Telemed and Telehealth – The Five W’s and How – Nathan Little
7th January 2021
A common form of problem investigation and solving in research and journalism, as well as other fields, is the art of questioning. As professionals in the medical field, one is taught to use logic, rational and questioning to derive a conclusion on all sorts of perplexing patient presentations.
However, eye care professionals (ECPs) are also called upon to use this same skillset when it comes to making business decisions – whether it be to buy or lease space, purchase new equipment or institute a new business model.
Given the challenge of this decision-making process, we look to demystify one of the most relevant challenges of the day – understanding and implementing telemed/telehealth into a working ECP clinic.
We will be using the classic 5W’s + H technique (Who, What, When, Where, When & How) to provide clear and concise information about telemed/telehealth and its adoption in the eyecare space.
To begin, let us properly layout the WHAT.
There are a few key definitions that one will see/hear in any telemed/telehealth conversations.
Moving forward, the terms below will be used according to their proper definitions.
Telehealth – An umbrella term used to describe all types of telecommunication interactions between healthcare providers and patients. It includes a range of services such as educations, preventative, promotive and curated care.
Telemed – A more narrow term that falls under the telehealth umbrella that directly correlates to clinical care happening in a remote setting, such as diagnosis and monitoring.
Synchronous care – The Office of the National Coordinator for Health Information Technology (ONC) defines synchronous telemedicine as live video-conferencing, two-way audiovisual link between a patient and a care provider.
Asynchronous care – The ONC defines asynchronous telemedicine as the transmission of a recorded health history to a health practitioner, usually a specialist.
WHO has adopted telehealth or telemedicine in the eye care space? And to what extent?
A recent report from American Well surveyed 800 physicians in the US and reported that the use of telehealth across all medical specialties was up more than 300%.1
Of the increase in the use of telehealth, roughly 62.5% of adoption was from primary care, while 37.5% was from specialists. 1 Of all specialties, ophthalmology/optometry reported a 63% willingness to use a telehealth service while only 26% have actually adopted a service.1
A recent survey from TheTeleop reported that 43% of optometrists in the US had actually completed a virtual at home visit, with a myriad of different tools being used, including non-specialty (Zoom) and specialty tools designed specifically for ECPs.2
Extrapolating these numbers to represent the ECPs in the US (roughly 60K (40K ODs, 20K MDs), there is an estimated 25K ECPs in the US who have adopted telemed services and 17K optometrists who have used a virtual home visit technology at least once.
WHY should ECPs consider adopting the technology into their practice and HOW does reimbursement happen?
Many ECPs around the world are considering adopting a telemed platform, but have concerns about reimbursement and payments. Roughly 77% of all physicians surveyed by American Well reported uncertainty or worries about reimbursements.1 This concern about payments can be addressed with significant online resources that speak to the payment system that surrounds the telemed payment space. Below we reference a few of the most common reimbursement codes and their payouts in the US.
Table of Services, Codes and Average Reimbursements2
|Service||Code(s)||Communication Method||Live Patient Interaction||New Patients Allowed||Patient Must Initiate||Informed Consent Required||Reimbursement|
|Remote Triage/Video Evaluation||G2010||Clinician response via wide range of options||No||Yes||Yes||Yes||$15|
|Virtual Clinic||G2012||Telephone, interactive audio and video system||Yes||Yes||Yes||Yes||$15|
|E-Visit||94421-94423||Patient portal, secure email||No||Yes||Yes||Yes||$15, $30, $50|
|Telephone Service||99441-99443||Telephone||Yes||Yes||Yes||Yes||$15, $30, $40|
|Interactive audio and video||Yes||Yes||No||No||$47, $77, $109, $167, $211
$46, $76, $110, $148
The table above is only for reference and does not imply billing or reimbursement advice for practices. All readers must verify and confirm all billing and reimbursement details. AOS is not responsible for any inaccuracy.
Telemedicine was a growing portion of patient requests prior to the Covid-19 pandemic, but as a result more and more patients are requesting telemedicine services.
The WHY, is just this: that patients are requesting the service due to fear, convenience or any other reason. But regardless, the patients are requesting it.
In addition to patient request, telemed is also an opportunity for the ECP practice to drive new revenue models and patient engagement through more convenient services for the patient and practice.
Engaging with patients inside and outside of the clinic is a new dynamic that curates patient retention and new revenue models like subscription-based eye care plans.
Factor in the patient drive with increased reimbursements and new technologies like AOS that allow for synchronous and asynchronous care, and it is clear that telemedicine will continue to grow within the industry.
WHEN should adoption of telemedicine be within practices?
The time for practice adoption of telemedicine is now. Covid- 19 is driving change in global business and eye care is not immune.
Patient sentiment toward telemedicine has changed and educated consumers believe that telemedicine should be a part of the service options provided by the ECP.
While no telemedicine interaction can replace in-clinic care, remote triage and monitoring via telemed has its benefits.
WHERE can telemedicine be applied within a clinic?
We at AOS believe that our technology is a bridge that spans the gap between in-clinic and remote care, providing options for synchronous and asynchronous care.
Our goal is to always include the ECP in all patient care and that any solution that replaces the ECP is ultimately doomed for failure.
At AOS, we are driven by the use of new technologies that integrate into clinic workflow that empower better clinical care while enabling remote services such as telemedicine and telehealth.
We believe that the best solutions enable the seamless transition between in-clinic and remote care and that any tool should have applications in both in arenas (clinic and home).
AOS has many applications within the patient care journey and they include dry eye management, ocular surface health, remote contact lens management, in-clinic digital imaging (using the physician/slit lamp app), remote imaging (via the patient app) and of course live and encrypted video calls.
In summary, there are a lot of reasons to adopt new technologies into a clinic however ECPs need all the relevant information to make informed decisions. Our hope is the above info is somewhat helpful in the decision-making progress.
The appendix below is also provided as a reference for other definitions that one may find useful when exploring telemed options.
Authentication: Method of verifying the identity of a person sending or receiving information using passwords, keys and other automated identifiers
Data compression: A reduction in the number of bits needed to represent data to save storage capacity, speed up file transfer, and decrease costs for storage hardware and network bandwidth
Digital camera (still images): Camera that stores images digitally rather than recording them on film, allowing data to be downloaded to a computer system
Digital Imaging and Communication in Medicine (DICOM): A method to reduce the volume of data using encoding that results in the data having fewer bits of information than the original dataset to reduce image processing, transmission times, band- width requirements and storage requirements
Digital signature: Hardware or device not part of the central computer that can provide medical data input to or accept output from the computer
Distance learning: Incorporation of video and audio technologies, allowing students to “attend” classes and training sessions that are being presented at a remote location
Distant provider: Telehealth service where provider giving care is not physically on site but is communicating directly with the patient and seeing live data. Provider may be a specialist remoting or the primary caregiver
Distant site: Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system
Electronic Data Interchange (EDI): Allows one company to send information to another company electronically rather than with paper
Encryption: Mathematical system for authenticating digital messages or documents. Valid signatures give the recipient evidence that the message was created by a known sender and not altered in transit
Mobile telehealth: Delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies
Originating site: Location of the patient in a telehealth visit
Patient exam camera (video): Devices that do not record video but serve as a conduit for video signals
Peripheral devices: Internal or external device that connects directly to a computer but does not contribute to the computer’s primary function
Teleconsultation: Health care consultation carried out remotely using audiovisual telecommunications between doctor and patient
Telemedicine: Technology-enabled health and care management and delivery systems that extend capacity and access
Virtual, at-home visit (VAHoV): Health care visit delivered to a patient who is at home or other private location by a health care professional via an audiovisual connection in real time
By Nathan Little, Chief Strategy Officer for Sparca