Telehealth also presents certain challenges, such as those inherent to a virtual physical exam. Dr. Zickuhr noted that unlike certain other specialties, such as neurology, rheumatology doesn’t yet have studies comparing whether one can reliably and effectively gather the same information virtually as one can via an in-person exam, and this remains an important area for future study.
In her own research, Dr. Zickuhr has found that strong physician/patient relationships are a critical part of supporting shared decision making during virtual encounters. Improved shared decision making may both be a cause and result of these strong relationships, leading to better patient adherence while also enhancing the patient experience.7 Dr. Zickuhr hopes to further study best practices for virtual encounters and incorporate them into a curriculum for rheumatology fellows.
Telehealth Competencies
Achieving mastery of telehealth requires a range of skills, not just those related to the quality of the medical assessment itself. All three panelists were part of an ACR group that co-authored a recent paper on rheumatology telehealth competencies. They adapted these from an initial version from the Association of American Medical Colleges and modified them to address aspects relevant to rheumatology fellows at their level of training.8,9
These competencies describe skills that rheumatology trainees should achieve across multiple domains, including those pertaining to patient safety, appropriate telehealth use, equity and access issues, communication concerns, data collection and diagnostic assessment, technology considerations, ethical practices and legal requirements, as well as the interface of telehealth with broader healthcare systems.9
“The rheumatology telehealth competencies add to our tools for evaluating and assessing fellows,” said Dr Bolster. “Importantly, competency isn’t only for in-person visits—it really should also include the unique aspects of virtual care that we can provide.”
Moving Forward
Many of his patients have found occasional virtual visits very convenient, especially if they live several hours away, Dr. Kolfenbach noted. “For example, if someone gets a bone density scan and they are a candidate for treatment, they might set up a video visit,” he said. “Before, they might not have initiated treatment until the next time they saw me in person, months later.”
Dr. Zickuhr agreed that since the start of the pandemic she has noticed more patients engaging with telehealth as a choice that makes sense for their lives, whether that’s through exchanging virtual messages with providers or having an audio-only or video virtual visit. Dr. Bolster pointed out that from the provider side, it gives another opportunity to check in more frequently with some patients when that may be helpful.
