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?