Is the doctor in?

| December 14, 2016

Is the doctor in?

It’s late night and your patient is up, pacing their kitchen floor. They’ve suddenly broken out in a new rash, and they don’t know what to do. But your office, and urgent care, are both closed – and it’s certainly not worth a trip to the ER.

Unfortunately, allergic reactions don’t wait around forever, and by the time they schedule an appointment and see you, the rash is nowhere to be seen. Frustrating, but often times, a common occurrence. Is there anything that can be done to help bridge this gap in care? Instead of taking time off from work or school, what if they could just schedule a video call with you in the morning? Telehealth can make this possible.

So, what exactly is telehealth? Let’s hear from three College members who are practicing telehealth.

“Telehealth is the use of a wide variety of technologies to manage a patient’s health by exchanging medical information over a distance. These technologies include the use of computer-based audio and video conferencing along with digital examination instruments in health care encounters where the provider and patient are separated geographically,” said Chitra Dinakar, MD, FACAAI. Most telehealth services now include a video call so you can see your patient and do an examination. Some even involve using a remote exam room and nursing staff in conjunction with a video visit from an allergist. As technology rapidly advances telehealth should follow along.

There are a lot of reasons why you might consider getting involved in telehealth. One of the biggest benefits is the ability to interface directly with your patient, instantly, during their moment of need. “When I was seeing patients in my private practice, they would come to me three weeks after an allergic reaction, and I would hope they had pictures that captured the condition. Getting an accurate history is challenging. Wouldn’t it be great if you could pop up on the other side of a screen, exam them and treat them right away?” said Tania Elliott, MD, College member and medical director of a prominent telehealth company. “What if you could even help out a patient using an epinephrine auto-injector, and actually walk them through their action plan, step by step?” There are a lot of possibilities when you consider how many treatments in allergy, asthma and immunology care revolve around seeing patients quickly, creating at-home action plans and frequent follow-up. Telehealth can bring you to the patient, on their own time, which can help increase their satisfaction with their care.

It’s also great for expanding the reach of your practice. The unfortunate reality is that many patients who most need your care live in rural areas and might not have access to an allergist. This is another time when telehealth can really come into play. You can see these patients by coming to them – or they can travel to an exam room nearby – and examining them via video call. With digital spirometry equipment and more, patients are getting a comprehensive exam. “You’re not sacrificing anything by doing telemedicine, the patients are universally satisfied with the care they receive,” said Jay Portnoy, MD, FACAAI, author, along with Dr. Dinakar, of a recent Annals of Allergy, Asthma and Immunology study on patient satisfaction from telehealth exams (Sept.. 2016, Volume 117, Issue 3, Pages 241–245). The study demonstrated patients were just as satisfied with telehealth exams as they were with regular exams. Other benefits of telehealth? “You’re able to see a large number of patients. It’s more efficient. I can get more done because I can actually input information into my EHR while I talk to the patient. You can have fewer exam rooms, or avoid travelling from office to office,” said Dr. Portnoy.

“This is the wave of the future and it is important for allergists to think of this not as competition, but as a way to augment and revive our specialty,” said Dr. Elliott. “Allergy/immunology has unique ways we can implement this technology, and it’s going to bridge the issues of access to care and allow allergists to expand their scope of care. We know that home-based interventions work, and telehealth can bring you into the home.”

So how can you get started? You might already have a lot of what you need, like web access, a web cam, and a secure portal tied into your EHR. You can be an independent contractor for a large company, where you use their software. Or, you can purchase software and start seeing patients that way. There are a number of new startup companies offering telehealth software that sell directly to providers who are looking to get started. However, you do need to learn the rules of billing for these visits, and depending on how you chose to see patients (like within a hospital), you may need special credentials. You’ll need to check the laws in your state before you begin.

Patients are already embracing this technology, so now is the time to dive in. Between expanding the scope of care of your practice to reaching out to patients in their time of need, there are lots of ways telehealth could make real sense for you. “Of all the medical specialties, allergy is the most prime and ripe for telemedicine video visits,” said Dr. Elliott.