Telemedicine is changing the way we see doctors

Three TechRepublic reporters discuss the way the coronavirus has changed the way we do healthcare and mental healthcare.

Telemedicine is changing the way we see doctors
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TechRepublic's Karen Roby, Macy Bayern, and Veronica Combs discussed the changes in healthcare during the coronavirus pandemic. The following is an edited transcript of their conversation. 

Karen Roby: One of the things that's really emerging is telemedicine. Veronica, I know you've put together some great articles here as far as what is available to people, how people can still see and talk to their doctors when they're in need. Talk a little bit about some of the resources that you've found and have been writing about, and how that can really help people at this time?

SEE: Coronavirus: Critical IT policies and tools every business needs (TechRepublic Premium)

Veronica Combs: I think people always consider the gold standard is a visit with your doctor, like I'm looking at you, you're looking at me. You can tell my health. But now, it's really flipped around that you don't really want to leave your house if you don't want to, and doctors don't really want you breathing on them if you don't have to. Some of the hospital and health systems on the coasts were faster to have these telemedicine platforms.

Sometimes, it's a chatbot and you just type in the answers to questions and they'll run you through the symptoms. Sometimes it'll be a nurse practitioner and you can log on, make an appointment, download the software, log on, and talk to someone.

One of these stories that I wrote about this week which was really interesting was Johns Hopkins Medicine is working with a company called emocha Digital Health, and they're actually working with hospital workers to screen them for COVID-19 and screen their symptoms. It's actually asynchronous video chats. It's an app, and you answer some questions. Do you have a fever? How are you feeling? And then, you record a quick video and you submit that. The digital health company certainly looks at your answers to your questions, but the president of the company was saying sometimes the answers to the questions are different from what a person says on video, so it's maybe a more honest recount of symptoms or how you're feeling or whatever.

There's options for people who are just worried about symptoms. There's options for people who actually need to talk to someone. And now, they're screening health care workers, thank goodness, because without doctors and nurses, and physicians' assistants, we will all be in real trouble.

Karen Roby: When we talk about the long-term effects and if the health care workers on the front line are getting sick then it's a trickle-down effect having an impact on all of us. One of the big facets of this, I think, Macy, and I know we've talked about this several times, from a mental health standpoint, people used to going in to seeing their therapist on a regular basis, so you have that, but you also have people that are now cooped up inside their house. They're scared. We have anxiety. We're concerned. 

Macy Bayern: I've been doing a lot of research for months now for a cover story about telehealth resources, particularly for rural Americans. But in that research, I've also been learning a lot about the telemental health services that are just for everyone too that are in big cities. What I've found is that some of the things that Veronica mentioned, a lot of the telehealth resources that we are familiar with and that are very common include pharmacy services, chronic care management, even ICU tools, and the American Hospital Association goes into all of those things on its website.

But when it comes to mental health, people haven't really been turning as much to telehealth for mental health for as long as they have for physical health needs. And what's really interesting is, I think it took a lot of insurance companies longer to cover those sorts of things and it took, I think, people longer to seek out those types of services because I think that we can all agree there has been a lot of stigma surrounding mental health, obviously, and both a systemic and systematic stigma, and that has a trickle-down effect, especially when it comes to people seeking out these services, and that becomes even more difficult when you're cooped up at home.

People can often use that as an excuse and say, "Well, I was going to try to make the jump and go, but now I'm at home." But there are websites; a really popular one I found was called Talkspace, and I think even our company covers it or one similar to it, where you can just go online and get matched with either a nurse practitioner or with a therapist or a psychiatrist and have your services just like you and I are talking right now at home, and it makes it really easy and it almost helps to make it more comfortable, I think, for people that are worried about going out and having those meetings in-person.

SEE: How telemedicine keeps patients in rural communities healthy (TechRepublic)

The whole quarantine situation might actually be helpful for people that are wanting to take the leap and start therapy, but it also makes it pretty easy for people to continue therapy that have already been doing so for a while.

Karen Roby: I hadn't thought about it from that standpoint but you're right. If people are nervous about seeing someone face-to-face, actually driving to an office and having to walk in for the first time can be a little bit overwhelming, I'm sure. We're also going through social media, of course, every day, and reading the news. Do you feel like this is being addressed more, are you hearing about it more?

Macy Bayern: Yes, I think right now particularly because of a lot of the uncertainty and chaos surrounding COVID-19. I think for a lot of people, that's very anxiety-inducing. I have a good friend who's always struggled with anxiety who has seen even heightened elevations of worry with everything going on because it's a scary time. I think that a lot of self-care and mental health, at least I've seen through social media, has been amplified throughout all of this. Because being cooped up at home, especially for people that struggle with depression and anxiety, can be really tough because getting that social connection and getting outside and being with people is often something that people who struggle with these things need.

I read that a lot through my research and with a lot of telehealth professionals that I've talked with, that the good thing about telehealth technology is that it can bring back some of that connection, and it can establish some of those social aspects that are necessary for people that struggle with those things. I think there are a lot of good aspects of that. Veronica, in your research have you seen anything really that has to do with mental health, or do you see more of the physical health side of it?

Veronica Combs: A lot of entrepreneurs focus on something specific, like people with diabetes or transplant patients, or some health conditions need a lot more support and attention than others do. Emocha Health, the company I mentioned before, actually started with tuberculosis patients because you have to take a drug every day for seven months, and so they are doing these asynchronous video check-ins with tuberculosis patients and public health workers. So you could actually prove, "Yes, I am taking my medicine at the time I'm supposed to take it, every day."

I think from a health care provider point of view, it's really given them more capacity because if you call, you can't get in. There is no way hospitals or a doctor's office could answer 40,000 calls a day to answer questions about COVID-19. I think these tools that maybe some doctors are like, "I don't know, maybe, maybe not," they see that they can help a lot more people and they can find the right fit. Maybe it's a text back and forth, maybe it's a video check-in. Maybe it's just a chat bot that answers your questions.

I think from a doctor's point of view, it helps with volume. It helps reach more people. It helps the doctors and nurses spend more time on the people who really need attention, so finding the right level of support. That's what I've seen with mental health, but also just dealing with the volume of questions that people have.

Karen Roby: And thank goodness at a time right now, for social media. I know, like you mentioned, Macy, that with the rural communities and often people don't know the resources available to them, it seems like that the health care companies and the insurance companies that the providers are really starting to push the message out there of what's available to them on the mental side as well as for every other thing, too.

Macy Bayern: Even before the coronavirus outbreak and craze, there were already services being offered to rural communities and already progress being made there. Because when I started doing this research for the cover story, this was before all of this happened. And what was really interesting was that universities were playing a huge role in bringing tele-mental health services to rural communities, which I thought was really interesting because all hospitals offer mental health services but that's really difficult for people that live in these outer areas where the commute is really difficult. Or, like Veronica mentioned, the availability isn't great.

But what universities are doing with their medical schools, they have their psychiatry residents partnering with clinics in these rural areas to offer services and to both train the residents and also bring that availability to the rural areas. So, just the regular mom-and-pop clinics in rural areas are finally able to offer services to people that live in those areas, and I feel like this is probably something that's even more critical right now, and maybe something that's even expanding to the physical health side. I don't know. Veronica, have you seen anything interesting in regards to rural care in your research?

Veronica Combs: There is a hospital out in Utah called Intermountain, and they have a bunch of different clinics and they really rely on telemedicine to reach some of the patients who live on the other side of the mountain or five hours away, or there is no one there.

I think the other change that we've seen over the last few years is that now doctors can get paid for doing this work. Because before, maybe you have a doctor who's like I love video-conferences, I love texting my patients, let's do that. But if they can't get paid for it, then how can they justify spending their time on it?

One entrepreneur I talked to about five years ago, he was doing a telemedicine service, and he had to hire doctors who are licensed in every state because if you're in California but the patient is in Colorado, you had to have a doctor certified to practice in that state. So now, the government is catching up. They're making it much easier for people to practice telemedicine to get paid for their time and the insurance companies are finally catching up too and saying, "Yes, we will cover mental health counseling over Skype or over FaceTime, or whatever platform."

Macy Bayern: I know Medicare definitely covers it. It varies by state in regards to certain insurance companies, but I know most major insurance companies will cover telehealth services now, which I think is very indicative of where the industry is moving, especially during quarantines.

Veronica Combs: Well, now that patients know this is possible, there will be a lot bigger push, like, "Well, you did it before, why can't we keep doing it?" Help us stay healthy.

Karen Roby: I know one thing that certainly helps is, when we see the sun, and it's like you can get outside and finally get to feel a little more normal and take a walk or walk the dog, it makes a big difference.

Macy Bayern: It really does. Even yesterday, it was not great weather in Kentucky, and it was raining, and that made me feel even worse. It's like not only have I been cooped up in the house all these days, but now I can't even go outside and just get a little bit of fresh air. I think that right now in particular with both physical and mental health, that those telecommunication services are even more instrumental.

Veronica Combs: A lot of telemedicine or digital health companies talk about nudges, kind of like your Apple Watch tells you you haven't completed your circles, so maybe you need a nudge to go outside or you need a nudge to record your mood, or you need a reminder to take your medication. These platforms can provide just a little bit of support. Not a full-on doctor visit, but just a little help to tell you to get out and take a walk or tell you to call your friend or your mom or your aunt or whoever you need to talk to that day, which is another big advantage of this different way to practice medicine.

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Karen Roby discusses telehealth with Macy Bayern and Veronica Combs.

Image: Mackenzie Burke, TechRepublic