Telemedicine is the practice of healthcare in an online format. As video conferencing technology has developed and become more reliable and secure (including being HIPAA-compliant), many physicians and specialists have begun offering their services through video calls in addition to or instead of in-person appointments. Although telemedicine has traditionally been beneficial for people who live in rural areas or for whom visiting their physicians in person is burdensome (due to long travel times, busy schedules, or the increased expense of an in-person consultation), the COVID pandemic has led to a rapid rise in the number of people giving and receiving care through this channel.
While telemedicine isn’t intended for emergency care (like a broken bone, heart attack, or mental health crisis) or certain procedures (like immunizations or providing samples), it is appropriate and has been found to be quite effective for long-term care, follow-up appointments, issuing prescriptions, and answering simple questions. This makes it a great choice for people with Parkinson’s. Telemedicine eliminates the potential challenges of traveling to an appointment and gives you ready access to your providers when necessary. It also helps you conveniently build and maintain long-term relationships with your care team.
Why hasn’t telemedicine become ubiquitous?
Although telemedicine presents numerous opportunities and advantages, it still isn’t widely used. There are a few main reasons why, including:
Expensive training and technology
Training doctors, nurses, receptionists, and administrators to schedule and use video conferencing technology can be both expensive and time-consuming. Doctors’ offices and hospitals might have to invest in new technology, and the time and money required to train personnel on how to use the technology have kept many healthcare providers from embracing telemedicine.
Insurance coverage uniformity
Although a primary benefit of telemedicine is reduced cost of care, not all states have laws in place that guarantee coverage for telemedicine (and those that do often have trouble with enforcement). Therefore, some providers may be less enthusiastic about transitioning to telemedicine, and some patients may face challenges in ensuring that their virtual visits are covered by their insurance (whereas in-person visits are less likely to be subject to that uncertainty).
Liability from potential misdiagnosis
There are laws in place across the US to protect both physicians and patients in case of misdiagnosis, but because those laws are largely related to in-person care, the ambiguity surrounding telemedicine is potentially a deterring factor for healthcare providers. Additionally, many doctors feel that misdiagnosis is more likely in a virtual setting than in person, which makes them more reluctant to engage in telemedicine. Furthermore, ensuring HIPAA and HITECH compliance to protect patients’ privacy can create an extra barrier that would make providers less inclined to offer telemedicine services.
Psychology may also play a role in why in-person doctors’ visits are still so popular. Despite research to the contrary (as discussed below), many people still believe they will receive better care face-to-face than over a video call. Our traditional feelings about doctors are closely tied to in-person meetings with physicians who know us well, so the idea of seeing someone new in an on-demand and remote setting is unsettling for some people.
Not only would physicians, nurses, and other healthcare staff have to be trained to use the appropriate technology, they would also often need to help patients troubleshoot technological problems. . If patients struggle to use the required technology, much of their appointment time may be spent addressing technological issues rather than the patient’s health. Furthermore, other technological difficulties (such as lost internet connection or poor video or sound quality) could result in charges of patient mismanagement.
Potential for reduced continuity and quality of care
While many people with Parkinson’s may begin to use telemedicine to communicate and meet with their regular providers who know them well, a popular form of telemedicine is the on-demand style, where patients can reach any available physician to ask a question. This has the benefit of timeliness and instant gratification, but many people recognize that continuity and quality of care are potentially sacrificed as a result.
Since doctors are only licensed to practice medicine in specific geographical areas, the potential for accidentally practicing outside their licensure could arise. Although telemedicine offers the opportunity to connect doctors and patients across the country and the world, the limitations associated with licensure mean that patients’ ability to get appointments with distant specialists may be less possible than it would seem at first glance.
What laws and practices have changed since the COVID-19 pandemic began?
It should come as no surprise that telemedicine use has increased dramatically since the COVID-19 pandemic began. In fact, studies have found that due to the pandemic, there will likely be more than one billion total telemedicine interactions by the end of 2020 and that in March alone, telemedicine visits soared 50%. Some providers have offered telemedicine appointments for the first time, while others with existing services increased the number of appointments available or switched to online-only consultations.
Though many doctors’ offices are now open for in-person appointments again, many people with Parkinson’s would do well to continue to limit interpersonal interactions in order to protect themselves against contracting the virus, and telemedicine is a great way to do that.
Since the pandemic began, many insurance companies have quickly expanded their coverage to telemedicine appointments to accommodate their clients’ adjusted needs. Therefore, even if you’ve been turned down by your insurance company for coverage for telemedicine before, it’s worth checking again to see whether their policies have changed. Additionally, government healthcare options are now also offering increased access to telemedicine by reimbursing Medicare patients and expanding the number of telemedicine services covered by Medicaid.
In addition, the Office for Civil Rights (OCR) within the US Department of Health and Human Services (HHS) announced that “OCR will exercise its enforcement discretion and will not impose penalties for non-compliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” By allowing healthcare providers to use non-public facing video conferencing technology, including Skype, FaceTime, Google Hangouts, Zoom, and more without fear of repercussions under HIPAA, HHS greatly increased the capacity of doctors’ offices to provide care to their patients during the pandemic.
What is telemedicine like for the doctor?
Many physicians are enthusiastically embracing telemedicine in the age of COVID-19, and reports show that not only is it fairly easy to incorporate into their practices, doctors also find it quite effective and see that the benefits outweigh any potential shortfalls.
After reviewing medical history, baseline metrics, and any other information a nurse or administrator may have gathered from the patient prior to the visit, the doctor can approach their patient’s primary complaint much as they would during an in-person appointment. Whether that means asking questions, requesting that the patient use their camera to conduct a remote physical examination, or asking the patient to perform tasks and examining the results, the doctor can make appropriate recommendations, referrals, or prescriptions. In some cases, it may not be possible to discern a diagnosis or the video conferencing platform may simply not be appropriate for the patient’s complaint, in which case an in-person appointment might have to be scheduled. For the most part, though, telemedicine appointments are not vastly different than in-person appointments for doctors.
What is telemedicine like for the person with Parkinson’s?
Often, your visit will begin with a check-in from a nurse or administrator to get some baseline information from you (just like an in-person appointment would). They’ll typically begin by asking questions about your medical history, primary concerns, the reason for the visit, and maybe even some vital signs, including self-reports of your height, weight, temperature, blood pressure, and pulse (depending on the equipment you have available). They may want to conduct a virtual physical exam, depending on the reason for your appointment, so having a reliable camera and internet connection are especially important. They may have you fill out questionnaires like anxiety or depression scales, or it might just feel like more of a conversation where the provider asks you questions to get to the heart of the issues you are having.
After gathering applicable metrics and information, your doctor will then give you a diagnosis, prescription, referral, and/or follow-up, as is appropriate to your individual concerns. Don’t be afraid to ask questions, share your concerns, and disclose your symptoms, just as you would in an in-person appointment. You are still protected by HIPAA and HITECH laws that ensure your privacy, and to receive the best care possible from a telemedicine appointment, your honesty and disclosures are important, just like in traditional appointments.
You may then be rerouted to other staff members to schedule a follow-up or to make a copay.
How can I set myself up for a successful telemedicine appointment?
Make sure you have access to the appropriate platform to meet with your doctor. Verify that your camera and microphone are turned on, and make sure your internet is working well. (Video visits work best when your internet is unencumbered, so try not to have anything streaming during your appointment.) Grab a paper and pen to jot down any questions you have for your doctor and the advice you’re given during the appointment. Depending on the purpose of the visit, you might want to have someone else (whether it’s your care partner, adult child, or a friend) present for support and to ensure you don’t miss anything.
How can I find out whether my doctor offers telemedicine appointments, and if they do, how I can schedule one?
Some doctors’ offices will offer an online patient portal in which you can schedule appointments, be they in-person or telemedicine appointments. If your doctor doesn’t use a patient portal or you’re not registered for the portal they manage, check online or call their office. Once you know whether telemedicine is an option, you can proceed with scheduling the same way you usually make appointments. Whether you call the front desk or schedule your telemedicine appointment online, you will likely receive an email from your doctor’s office with information on how to access the video conferencing technology that you will use during your appointment. If you have any questions about how the appointment will work or how to use the technology, it’s best to get in touch with your doctor’s office before your appointment.
Don’t hesitate to ask questions; the staff at your doctor’s office will be trained on how to use their specific videoconferencing platform, and you won’t have to use your appointment time to ask questions about the technology.
Can I find a new doctor who practices telemedicine?
Yes! If your doctor doesn’t practice telemedicine, you can find someone who does. Ask friends for recommendations. Reaching out to people in the Parkinson’s community is a great way to find neurologists; primary care providers; and occupational, physical, or mental therapists who offer telemedicine services. You can also explore different doctors’ websites and call their offices. A third option is to look into services like Teladoc, Doctor on Demand, and Amwell. Make sure your insurance will cover your visit, and check to ensure HIPAA and HITECH compliance to guarantee that your privacy is protected.
What does the research behind telemedicine show about its benefits?
Since telemedicine has been in existence in one form or another since the 1950s, numerous studies have shown its efficacy and benefits. In a 2019 study in the American Journal of Emergency Medicine, researchers found that net savings per person per visit (compared to in-person appointments) ranged from $19 to $121. Additionally, they found that a large majority of patients in the study had their concerns resolved in a single visit, emphasizing the efficacy of telemedicine. Another study, published by Cochrane Review in 2015, found that across the literature, telemedicine has been shown to as effective as in-person treatment, though factors like the severity of the condition and the individual healthcare provider caused some variation. A 2017 study from BMJ Open found that across the literature on telemedicine, patients were satisfied and their expectations were met when using telemedicine services, although some studies found differing results in terms of efficacy and efficiency.
In terms of elderly people, in particular, a 2017 study from the American Journal of Accountable Care found that telemedicine can be used to notify caregivers of changes in health, including falls, lack of movement, or activity changes, and the capability to transmit that information to healthcare providers quickly and securely can not only help get faster care but can also help keep seniors in their homes longer. The same study found that telemedicine also helps patients increase their autonomy and take on a more active role in their own care. Additionally, remote monitoring systems can help keep track of people’s health through biometric measurements that are monitored by a doctor remotely; if something concerning happens to their body, the provider can get in touch through telemedicine right away.
In addition, the Davis Phinney Foundation’s support for early work in this field has also been integral in the area of telemedicine. In 2013, we supported one of the first projects regarding telemedicine and Parkinson’s. Spearheaded by Dr. Ray Dorsey from the University of Rochester, the “Remote Access to Care, Everywhere (RACE-PD)” study was a multi-center study designed to assess the feasibility, impact, and acceptability of using telemedicine to remove barriers to care in Parkinson’s. This study revealed that virtual visits with physicians were impactful. People with Parkinson’s saved time by reducing travel, felt satisfied with their care, and experienced a similar quality of life to those who received in-person care.
Overall, despite some of the concerns outlined above, the benefits of telemedicine often outweigh the challenges. While not every health-related question is appropriate for telemedicine (especially emergency care), the cost savings and equal patient satisfaction and concern resolution compared to in-person visits demonstrate that telemedicine is a viable alternative in many situations. Consider talking to members of your care team to see whether telemedicine is a good option for you.
Ready to advocate for telehealth?
One of the silver linings of the pandemic has been greater access to telehealth. However, its future is still uncertain. Congress is now deciding whether certain types of telehealth coverage should be permanent. Please consider emailing your Senators and Representative and ask them to make telehealth rules permanent so people living with Parkinson’s can have access to providers they otherwise might not be able to see in person. Thank you to the Michael J. Fox Foundation for your advocacy in this area. Visit their site here to complete an email template you can send to your lawmakers.