Screen Tests

Doctor visits, exams, consultations and therapy are taking place via telehealth

by JAY BERGER

Jay Berger is a physical therapist and co-founder of VirtualKare.com, a clinician-owned telehealth and wellness company.

In 1924 the magazine Radio News published "The Radio Doctor—Maybe!", portraying the future of patient-doctor visits using radio and video.

It seemed like science fiction. Yet it predicted today's telehealth services: the use of electronic communications to remotely access and provide health care information and services.  Using phone, video, text, or app, telehealth connects patients virtually to health professionals using wireless communications, remote monitoring, and mobile health technologies like a smartphone, app, or wearable device.  

The COVID-19 pandemic has fast-tracked awareness and adoption of telehealth in Canada.  Before, only 15% of total billable physician services were virtual, according to the 2015 Canadian Telehealth Report.  The Ontario Physiotherapy Association survey showed less than 6% of physiotherapists provided virtual care.  Says Costco member Anna Yufa Laserson, DPT, a physiotherapist, most therapists were unaware of virtual care. 

Keith Thompson, MD, a primary care physician, IEEE Standards Association advisor, and Costco member, explains virtual care adoption was slow partly because it was cumbersome and not cost-effective.  Ontario physicians had to pay a fee and get credentialed to be eligible for virtual care reimbursement.   Thompson, a prior Teledoc advisor, said there were no physician billing codes to get reimbursed appropriately for virtual patient visits.  As demand for virtual services soared, the Canadian government responded, allowing every province and territory in April 2020 to create new billing codes so physicians could provide and be paid for virtual care services, increasing physician adoption.  By May 2020, the Canadian Medical Association (CMA) poll showed 47% of all Canadians had used some virtual care option during the pandemic.  

Virtual care has proven an indispensable tool and silver lining during the pandemic, permitting clinicians to provide patient care remotely.   Clinicians can receive transmitted data to assess and treat patients.  Telehealth links patients to their health care teams, allowing clinicians to closely monitor and manage patients with chronic illness and intervene earlier to prevent rehospitalization.  Employee benefit plans have begun to offer digital health solutions to improve employee access and engagement with their health benefits. 

How it works

Let's say Joe, a patient, needs an appointment. He uses the provider's online scheduling system or calls. Once the visit is confirmed, Joe receives an email or text message with a link to his virtual appointment and, if needed, a link to download the (safe) video software.  Joe completes and digitally signs any forms he receives, by email, in his patient portal, or on the provider's website.  At his appointment time, Joe clicks on the email or text link and begins his visit.  

Why it works

The 2019 Frasier Institute report found Canadians have one of the highest wait times in the world to see a physician and considerably longer for a specialist.  Virtual care is well suited to Canada's climate and vast geography.  It benefits patients, health outcomes and reduces health care costs.   Patients, especially those in rural and underserved areas, have faster and increased accessibility to clinicians, including specialists.   The same level of care can be provided to patients at a much lower cost, availing more taxpayer money for other needs.

Remote visits ease clinician workflow while increasing patient convenience.  With less travel and fewer interruptions, clinicians can see more patients and provide more focused care.  It relieves the hardships many patients face to leave home for appointments, removing lengthy waits at a clinic, urgent care, or ER; potential exposure to germs; and mobility or transportation issues.  Patients take more ownership for their care, observes Costco member Maggie Bergeron, PT, co-founder of the Embodia App and owner of The Yellow Room Physiotherapy. 

Concerns

Logistical and regulatory barriers remain that fragment and limit further use.  Each provincial government is responsible for its provision of telehealth services.  Clinicians can only practice in the province or territory they hold a license.  There can be language and cultural barriers.  Not every patient or practitioner has the equipment, internet connection, ability, and comfort to use the technology.   Access to provide service varies in each province and territory, and according to Thompson, contributes to different physician success rates.  Bergeron suspects the over 50% drop in therapist use since 2020 is because it's difficult for therapists to change their 100-year-old therapy model. 

Concern has been raised telehealth will disrupt the intimacy and personal connection of inpatient visits.   Yet patients in the CMA study who used virtual care reported a 91% satisfaction rate.  Given the option, 38% said they would continue to use it, preferring a virtual visit as a first point of contact with their physician.

Virtual care will never fully replace in-person care but is here to stay.  The Canadian Attitudes on Healthcare and Telemedicine Report shows 70% of Canadians believe telehealth represents the future.  Thompson says physicians want and believe funding should continue.  He envisions a continued hybrid model of face-to-face and virtual care sessions but emphasizes virtual care works best when the clinician already knows the patient.   What virtual care does, that in-person visits do not, is to offer the patient a choice to be seen in their home and become more actively involved in their health care. 

VIRTUAL CARE TIPS

For a better telehealth experience:

Before your session, fully charge your electronic device. Before the call, find a quiet, well-lit area and test your microphone and camera connections for clarity and connectivity. This pre-call test at tokbox.com/developer/tools/precall can check the quality of your online connection, media access, and quality.  If your internet speed is slow, shut off any streaming video or other bandwidth hogs during that time.

If more than just your face and upper body need to be seen, configure the camera far away enough that it captures your entire body on the screen.

Log on about 10 minutes early to troubleshoot any potential issues. JB