Telemedicine in the Age of COVID-19

What patients should know

With Joseph Kvedar MD, Shahrzad Akbary DO, and Jill Butler MD

Telemedicine is a way to safely consult with your doctor and renew existing prescriptions without risking infection from other patients.

While many facts about COVID-19 are still under study or debate, such as what percent of the population is already infected, who has antibodies to COVID-19, and how long lasting they are, some are clear. Those with underlying conditions—and that includes diabetes, obesity, and other endocrine disorders, are at a higher risk of severe complications if they become infected. So, it's all the more reason to consider staying out of the doctor's office or clinic and making the switch to telemedicine.

Despite what you may have heard, telemedicine isn't new, and can be traced all the way back to the late 1950's, when the psychiatry department at the University of Nebraska Medical Center conducted group therapy and instructed medical students by linking classrooms and clinics remotely.

Some physicians have been offering it as an option to patients who prefer it for decades. One of those is Joseph Kvedar, MD, a professor at Harvard Medical School and president-elect of the American Telemedicine Association. He would urge his colleagues to think about how efficiency could be improved for both patients and healthcare practioners in situations that didn't need to involve physical interactions or office visits.

Now, healthcare providers realize, patient safety and patient needs can often be maintained by switching in-person visits to virtual visits whenever possible, says Kvedar. Not everything can be handled virtually, of course. But you may be surprised at the scope of health needs that can be met without having to physically enter your doctor's office.

Telemedicine can be:

  • An email message or back-and-forth conversations through your health plan's portal
  • A telephone call—yes, even from your land line
  • A conversation via Zoom or FaceTime
  • A Google Hangouts appointment via video
  • Whatsapp video or another chat platform
  • A virtual visit on your doctor's platform or your health plan's platform

How to protect your privacy

If you care about privacy, ask about the security of the platform or mode you will be using. For instance, Shahrzad Akbary, DO, a dermatologist with the Faced Medical Group in Los Angeles, is using Zoom to meet with her non-emergency patients. But if a patient is concerned about Zoom (the company addressed some security concerns recently) she will inform them that each doctor in her practice uses a private Zoom link. If a patient is still not comfortable, she offers to set up a phone meeting.

Preparing for your digital visit

  • Check ahead of time what you need to do to prepare. Some patients will have to go to their patient portal or online ''chart,'' and then click a link to enter the visit.
  • Test the camera and microphones on your device to be sure they are enabled and working OK before your appointment.
  • Ask your healthcare provider for specifics so you can maximize the amount of time you spend actually meeting with your doctor, and minimize time spent on technical adjustments during your appointment. 
  • Organize your questions for a virtual visit just as you would before an in-person one, says Jill Butler MD, an internist with VNAHG Visiting Physician Services.
  • Have your medications or a list of them handy, as well as input about blood glucose readings, if that’s up for discussion.
  • Have any diabetes tools and medicines you may be discussing close by, too: insulin, CGM, meter, and medications.
  • Pick a quiet place in your home or office, and be sure it's well-lit with a solid wall as your background. Because the doctor can't see in-person body language, it's ideal that you be as visible as possible.
  • Your healthcare provider may be almost as new as you are to telemedicine, so expect some glitches. You may need to wait a bit in the virtual ''waiting room." But at least you won't be stuck in traffic getting there or returning home.
  • It's easier for your healthcare provider to read ''body language" in person, of course. So you may need to give extra information about how you are doing or feeling.

Experts have found telemedicine visits make it possible to share results of blood sugar levels remotely, address concerns and even help lower blood sugar levels. Patients report being satisfied with the approach.

In the era of the pandemic, even with glitches in telemedicine, staying out of a busy clinic or hospital has the added benefit of keeping you safer, with less potential for exposure to the Coronavirus.

Due to COVID-19, federal officials have made it easier for healthcare providers to do telemedicine during the pandemic. According to the Department of Health and Human Services' Office for Civil Rights, healthcare providers can offer telemedicine by way of audio, text messaging or video communication technology without fear of violating HIPAA regulations. However, Medicare and Medicaid may impose their own restrictions on the types of technology that can be used. And HHS says the technology must be ''non-public facing"—so that prohibits Facebook Live, Twitch, TikTok, and similar apps.

What about payment?

Some health insurance plans are waiving all costs for telemedicine visits; others are reimbursing telemedicine appointments at the same rate as traditional ones. A summary of many plans and what they are doing is on the website of the industry group, America's Health Insurance Plans. It lists details on payment for COVID-19 testing, but also how plans cover telemedicine visits. Medicare has OK'd the use of telehealth to treat COVID-19 and for other ''medically reasonable purposes," noting that coinsurance and deductibles apply, but that some healthcare providers are reducing or waiving the amount you pay for telemedicine visits. If you're in the virtual waiting room a bit, the American Telemedicine website has more information.  

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