By Dr. Conrad Lotze
Contributor, EDM Digest
“What’s UpDox?” That’s the question I recently found myself asking my wife as she researched ways to move her private practice online. In the world of education, since the advent of COVID-19 isolation orders, we have found ourselves suddenly thrust into the brave new world of Zoom meetings, Google Hangouts, and Schoology – all in an effort to “do” education at a distance.
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There are similar tools in the healthcare world, but they require high levels of privacy and accountability if the provider wishes to be compensated by an insurance company for an “online encounter.”
My wife, a family medicine MD with a thriving local private practice, chose Updox as a secure, insurance-approved, HIPAA-compliant format to facilitate face-to-face “telemedicine” video chats with patients remotely. After some initial hiccups (one of her patients still owns a flip phone, for example), she has settled into a work from home routine that has her sending links to instant sessions that she holds from our newly converted guestroom home office. The Doctor is in!
Her relatively smooth transition online was mirrored by my own physical therapy experience dealing with a hip injury endured while skiing back in early February, BC. The fine folks at Pivot Physical Therapy made the transition to telemedicine, using 8×8 teleconferences. Prior to my appointment, I am sent an email link, and we are instantly connected. My physical therapist can see me do my exercises, correct my posture when needed, and chide me at a distance for not doing the exercises as often as prescribed. I can hardly tell the difference. Evidently, I’m able to maintain my “bad patient” status remotely.
My curiosity was piqued, however, so I thought I’d document a few other providers’ experiences when they moved their practices online. To this end, I interviewed Dr. Quianda Harris, the wife of a colleague, who works as a clinical counselor at a large university, about its Employee Assistance Program.
Dr. Harris said many of her colleagues had done some tele-counseling, but now they have implemented both telephone and Zoom conferences. Interestingly, patients have stated they are actually more comfortable with online counseling than face-to-face sessions. Presumably, the camera removes a perceived stigma, while also making accessibility much easier.
The topic of Dr. Harris’s dissertation was online therapy/counseling. Specifically, she investigated whether or not college students found online therapy beneficial. Her research indicated that overall, tele-counseling provides greater access to more people who would not have had access otherwise. Thus, tele-counseling can be seen as a positive development.
Now that tele-conferencing is the only option thanks to the coronavirus pandemic, Dr. Harris and her colleagues’ work has slowed down a little, but not much. They do both telephone and videoconferencing appointments from their office. So far, most insurance companies appear to be accepting tele-counseling/telehealth and are reimbursing providers for that service.
While Dr. Harris admits that on the phone, she cannot read non-verbal cues, on zoom, however, that’s not an issue. She can see the cues perfectly. Her office has had Zoom installed on the computers. They simply informed clients about the new modality and gained their consent.
Overall, patients seem to love it. Counselors also report enjoying it because it gives them a literal glimpse into their clients’ world. Today’s traditional college students are extremely comfortable with the online environment. Generational differences exist, of course, but clients appreciate the flexibility the online app offers
In fact, once the national lockdown is all over, Dr. Harris suspects that people will want to continue going online due to the convenience factor. Moving to online appointments avoids all of those hassles of traffic, parking, scheduling, and showing up in person. In the past, she and other colleagues used to answer the crisis call line, so this is similar. They have also been using text messages, so none of this is new.
I asked Dr. Harris what advice she would give to others considering switching to tele-consulting and she said: “Don’t be afraid of it. Trust the skills that you have. Those skills translate into any mode of therapy. The biggest worry is what if someone is suicidal?”
She suggested coming up with a plan. Crisis lines have been around for a long time. This expands access to so many more people, and can only help! Being online provides an alternate way to provide therapy. It makes it feel more anonymous, so clients feel more comfortable. Thus, a larger number can be served – the elderly, disabled, anxiety-ridden, rural folks for whom transportation is an issue. Consider how you can truly impact society.”
I also emailed some questions to my Physical Therapist, a local doctor of physical therapy (DPT) who prefers to remain anonymous. Below are the questions I asked, along with her responses, slightly edited for brevity.
- What platform(s) are you using?
Using 8×8 Virtual Office
- What challenges did you face when moving online?
Some patients were unable to log on.
- How did you overcome them?
Our IT department made a step-by-step PDF for the patients to follow.
- Are insurance companies reimbursing online encounters? At the same rate as before?
Initially, healthcare insurance companies were not reimbursing, but most are now reimbursing at the same rate as in-person visits.
- How are your patients responding to the different medium?
The patients who are able to get it to work are responding well. Most seem to like the convenience it provides and the ability to continue care at home.
- What challenges do/did they face?
Patients who were not technologically savvy required more assistance to walk through the process of getting onto the video call; some also had difficulty downloading the app onto various devices.
- What long-term effects do you see arising from this unique time in our history?
Patients not getting the same type of care to an extent (inability to perform manual therapy via telehealth) and possibly taking longer to heal or meet goals. Potential long-term benefit: Ability to carry telehealth forward and give patients another way to access healthcare providers.
- What advice would you give to others seeking to do the same?
Practice! Try to clear up any issues before starting a video call with a patient by practicing with coworkers. Also having a step-by-step instructional guide for patients to follow prior to implementing telehealth.
And just for completeness, I asked my wife for her input as well.
- What platform(s) are you using?
UpDox, Google Duo, FaceTime, Messenger. UpDox is the only HIPAA-secure one, but that regulation has been relaxed during COVID-19.
- What challenges did you face when moving online?
Educating patients about the technology, which took time and made seeing patients almost twice as long.
- How did you overcome them?
I spent the time figuring out which platform works best for each patient and made note of that so the next visit went a little faster and smoother.
- Are insurance companies reimbursing online encounters? At the same rate as before?
Well, yes and no. The amount we receive for lower-level visits are the same, but we can’t bill for higher-level visits. As a result, for similar time spent working with a patient, I get roughly half the amount of money.
- How are your patients responding to the different medium?
Most are responding fine when it is something that has to be addressed. A lot of routine care is simply not happening and just being put off to a later date.
- What challenges do/did they face?
Difficult situation for patients who do not do well with technology. People with anxiety and stress-related medical concerns are having a hard time with COVID-19. Also, hands-on therapies like massage and acupuncture, which people use to manage their health concerns, are not able to happen.
- What long-term effects do you see arising from this unique time in our history?
More telemedicine will be used in the future.
- What advice would you give to others seeking to do the same?
While frustrating at times, stick with it, telemedicine is a great option for use now, and I suspect some will even want to continue with the modality in the future.
In these unprecedented times of isolation and disruption to our daily routines, it is comforting to know that technology has evolved to the point where many of our essential services, including education and healthcare, have been able to rather seamlessly transition online. Folks who embark on this path should anticipate potential technology interaction issues with less tech-savvy individuals, and develop appropriate supports to assist.
About the Author
Conrad Lotze, Ph.D., is an Assistant Provost & Dean of the School of Education at APUS. Conrad possesses over 25 years of Higher Education experience as a teacher, manager, professor, and administrator. His background includes degrees in Mathematics and Mathematics Education, and his research interests lie in the use of technology to enhance teaching and learning. He lives on a farm outside of Charles Town, WV with his wife and daughter. When not in isolation due to coronavirus, he enjoys traveling, live music, photography, and skiing.
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