedside.

Telepsychiatry

Perhaps nowhere is telemedicine more effective than in psychiatry. Telepsychiatry has been a valuable tool for several years to deliver care to underserved areas. A few years ago, I attended an APA meeting where a young psychiatrist presented. She had designed markers to support the efficacy of telepsychiatry in treating a rural population. Her results were positive and her enthusiasm was impressive and contagious.

Telepsychiatry has been found to be as effective as face-to-face treatment. Since the pandemic, it has become the major method of treatment for diagnosis and assessment, medication therapy management and in-depth psycho-dynamic psychotherapy. And may be even better than in-person treatment for children, veterans and individuals with agoraphobia.

The change in living situations, necessitated by the pandemic has raised many profound issues and increased anxiety and depression for several of my patients who now require intense treatment. 

Telepsychiatry has another advantage of adding an extra dimension of making a home visit possible via Skype. One session focused on helping a woman-homemaker whose symptoms revolve around disorganization and clutter.

During an interview with a new patient (who was tense and hesitant to relate her history) the ice was broken when her cat wandered across the screen and evoked our mutual amusement.

Another patient, who had selected me as her psychiatrist because of my photo with my dog, was able to see him in my home office. 

The advantages of telemedicine are numerous and include:

1.Greater access to treatment improves patients’ health

2.Decreases time spent traveling

3.Cuts down on office costs 

4.Offers greater access to expert care 

      5.Helps to cut down on hospital time

6.Makes fewer demands on the healthcare system

With the possibility of self-monitoring, patients have a greater sense of control and may be more willing to stay on their treatment plans as they are more invested and included in the process. 

Remote monitoring or self-monitoring has been especially useful for managing chronic diseases or specific conditions like heart disease, diabetes, and asthma. And have been found to provide health outcomes comparable to traditional in-person visits.

But there are still barriers to wide-scale adoption, including:

The regulatory challenge of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities. (Although this consideration is also experiencing a great deal of flux.)

Resistance by government and insurance carriers to reimburse for the practice of telemedicine. 

The reluctance by physicians to change the way they practice.

FUTURE 

With continued use and research regarding the efficacy of the vast possibilities in each medical specialty, the government and more insurers will cover the vast range of therapies that avail us all now through the ever-increasing availability of technology. 

Although its future in post-pandemic days is uncertain, many experts agree that this valuable tool will be integrated and used more widely than before the onset of social distancing.

N.B. I’ve excerpted some details from a scholarly article. My brief blog is by no means comprehensive in any way. I hope the tidbits of personal experience add to the mix. I’m most fortunate and grateful to be able to continue treating my patients via telepsychiatry without a glitch thanks to Fieve Psychiatry (212-249-1600) and our manager Paula Puia. With her technical skills and know-how, she rapidly set up the system that offers confidentiality via Skype. She and the staff process the paperwork to secure reimbursement from a variety of insurance companies.