Telemedicine: One Rheumatologist’s Experience

Telemedicine has yet to gain a foothold in rheumatology practice. A quick Google search shows but a handful of articles, most with headlines, such as, “Does Telemedicine Work in ‘Hands-on’ Specialties?” or “Seven Reasons to Embrace Telemedicine.” And the legal barriers, such as licensure, consent, patient encounter, scope of services, reimbursement and patient privacy, can be challenging to overcome.

Yet practitioners utilizing telemedicine—also known as telehealth—for their rheumatology patients really love it. It solves many of the access issues rheumatology patients encounter and can increase provider productivity, according to Daniel Albert, MD, professor of medicine and pediatric rheumatologist at the Center for Telehealth at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Benefits
“There are a lot of patients we see that cannot get to us at all,” says Dr. Albert, who adds that access is not just a rural issue. “Telemedicine is far, far better than the care those patients are getting, which is no care at all.

“The other motivating factor is money. It saves time and money, for the patient and for the providers. There are a lot of applications for telemedicine. If you can overcome the administrative barriers, it can be widely used.”

Personal Experience
Dr. Albert has incorporated telemedicine into his practice for roughly the past four years. He has a video camera attached to the laptop he carries with him during the day. The software the Dartmouth-Hitchcock Medical Center uses provides a Health Insurance Portability and Accountability Act (HIPAA)-compliant video link to patients. Both the video camera and the software are relatively inexpensive, he says. During clinic, he toggles between live patient encounters and video appointments.

“It is really flexible. A [telehealth] encounter is roughly one-third as long as a conventional, face-to-face appointment,” he says. “It doesn’t require a lot of office space, either. I have seen no reduction in RVUs. For me, a telemedicine visit is actually better for my schedule. I can do four telemedicine returns in an hour.”

Dr. Albert says administration and a provider’s comfort level with the technology and format are the main challenges. But he believes both can be solved with help from technology and billing support staff. His group just published some data on telemedicine practice in Seminars in Arthritis and Rheumatism, which he says validates telemedicine in a variety of settings.

Motivated providers will find most rheumatology patients are comfortable with the video chat format, too.

“Don’t assume older patients won’t like telemedicine,” Dr. Albert continues. “It is actually the opposite. Older patients are early adopters. They are used to Skypeing with their grandchildren. Many are pretty savvy; most are very comfortable.”