Dr. Marissa McGinley, MD, neurologist at Cleveland Clinic says “almost any service that is not a procedure can be conducted in some capacity via telehealth.” Since telehealth is a broad term and covers a wide range of services, it’s important to know what it means. According to Centers for Medicare & Medicaid Services, “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health.”
Synchronous vs asynchronous telehealth communications
Another important breakdown is the concept of synchronous and asynchronous telehealth communications. Providers and patients often will communicate through patient portals, which is asynchronous telehealth, Dr. McGinley explains. Through this form, the following are common uses:
Prescription refillsDiscuss new concerns/symptoms and determine if a synchronous telehealth or in-person visit is neededTesting results can be released and discussedScheduling appointmentsEducational information regarding a certain condition, treatment, etc.
Synchronous telehealth are the virtual visits conducted with a provider (MD/DO, NP/PA, etc.). These visits can be conducted via audio-only or video and audio. When these visits are performed with video, they can often provide the same type of diagnosis and treatment options as in-person visits. “Prior to the COVID-19 pandemic, these visits were often limited due to insurance coverage and/or license restrictions across state lines,” says Dr. McGinley. “Although these issues continue to be in flux during the pandemic, there has been an exponential increase in access to telehealth visits. These visits are being conducted for new patients and follow-up patients.”
What to expect during a telehealth appointment
If a patient is being seen for the first time, they can expect to review their history and symptoms, review any testing that has already happened, and perform a virtual examination. Depending on the symptoms and what has been done the provider may be able to give the patient a diagnosis or will plan to set up other necessary testing and an in-person evaluation, Dr. McGinley explains. Even if a diagnosis cannot be made at the time of this first telehealth visit it can help expedite work-up and make the first in-person evaluation more meaningful. For follow-up evaluations, patients can often expect a similar experience to in-person visits including:
Education regarding a conditionOrdering tests (labs, imaging, etc.)Changes to medicationsOrdering/setting up proceduresPost-operative follow-upRehabilitation services such as physical and occupational therapy
Benefits of telehealth
There are various benefits that come along with virtual healthcare. “Now that telehealth visits are more accessible it can often prevent patients from having to drive in for an appointment which may save patients’ time off work and the expense of travel,” Dr. McGinley states. “Providers can also more easily offer visits at times they may have not been able to offer previously (such as nights and weekends).” Additional services such as remote monitoring of vital signs and other objective physical and cognitive assessments are currently being investigated and implemented. Patients may be familiar with “event monitors” that monitor heart rate and rhythms at home. These devices have been around for a long time and are a method of testing that is outside of the home, Dr. McGinley adds. Other assessments such as sleep studies and seizure monitoring are other tests that at times can be done remotely. “Since a physical examination can be limited in some ways during a telehealth visit there are many efforts to develop ways for patients to perform certain tests at home," says Dr. McGinley. “These tests may have the potential to provide more frequent information about a patient’s condition and symptoms. Patients may already discuss their activity monitoring information (gathered through something like a FitBit or Apple Watch) with their providers and these other tests will likely augment this type of information.” Behavioral health is one of the most commonly used (and highly praised) branches of telehealth.Dr. Jaime Marrus, MD, clinical psychologist, explains the wide variety of benefits:
Ease of access and efficiency
Therapy sessions are typically 45 minutes long. That means you can fit one in on your lunch break without having to add additional commute time back to the office.
Broader access to professionals
Clients are not limited to therapists near their physical location. Psychologists are licensed by state, so clients are able to see any provider in the state through telehealth, which may provide them with access to experts in a particular area, or more options to connect with clinicians who may be a good fit.
Live coaching for parent-child work
When working with children, it is often most appropriate to conduct in-person sessions. However, there are some great benefits of incorporating virtual sessions throughout the pandemic. Very often, parents report challenges at home that are unable to be observed in an office setting (for a variety of reasons). Teletherapy provides a more naturalistic setting during which therapists can coach parents and children through struggles in “real-time.”
Access to other coping techniques, like pets
Sometimes, therapy sessions bring up difficult emotions as clients process various experiences. Being in one’s own home while this occurs may make this easier—one of Dr. Marrus’ favorite reasons for this is that pets often provide much emotional support and comfort while clients are experiencing anxiety, or processing difficult emotions. “Overall, telehealth is an excellent service that has expanded our ability to provide care to patients,” Dr. McGinley explains. “It has helped remove some barriers to accessing care, which allows us to evaluate patients sooner and more frequently if needed. Additionally, it allows for increased communication with patients regarding test results, prescription, symptoms, education, and appointments.” With increasing communication and options for delivering health care, the hope is that patient outcomes and satisfaction will continue to improve. Next, read about how caregivers can benefit from telehealth services.
Sources
Dr. Marissa McGinley, MD, neurologist at Cleveland Clinic Cleveland ClinicDr. Jaime Marrus, MD, clinical psychologistCenters for Medicare & Medicaid Services: “Medicare Telemedicine Health Care Provider Fact Sheet”
