Transcription:
Telehealth in the Age of COVID-19

Michael Carrese: While restrictions on work, social activity, and other aspects of daily life are starting to loosen up. Physical distancing is still really important to slowing the spread of COVID-19. That's why Southwest general is offering virtual visits to provide a safe option for you to manage your healthcare needs from the comfort of home. Dr. Jose Bocanegra, a Board Certified Family Medicine Physician on the medical staff at Southwest General Health Center, and also located at North Royalton Family Practice Facility is here to tell us all about it. This is Southwest General Health Talk. I'm Michael Carrese, and Dr. Bocanegra. Perhaps we can start by getting a basic description of what you mean by telehealth.

Dr. Bocanegra: So telehealth is delivered in one of two ways here in North Royalton, we can deliver telehealth medicine, either through a telephone conversation or virtually using an interface on the computer. So it's actually a video and audio transmission in which we can see and hear the patient and communicate back and forth that way.

Host: And do patients need any kind of special equipment or software or cameras or anything like that?

Dr. Bocanegra: That's a good question for the video component, we do send an email to them and we utilize a delivery mechanism that allows them to open up that email. And then it's very simple instructions to follow to activate, but all they need basically is either a cell phone in which the phone has a camera capability or a laptop computer, or a desktop computer that also has a camera as well as a microphone.

Host: So these days everybody's used to doing these Zoom calls, it'd be sort of like that?

Dr. Bocanegra: Very similar. Yes.

Host: And how does it work otherwise? I mean, does it seem like a regular appointment in some ways or how is it different for folks?

Dr. Bocanegra: Well, I think the folks are going to find that it's pretty similar to a regular visit. They'll see me for example, when we do the, you know, the video and audio interface, they'll see me dressed as usual as they normally see me and they'll see me in the office. So the familiar surroundings will be there. And generally speaking, the flow of the visit is very similar in terms of the give and take and question and answer format that we usually go about in terms of obtaining a history, the only missing component, so to speak as a hands on physical exam. But otherwise it's going to look and feel very similar.

Host: Do people ever need to move the phone or the camera around so you can see something?

Dr. Bocanegra: Yes, well, sometimes we'll have them direct the camera to a certain part of their body. If I need to take a close look at a particular rash or a spot on their body that they're concerned about, or, you know, some other area, it is limited in terms of what we can do, you know, through the camera. But I think that what we're going to see with improving technology is we're going to be able to do more and more through that interface, you know, especially during this time of COVID-19, you know, as they say, necessity is the mother of invention. And so we've all sort of been thrust forward into this new medium. That's been existing now for a better part 10 years and it's gradually been adopted, but I do think now we're in an acceleration phase and I think it's going to be part of the permanent landscape of how we deliver care to our patients.

Host: You know, yeah, I was just reading about a device that basically you can send to your patient and it'll do basically an echocardiogram if I understood it correctly.

Dr. Bocanegra: Yes. That, and there's just a whole host of different mechanisms now that are going to be available to patients and to us as well, so that we can better monitor individuals at home, both for chronic conditions, as well as in select cases for acute conditions. We're living in a pretty exciting time where I think you're going to see an extension of the things that we can do in the office. We can also do them virtually through this new technology.

Host: Yeah, no doubt. So how do you as medical professionals decide if an appointment should be done by a phone call or video call or that it needs an in person visit?

Dr. Bocanegra: That's a great question. I think for myself, what I've found that's worked best is if I really feel that it's a situation in which I'm dealing with in new onset of a systemic illness. So that means something a bit more serious than which the body's having a hard time fighting off whatever's going on, or it is an unstable chronic medical condition. I'm bringing them in, it really just I, you know, it's important that convenience and, or safety is not compromised in terms of being able to deliver the best care and prevent serious complications that may put that person at risk for more serious problems. Other than that, I think that what's been very nice about the telehealth for us telemedicine is that we can now you know take care of patients from the convenience of their home or their other location at work, but also not just the convenient component, but also the safety component. We're able to keep people out of the office that are perhaps at increased risk for complications, should they contract COVID-19. And so generally speaking, it's broken down into two categories for me, routine care or limited acute visits versus complicated care and, or unstable acute conditions.

Host: And how has it been going generally speaking for you and your patients?

Dr. Bocanegra: I think it's been going very well. You know, my day is now a little bit more varied in that. You know, I see patients here in the clinic and then woven in throughout the clinic, my clinic schedule, I have virtual visits. So it's a nice variety I would say.

Host: You do hear folks raise a concern or a question now then about privacy and security. You know, I'm going to be out there on the internet and everybody's going to be able to find out what's wrong with me. What do you guys do about that?

Dr. Bocanegra: Well, that's a very good question. The particular platform that we use is Cisco WebEx, which is an industry leading HIPAA approved delivery mechanism, a platform.

Host: And HIPAA, just so folks know HIPAA is what?

Dr. Bocanegra: Oh, that's the patient privacy, that's a federal patient privacy law that helps protect patient information so that you know, it is not compromised or, you know, susceptible to other problems. It's a federally protected statute.

Host: So what do people need to do to prepare for this appointment that they wouldn't do normally?

Dr. Bocanegra: Great question. So what I ask my patients to do is if it's a routine follow-up for, let's say a chronic medical condition in which we're going to be doing a comprehensive review, I ask them to gather any documents such as recent visits to other healthcare systems that may not be available through the computer, you know, in an immediate fashion. Any medications that they have, any supplements that they're taking, any questions that they have, I'd like them to write them down in a list. So they have them ready to go. And any family members that they think may need to be present for that particular visit in particular that's for my seniors, they like to sometimes have one of their children, adult children present. Or if it's a child, obviously one or both parents, they need to be present for the visit as well. So once those resources are gathered in advance, well, then it makes the visit go much more smoothly.

Host: Yeah, I would think so. Are these visits covered by insurance?

Dr. Bocanegra: Another great question. Our experience has been so far that yes, almost virtually all insurance companies will cover these visits in terms of Medicare that's it's a blanket coverage. So there's, you know, that coverage is the same as though they came into the office in person and private insurance is a little bit more variation, but what we're finding is as the days go on, you know, the reality is I think the value and the necessity of this delivery mechanism is being recognized by the insurance industry as well. And so they're all getting on board.

Host: I'm also seeing in the news, a lot of healthcare providers saying to folks, look, if you do need to come see us, you know, don't hesitate. They're worried that they've seen a big drop-off in people seeking medical care. So I guess one thing to, one way to tackle that is to talk to folks about what it's like to go, what kind of precautions have you put in place there in North Royalton and of course all across the country so that they are safe when they come to see a Doctor?

Dr. Bocanegra: Great question. So we've implemented a series of steps that are in place prior to the individual coming to see us. So the first step is when the patient calls we have a series of questions that we use to screen them, to ask them for signs or symptoms of COVID and, or exposure to individuals that have had COVID or are suspected of having COVID. That's the first sort of screening. Once they've passed that screening and they've been approved to come into the office for a visit, we ask them to bring their own mask. And if not, if they do not have one or they forget one, we have masks here as well. Prior to entering the clinical area, there's a front office area, sort of a waiting room. And in that area, we screen them with the temperature, confirm the questions, make sure that they have a mask placed and then bring them back into a designated space for patients that are at high risk for complications of COVID.

So they can track that. So they're placed into a special room, that's been prepared in advance sanitized and approved for use. Once they're placed there, the medical assistant will then go through the normal routine of obtaining their vital signs and asking their questions, maintaining social distance, as best as possible for that part of the exam. And then I enter and we all wear protective personal equipment, which consists of masking gloving and shielding. To this point, I think patients have found that it's a very good process. That's pretty smooth, still patient friendly, but they can see, you know, the value of taking those steps intentionally to maintain, you know, a safe environment for them.

Host: Absolutely. So how do your patients go about making a telemedicine appointment?

Dr. Bocanegra: The process is the same as though they would make an appointment in my office to come in person. They simply call our phone number. And when they call, they say, Hey, I would like to make a telemedicine appointment with, you know, with myself or one of the other physicians here. And the receptionist then obtains a couple of insurance and other demographic information that they will need to process that for the visit. They are then sent an email to a, you know, an email of their choice. That is a link for them to click on. Once they've clicked on that link, there's a test run at that time to make sure that it works with the receptionist, once that's confirmed their appointment, date is confirmed. And then when their appointment time comes up, the office reaches out to them, contacts them, and makes sure that everything is up. And running and then they patch me in, and then we start the deployment

Host: Sounds pretty simple. And if you want to learn more about telehealth services at Southwest General, you can call (440) 816-5050 that's (440) 816-5050. Or you can visit SWgeneral.com. I want to thank my guest today, Dr. Jose Bocanegra, he's a board certified family medicine physician on the medical staff at Southwest General Health Center located at North Royalton Family Practice Facility. Doctor, thanks so much for being here today.

Dr. Bocanegra: Thanks, Michael. I enjoyed it. Appreciate it very much.

Host: If you found this podcast helpful, please share it on your social channels or you can check out the full podcast library for additional topics that may be of interest to you. This is Southwest General Health Talk. I'm Michael Carrese. Thanks for listening.