A Letter From Dr. Susan Apkon to the MDA Community: How Telehealth is Changing Medicine (and How to Prepare for It)

MDA Care Center physicians across the country are working on the frontlines of the novel coronavirus pandemic. Every day, they’re fielding patient questions and finding new ways to practice medicine in a new time. Today, Dr. Susan Apkon, chief of the Department of Rehabilitation and MDA Care Center Director at Children’s Hospital Colorado, shares how telehealth is connecting providers and patients safely.

Growing up in the 1960s and ’70s, I was enthralled by the TV show “The Jetsons” and the space-age way they lived. In one episode, Elroy, the son, was sick, and Dr. Racey magically appeared on the TV screen, donned his mask, and proceeded to examine and make recommendations to Elroy and his mother. While telehealth has been used over the last decade, the COVID-19 pandemic pushed our use of this technology forward exponentially and I believe will forever change the way we deliver healthcare to our patients with neuromuscular conditions.

Telehealth is a video call between a healthcare provider and patient using technology that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The virtual clinic visit, like an in-person visit, allows me to obtain a history, perform a physical examination, and make recommendations pertinent to the purpose of the visit. While my examination is certainly going to be different, I have been impressed with how much information I am able to obtain in order to guide my decision making. Telehealth visits can be used for new patient visits, follow-up visits, and urgent sick visits. Given the obvious limitations, telehealth should not be used for emergency visits. It’s also important to know that some therapy services can be provided via a video call and are often referred to as telerehabilitation or telepractice. 

During the COVID-19 pandemic, federal and state governments, recognizing the benefits of telehealth, eased many restrictions that were in place. Use of non-HIPAA-compliant technology such as Zoom, Skype, and Apple FaceTime are currently allowed but may not be in the future. Restrictions were also loosened in some states to allow healthcare providers to perform telehealth visits with their patients who live in different states.

Here are some benefits that you may experience receiving care through telehealth:

• Save time and money: Because you are not traveling to the clinic, there is no transportation time or costs, fewer childcare issues, and less time missed from work or school.
• Convenience: Telehealth can be very convenient for people with neuromuscular conditions who are relying on technology for breathing or who have physical limitations making travel to a clinic challenging.
• Minimize exposure to COVID and other viral infections: When you do not leave your home, you have less exposure to illnesses spread by others.
• Home assessments: A rehabilitation physician or therapist can assess your home environment during the visit to address any equipment needs that you have.

The following are some key points to consider when setting up a telehealth visit with your provider:

• Technology requirements: In general, you need a smartphone, tablet, or computer with a camera to be able to see your provider and be seen. A high-speed internet connection or unlimited cellular plan is important for a reliable and quality visit. Test your technology ahead of your visit if possible.
• Insurance coverage: Many insurance plans cover telehealth visits. If you have any concerns about your coverage, you should check with your insurer.

Preparing for your visit can help you get the most out of the time with your healthcare provider. The tips below can help assure a successful visit:

• Prepare like you do for an in-person appointment: Write down the questions you want to discuss and have a list of your medications, or even the medication bottles, handy. Some healthcare providers may send forms for you to complete before the visit.  Document your vital signs such as weight, blood pressure, and heart rate if you have the appropriate medical devices at home.
• Pick the right place in your home: Find a quiet space without distractions, sit in a comfortable chair, make sure the lighting allows the healthcare provider to easily see you, and have your technology on a stable surface to avoid movement of the camera.
• Have someone join you if possible: A family member or friend can help adjust the camera, take notes, and even assist in the examination during a telehealth visit.

While the COVID-19 pandemic pushed healthcare providers and patients quickly into the telehealth space, the benefits for those with neuromuscular conditions are significant.  As a neuromuscular physician, I do not think that telehealth will completely replace in-person clinic visits but will be a great addition to the care you already receive.