Telehealth Enables These Medical Practitioners To Effectively Work From Home

The COVID-19 (Coronavirus) pandemic has redefined what is normal and has impacted our daily lives in an extremely profound manner. Medical professionals are running ragged to protect people from the virus. Hospitals and health systems are being heavily overloaded and doctors and other medical personnel are literally running ragged in an effort to curb the spread of the virus and cure the infected patients. Due to the pandemic several practices are facing a grim choice of shutting down their medical practice, due to dwindling resources. Shortage of PPE (Personal Protective Equipment) has endangered the lives of doctors and other healthcare professionals.

The COVID-19 is an extremely communicable disease that thrives in unhygienic environments and has no known cure or vaccine till date. Believe it, or not, the waiting room of a hospital can be considered as a petri dish of bacteria and infections. Despite that place being regularly sterilized, it is where patients with all kinds of infections and disease gather and wait for their appointment. This increases the risk of spreading the virus. To make things worse, doctors are now struggling with much needed resources. Resources such as PPEs, ventilators, N95 masks are all in severe shortage at the moment. This shortage threatens the very safety of the treating doctors, their families and their patients.

An effective way to control the spread of the virus is by implementing social distancing. Due to the highly communicable nature of the Coronavirus, governments all across the world have shut down predictions and have implemented nationwide lockdowns. A 24/7 curfew has been established and all citizens have been sequestered to their own residences. This lockdown was implemented so aggressively that citizens were penalized for breaking the curfew. To ensure that the economy and the market would not plummet, the government has encouraged industries to implement the practice of work from home. This way the citizens are safe and production is maintained. But in the case of doctors, until recently, no such safety measures were possible. Doctors had to brave the risk of being infected due to severe shortage of personal protective equipment and treat the infected patients. In order to combat all these problems and to ensure the safety of healthcare workers and their families and enable patients to connect with their doctors without compromising on their safety Telehealth was introduced.

Telehealth can be defined as the distribution of health-related services and information via electronic information and telecommunication technologies. Telehealth was originally developed to enable doctors to provide quality healthcare, clinical contact, care, advice, reminders, education, intervention, monitoring and remote admissions for long-distance patients and patients in rural areas who don’t have access to proper healthcare access. Nowadays, Telehealth is being aggressively incorporated by hospitals as it is the best for doctors to provide treatment and consultation services. During the current crisis Telehealth system has proven to be an invaluable tool. It is not a stretch to say that Telehealth was the reason for a lot of hospitals to continue functioning.

Regarding the functionality of Telehealth, Doctors in almost all fields of medicine concur that using Telehealth services they are able to successfully provide consultations, treat and diagnose illnesses. Baring treatments or diagnosis that require having to touch their patients, the doctors say that they are able to treat all other ailments of their patient. There are certain practices that can completely function with zero limitations.

These practices can seamlessly transition their general practice into Telehealth practices :

Radiology is the medical discipline that uses medical imaging to diagnose and treat diseases within the human body. Teleradiology solutions can be traced back to the 1960s. Teleradiology allows patients to be treated in rural clinics. It compensates for the lack of imaging software in rural clinics. Let’s say a patient has checked-in a rural clinic’s ER, the patient needs to be scanned to diagnose the illness, however such resources are not available and to send the patient back home is simply unethical not to mention harmful for the patients. This factor is even more compounded during the current crisis. Radiologists are specialists that are available in certain areas which are mostly urban. Not all practices can afford to maintain a proper radiology department. Teleradiology helps the care physician to whom the patient is reporting to cross check and teleconsult and receive all the required images from a central physician or the place where the patient had initially gotten their scans done. This reduces redundancy and promotes efficiency and for the current crisis it virtually opens up every clinic or healthcare center accessible to the patient regardless of their resources. This wide range of options means that the patient can choose the most affordable and the nearest one irrespective of their resources as the scans can be easily transferred from the central system. Michael Greiwe, MD one of the leading Orthopedists in the world had this to say about teleradiology, “Many hospitals are already looking to decentralize their niche offerings, especially Teleradiology with the help of community extension services or by partnering with emergency care centers.”

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. Prior to the crisis, there were a lot of restrictions on health plans that would offer to cover the counselling sessions. Special plans were required to be purchased by the patient that would allow reimbursement for a certain number of clinical visits. But, in recent years, due to the increase of depression cases and PTSD cases, health plans now allow for more provisions for reimbursement. In psychiatry, the treatment prescribed is usually mood altering medications coupled with continuous guidance from their doctors. Psychiatrists are also specialists, they are not easily accessible to many of the patients in rural areas, patients who are in serious need of psychiatric intervention. Patients require continuous guidance and moral support from their doctors. There are even certain cases where patients visit their psychiatrists on a daily basis. The COVID-19 pandemic has made this a herculean task. Due to the pandemic a lot of patients may be going through sudden anxiety and panic attacks and for them to be kept away from their doctors, regardless of circumstances is really harmful to the patients. Telepsychiatry allows patients to get in touch with specialists they require. Psychiatrists can now connect with their at risk patients continuously and provide them the required treatments. In fact, due to the nature of treatment which in majority of the cases does not require that the doctors touch their patients, telepsychiatry is rapidly being adopted by doctors everywhere. Telepsychiatry is the best solution for doctors to work from home and treat their patients during this crisis. Dr. Shabana Khan, the director of telepsychiatry at NYU Langone Health, had this to say about telepsychiatry, “The Covid-19 outbreak is going to serve as an impetus. We have no choice”.

Dermatology is the branch of medicine dealing with the skin. It is a specialty with both medical and surgical aspects. Let’s say a patient has found a new mole on their body, and they are worried about it and with the current pandemic, the mind starts to go haywire and somehow convinces you that there is a chance it might be cancerous or melanoma or something sinister. In this highly panicked situation, generally people tend to consult their primary care physicians for their opinion. But with the current lockdown in place and given that leaving your residence can be quite dangerous, the person now has to go the entire day worrying about it instead of being able to consult their doctors. Teledermatology if incorporated can solve this problem in two cases, one being that the patient does not have to leave their residence and can schedule an appointment virtually and can get their consultations done to their satisfaction from their home itself, without risking their lives or the lives of the healthcare providers. The other case being when a patient was receiving treatment from a dermatologist and post check-up is being done by their primary care physician. In these cases, the PCP can get the required records electronically and when the need arises can confer with the specialist virtually and can accordingly prescribe post care treatments. Tom Scornavacca, MD, a family practice physician and Senior Medical Director of UMass Memorial Health’s Office of Clinical Integration and Population Health & Mary Maloney, MD, chair of the University of Massachusetts Medical School’s Dermatology Department had this to contribute on Teledermatology, “It’s much more efficient to take images and have a dermatologist interpret them than it is to schedule an office visit. Until now, there hasn’t been a good way to filter out who they see and who they don’t”.

Ophthalmology is a branch of medicine and surgery which deals with the diagnosis and treatment of eye disorders. Eye problems and disorders are an extremely serious concern. Let us say that while cooking or while crafting or gardening, basically any of the numerous tasks one tends to do to occupy their time during a lockdown, results in the person injuring their eye. Now, let us say that the injured person is now living alone and cannot drive themselves to the hospital. The only way that this person is going to receive the medical attention they require is by the use of teleophthalmology. Using two combinations of telehealth, the live telemedicine and store and forward telemedicine, a doctor can effectively treat their patient. Though this case is so far implemented only in emergency cases, this platform is also now being used to administer post care for patients who underwent eye surgery. Complete medical records can be maintained electronically and can be used for medical consultations by their doctors and this platform promotes easy and immediate access to eye care for patients. Right now this platform is also being used to diagnose and treat eye infections, for example, conjunctivitis commonly known as pink eye, more often than not requires a treatment schedule of eye drops, which can be administered by the patients themselves once the medicine is prescribed by the doctor and the patient has been informed of the correct dosage, incases such as this the patient does not need to consult the doctor through live visit, the doctor can do what is necessary though a PDA screen and can provide the required instructions to the patient. Michael F. Chiang , American Academy of Ophthalmology Board of Trustees member, Professor in Ophthalmology, Medical Informatics, and Clinical Epidemiology at Oregon Health & Science University and Associate Director of the Casey Eye Institute had this to say about teleophthalmology, “We’ve got this huge access need in rural America. Actually, we’ve got a similar problem in urban areas. But need is what drives change in this country”.

Nephrology is a specialty of medicine and pediatric medicine that concerns itself with the kidneys: the study of normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. Any infection or kidney disease is a serious issue and one that requires continuous monitoring. As mentioned earlier this is highly cumbersome to do during a lockdown and not to mention the always prevalent danger of contracting the virus. Telenephrology is the singular solution to ensure that the affected patient receives the right treatment without compromising their safety or the doctor’s safety. At this moment telenephrology is still in its initial stages. Currently, it allows a primary care physician (PCP) to consult with a nephrologist virtually and securely share records and necessary files. This also allows the PCP to establish a larger network of specialists, the doctor can use to consult for their patients. The platform allows the doctor and specialist to collaborate and consult each other on a continuous basis and provide the most effective treatment plan for the patient. Moreover, both the specialist and doctor can continuously monitor the patient’s health without the patient having to go in for checkups. Charuhas Thakar, MD , Professor and Director of the Division of Nephrology, Kidney C.A.R.E program within the Department of Internal Medicine at the UC College of Medicine had this to say on Telenephrology, “Telenephrology program enables patients with renal disease and other kidney related conditions to be treated at their local hospitals with direct access to care from medical experts”.

Obstetrics is a branch of medicine and surgery concerned with childbirth and midwifery. The doctors who specialize in this field are more commonly known as OB/GYN. They are responsible for delivering babies. Consider a patient in a rural area, with access to only basic clinics that do not have ultrasound machine, which is required to monitor the heart beat of the patient, determine the sex of the baby and in some cases also aid in the diagnosis of any risk factors involved during the pregnancy. So Tele obstetrics if implemented correctly is extremely helpful here. Prenatal care is one of the most important treatments a pregnant woman receives. It ensures a healthy fetus. Pregnancy is risky enough without the Coronavirus pandemic. But it is extremely complex during the pandemic. Prenatal vitamins are extremely important medication a mother takes in the early stages of the pregnancy and in some states a prescription is required. It is a risk for a mother to have to travel during the pandemic to get these prescriptions. Expecting mothers should not have to travel a long distance simply because the nearby clinic or hospital does not have enough resources to perform ultrasound imaging. Telehealth solves both of these problems to a greater extent. Prescriptions can now be filled virtually and the patient does not have to come in for appointments and the ultrasound imaging can be done once and an obstetrician can guide the patients local PCP on the expected progress of the baby. This platform would significantly reduce the external risk factors involved in a pregnancy. Dr. Yvonne Butler Tobah, a Mayo obstetrician and health sciences researcher had this to say about tele obstetrics, “Our goal is that OB Nest care becomes the model for low-risk women”.

Pathology is the study of the causes and effects of disease or injury. Pathologists are an integral part of the fight against Coronavirus. Pathologists research the cause and effect of diseases in a human body, that is they analyze and understand how the disease works in the human body. Consider the COVID-19 pandemic, this is not just a local outbreak, it is a global crisis that has crippled people all across the world. So, it requires continuous collaboration and a strong communication platform for pathologists and other community medicine experts to come together and analyze the problem and come up with a solution and the platform that makes all this possible is Telepathology. Using telepathology, researchers, virologists & epidemiologists can now easily collaborate and aid in each other’s research. They can easily transmit confidential data in a secure manner using the platform and can expand their network of specialists. This means that due to telehealth, pathologists can now easily communicate and help prevent the spread of deadly viruses such as the COVID-19 in the future through timely warnings and mass spreading of awareness through their research and network. Dr. Anagha Jadhav Practice Lead at Tata Elxsi had this to say about telepathology, “Technological innovations continually nurture the process of globalization and the way we deliver healthcare. Telepathology is one such change of delivering remote pathology services and a value-added clinical benefit for better patient care”.

In addition to all the aforementioned medical practices, teleoncology and telerehabilitation have also started to be implemented. Telehealth and telemedicine are how healthcare is going to be provided to patients in the foreseeable future. Due to the recent pandemic, almost all hospitals have started to implement telehealth services. Practices are now actively trying to find out if they are eligible to provide telehealth services and if their patient’s healthcare plans cover telehealth. Furthermore a PCP can now successfully diagnose and treat the following ailments common ailments such as Allergies, Arthritic Pain, Asthma, Bronchitis, Colds and Flu, Diarrhea, Infections, Insect Bites, Pharyngitis, Conjunctivitis, Rashes, Respiratory Infections, Sinusitis, Skin Inflammations ,Cellulitis, Sore Throats, Sprains & Strains, Bladder Infections, UTIs, Sports Injuries & Vomiting. At Least until the pandemic is done with, telehealth is going to be the safest way for doctors to treat their patients.