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Telemedicine in Physical Medicine and RehabilitationWinter 2020 State of the Science Symposium
12/16/2020
Betty Liu, MDAssociate Professor
University of Pittsburgh
I have no disclosures
Definition of Telemedicine :
The remote diagnosis and treatment of patients by means of telecommunications and informational technology
Brief History : 1940’s
in Pennsylvania – Radiology images were sent between towns 24 miles apart via telephone lines
1950’s
in Montreal, Canada – used to share and care for patients
1960’s
used in ED’s especially with interpretations of heart monitors in the field
Telemedicine Prior to COVID
pandemic
• Episodically used, Examples • Dermatology – interpretations of skin lesions sent by
patient or peers• Radiology – viewing of stat films when on call or as
consultant for remote locations during emergencies• Cardiology – consultant for interpretation of cardiac
tests• Physician Consultants for emergencies on airplanes
Current Telemedtechnology at UPMC for Outpatients
Through EpicCare
For Inpatients :
Other options : (must get consent from patient)
MyUPMCtelemedicine
• Pro• Can have more than one person on the encounter
with patient• Good for multidiscipline care at the same office visit
• Con• Patient need to have updated technology • If the patient is alone, limited physical view of
patient
Documentation of telemedicine visit
This consultation was provided via telemedicine from patient's home using two-way, real-time interactive telecommunications technology between the patient and the provider. The interactive telecommunication technology included audio and video. Verbal consent has been received.
HIPAA in Telemedicine
• As long as the patient gave consent, it is up to the patient to ensure his/her privacy as to WHERE they choose to have the encounter take place
• Physician just need to ensure his/her encounter is in a private place
Telemedicine in PMR from Jan to June 2020 –(data provided by Jesse Day via Epiccare encounters)
Type of visits :
Advantages of Telemedicine
For Patients :• No parking/transportation issues• No accessibility issues• More availability for rural population to an
Academic centerFor Physicians :- Able to f/u with patients sooner after d/c- Billable time spent answering questions via
telemedicine if it is an office visit encounter
- Able to see patient’s home environment- F/u for post procedure, wound care, DME
or medication change- Higher utilization for psychological counsel
sessions
Not so great about Telemedicine
For the Patient :• Comfort with technology, millennials
vs baby boomers• Updated technology• Internet access, rural vs urban
For the Physician :• Visual physical exam only• Cannot pick up nuances on a MSK
exam• Have to rely on patient’s history• For NEW patients (triage)
Telemedicine Etiquette :• Make eye contact – sometimes split screen with
the documentation is not possible• Ensure privacy
• Decrease background noise as much as possible• Acknowledge all people in the patient’s side of the
encounter especially contributor to patient’s history
Telemedicine PE :
• Laskowski ER, Johnson SE, Shelerud RA, et al. The Telemedicine Musculoskeletal Examination. Mayo Clin Proc 2020; 95:1715.
• More for able bodied patient• Great deal of the inspection skills • Instructions for patient to move or use
resistance or test for sensation for themselves
User Satisfaction?• Press Ganey data are being gathered from telemedicine office visits from patients
• Data is being gathered from physicians using telemedicine.
• Will it contribute or alleviate burn out in healthcare workers?
Billing for Physicians :
• Until Jan 2021, office visit level will be less for telemedicine due to limited physical exam especially for the NEW patients
• Reimbursements so far from insurances are 90 to 100% for telemedicine visits
• Must have modifier 95 and attestation statement(see above) in note• Can only be reimbursed in state as physician
What have I learned through using telemedicine as a Physiatrist?
• There is now another option to reach patients
• Inpatient follow up for non - local patients have less no shows
• Ability to observe the patient’s environment (at times)
My Best Side
Ways to improve telemedicine?
• Good question• Perhaps using a local physician extender or
therapist during the telemedicine encounter to assist with a more detailed PE
• Pods in rural areas with good WiFi reception and/or private computer stations(like an office)
QUESTIONS?