Telemedicine Provides New Challenges & Opportunities

Optimizing Telemedicine Visits

Dr. Hausmann: What can rheumatologists and patients do to optimize telemedicine appointments?

Dr. Jayatilleke

Dr. Jayatilleke: From the perspective of seeing patients in their home [via telemedicine], obtaining records and working through things in advance is really important. [That means] making sure we get all the information about who the patient is, documenting their consent to be seen remotely, getting some reasonable identification and making sure their identifying details are correct in their charts. Then walking through the process of how the visit will go, and ideally, having people prepare just as they prepare for office visits. Still, it is an additional demand on the staff who are also dealing with in-person care.

Dr. Peoples: It’s important to have a game plan for simple things, such as medication reconciliation. (Our staff calls the patient prior to the appointment to review medications.) Any information you can get from the patient about their disease activity is helpful. [The conversation] doesn’t have to be long; [the patient] can [provide] just the highlights they want to talk about.

I provide reassurance that if we can’t get to everything, we [will] make a plan to get through it at a later date. I encourage a lot of my patients to keep a diary of what’s going on with their symptoms and overall health. Many patients take out their paper diary, and we go over everything. Sometimes, they take such good notes on what’s been going on with them that we just scan that into their record.

Dr. Jayatilleke: It’d be nice to have patient-reported outcomes [entered] before the visit in a coordinated way to get some of their symptoms so you don’t have to spend time doing [that during the visit].

Healthcare Disparities

Dr. Hausmann: Healthcare disparities have come to the forefront with the pandemic because we know COVID-19 is not affecting everybody equally. To what extent is telemedicine going to magnify some of those disparities? Or is there a way telemedicine will actually bridge some of that gap and promote more health equity?

Dr. Jayatilleke: I worried about that in the very beginning because there was this uncertainty about whether the audio/video visits would be reimbursed at a higher rate than the audio-only [visits]. A lot of my patients, although they’re not in rural or remote areas, may not have internet-capable devices or Wi-Fi access. I was worried that we were going to leave behind those patients who didn’t have that access in pursuit of the higher reimbursement.