Prior to COVID-19, telemedicine was a foreign subject at our practice. Our 13-physician retina practice encompasses three sub-specialties: uveitis, ocular oncology and our inherited retinal disease clinic. All of our work was done in office, especially since, as a retina clinic, we had to dilate patients in order to assess them.

During the spring shutdown, our practice was open only for emergent care and those patients who needed ongoing treatment. Yet, we were able to maintain more than 40% of our typical patient numbers by incorporating telemedicine among other innovative processes that we have adapted (such as limiting ourselves to one doctor per location and having the same team members remain with one doctor, to limit exposure risks).

Telemedicine services became a way of reassuring many patients. Even in the absence of a physical exam, one of our physicians could still perform a remote consultation and determine if that person required an in-person visit. Telemedicine began as a way to triage patients and figure out if they needed urgent care, but we discovered that it also allowed us to see a steady of flow of patients during the shutdown.

JUMPED IN WITH BOTH FEET

When the Medicare requirements were first eased, we immediately jumped in and began using a variety of platforms like Zoom, Google Duo and FaceTime. We soon discovered that, with this patchwork of platforms, patients were sometimes required to create a login or know certain account information, or doctors’ cell phone numbers. This made it very difficult for our patients to consistently access the video component of telemedicine. Our EMR provider, Nextech, developed a video telehealth platform that has made the process much easier for our patients and doctors.

Within seconds of scheduling a virtual appointment, patients receive a link to access the platform. Our staff stay on the phone with the patient to ensure they receive the link. Additionally, patients are sent a reminder 15 minutes prior to their appointment time. When they receive the reminder, they merely have to click the text message on their smartphone or in their email to access the appointment.

To access a telemedicine visit, the physician clicks the video icon in the patient’s chart. Nextech has since added three-way conferencing, which allows the scribe or assistant to also be in the same virtual room documenting patient notes and assisting the physician. Anterior photographs are obtained via screen capture that automatically adds the image and information to the patient’s chart. It can also incorporate and save PDF files patients may want to share later.

SET UP FOR SUCCESS

Some ways we made a success of telemedicine:

1. Stay on the phone with patients to ensure they receive a link to the telemedicine platform. The staff person scheduling a telemedicine appointment is responsible for educating the patient, making sure they stay on the line to confirm receipt of the link. Early on, we had a few glitches where the patient did not get the link, creating wasted time for everyone come appointment time.
2. Call patients in advance of their appointment to ensure they can access the link. Even though setting up the platform is simple, our front desk staff called patients a day or a few hours before their appointment to walk them through the process. Some patients do not understand that they need to have a smartphone or computer with a camera, because the telemedicine visit is a video call. Taking these steps ensures a smooth telemedicine visit, with less confusion.
3. Ensure patients understand there may be a copayment. Based on insurance, some patients may be billed a copayment for telemedicine visits. It is important for patients to know that it is considered a visit. Our script for our practice was something like this: “To limit risk of exposure we do offer telemedicine visits for our patients, please keep in mind that this is considered to be a medical visit even though it is a through the virtual platform and you might be required to pay your copay.”
4. Assign a staff person to be available to assist in the event of technical difficulties. I made myself available for physicians to contact if they experienced any connection or disconnection issues. I would call the patients and stay on the line with the physician until the situation was remedied. We did not want our physicians to be the ones troubleshooting any problems.
5. Schedule patients according to physicians’ preferences. We found that our physicians preferred not to have telemedicine patients scheduled in the middle of their clinic because it was disruptive to their flow. Therefore, we began allocating time slots before clinic or during lunch, for example.

HYBRID APPROACH

With practices having reopened, we are now exploring hybrid visits. Patients can undergo diagnostic testing in the office and connect with their physician via telemedicine to discuss their results, a treatment plan and everything else related to their diagnosis. We are currently working with our genetics, uveitis and oncology sub-specialty clinics on ways of utilizing telemedicine in more creative ways.

POSITIVE, MUTUALLY BENEFICIAL

Our physicians have been impressed with how easy it has been to integrate telemedicine. They appreciate being able to maintain patient-physician relationships with a video encounter. Telemedicine also allows for capturing photographs of the anterior segment simply by the patient bringing their eye close to the camera for the physician to capture a screenshot. In the absence of being able to perform a retina exam, our specialists note that they can at least provide assurance to patients through telemedicine.

Patients also give positive reviews and report being pleased that they have an alternate way of talking to their physician face-to-face outside of an office visit. They can be assured that the physician will provide them guidance. They are also impressed with the ease of use.

Although the current acceleration of telehealth’s acceptance has been set in motion by COVID-19, its use continues to gain traction. A June survey conducted by data analysis company Doctor.com found that 50% of responding patients had used telehealth in the last 3 months. In response to the question, “How likely are you to make a telemedicine appointment after the COVID-19 pandemic is over?” 83% of respondents claimed they would.

Another survey, by practice growth technology company PatientPop, found that a vast majority of patients are happy with telehealth: 75.8% of respondents claimed they were satisfied with their telehealth appointments (patients aged 45-60 years made up the largest percentage of these patients). Staying away from sick people is certainly a motivating factor, but patients frequently cite other advantages such as saving time and faster appointments (61.5%); shorter wait times before appointments (47.5%); and overall convenience and comfort (36.9%).

CONCLUSION

As a practice that had never considered telemedicine, we were able to keep a substantial flow during the complete shutdown of elective medicine. This reinforces the importance of having an open mind about new processes. We always had good Net Promoter Scores (an index that measures the willingness of customers to recommend a company to others, which gauges customer satisfaction), but we have seen those rise because patients were so appreciative that we made every effort to connect with them.

Going forward, our practice plans to make telemedicine a larger part of our approach. OM

About the Author

Viktoriya Goncharov, COA, OSC, BS, is the clinical education manager for Colorado Retina. She may be reached at vgoncharov@retinacolorado.com or 720-326-4457.