Medical/Legal

Solutions to Patient Telehealth Obstacles

By Dan McDyer, MD Chief Medical Officer, OnCall MD Member of Florida Woman Care Clinical Governance Board dmcdyer@oncall.md

Telehealth, when used appropriately, has the potential to be a powerful tool for reducing the cost of healthcare and improving patient satisfaction while providing improved patient outcomes and increased physician and provider efficiencies. It can positively impact a large spectrum of healthcare categories including acute care, remote access to care and chronic care management. It also presents the capability to improve patient outcomes through its ability to enhance patient compliance with visits, increase accessibility to the physician/provider and promote patient retention of information discussed during the visits since they occur in more relaxed environments. Telehealth can also save patients valuable time and money since it eliminates the inconveniences of office visits. However, in order for telehealth to reach its greatest potential, there are numerous obstacles that need to be overcome for optimal implementation, especially when considering patient utilization. These obstacles include platform software issues, access issues, fear of technology and fear of privacy issues.

A commonly encountered patient obstacle to telehealth is the fear of technology. This is frequently seen in the older population or in patients who have limited experience with computeroriented technology and it can be worsened by telehealth platforms that are difficult to use. Solutions to this obstacle lay in the telehealth platform’s software which should be intuitive and simple to use with minimal steps for patient implementation. The telehealth company should also offer instructional support via educational videos, written instructions with screenshots and customer support. An additional step to help overcome this obstacle is to have the practice’s medical and administrative staff educated on the platform’s functionality to assist patients when they encounter problems.

Another common patient obstacle is lack of high speed internet access, especially in rural areas. High speed internet access is necessary due to the bandwidth requirements for the audio and video communications. Fortunately, there are several developments occurring in this realm that will help overcome this access issue. There are governmental grants becoming available for communities to obtain high speed internet and there are private sector programs that have been launched to provide 5G access to rural communities along with satellite-based internet and “line of sight” internet accessibility. Another potential solution is internet accessibility at community locations, such as libraries, etc., although this may present privacy issues unless there is a space in which the patient can be isolated.

An additional patient obstacle is the fear of privacy when using telehealth. This is easily overcome by implementing a telehealth platform that is cybersecure and HIPAA compliant.

A final and less frequently encountered patient obstacle to telehealth is a lack of access to a smart device with a camera that is capable of connecting to the internet. This is a challenging problem to which there is no current realistic solution other than accessing capable devices at community centers, such as a public library, as mentioned above.

Offering telehealth services to your patients can add a valuable dimension to your practice. Being aware of the obstacles that your patients encounter can help you decide if it is appropriate for your practice population. Once you have made the decision to move forward with a telehealth program, the obstacle that is in your control is your choice of the right software platform. The important features that you should seek for a positive patient experience are intuitive feature sets and functionality, simple and quick to use, reliable connectivity, HIPAA and cybersecurity compliance and educational and support tools to enhance your success and that of your patient. With the right choice, your patients’ satisfaction will increase as they engage in this mutually gratifying experience that efficiently enhances accessibility to high quality care.

On Thursday, July 21st the Escambia and Santa Rosa County Medical Society hosted a medical reception at Maserati Pensacola. Our guests enjoyed time with colleagues and friends while exploring the beautiful cars on the showroom floor.

Special musical performances by the very talented Emerald Coast Honors Orchestra and Pensacola Opera!

Of course none of this would have been possible without “Maserati Madrina Ciano” and Step One Automotive Group. Thank you for your generosity and kindness!

Event Sponsors: Fisher Brown, Underwood Anderson, Aaron Erskine Benefits, & PIP Legal Guide

What We Owe Long COVID Patients

By Dr. Zijian Chen, Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Peter A. Kolbert, Senior Vice President of Claim and Litigation services for Healthcare Risk Advisors, part of TDC Group

When Gov. Andrew Cuomo shut down New York City in March 2020, we knew little about treating COVID-19. While treatment has improved considerably, most dialogue has focused on two types of patients—those with severe, even lethal illness, and those with milder symptoms. Yet there is a third category of patients: those suffering from long COVID, whose symptoms linger for an extended period or mysteriously reappear months after their original infection.

Clinicians recognized the existence of these long COVID patients early in the pandemic. May 13, 2022 marked the two-year anniversary of the opening of the Mount Sinai Center for Post-COVID Care in New York City, a firstof-its-kind unit in the U.S. Since then, long COVID has emerged as one of the biggest but least-addressed medical concerns. Anywhere from 10% to 30% of those who contracted COVID-19 suffer chronic aftereffects, some lasting many months after the initial diagnosis. These patients face increased risk of thromboembolic disease, cardiovascular complications, hepatic and renal impairment, and systemic inflammatory response syndrome. While most of the U.S. has returned to “normal” (or at least a new version of it), these long COVID sufferers, through no fault of their own, have been left behind. They may have avoided the most serious outcomes of COVID-19 initially but are missing out on the return to life as they knew it. And while these patients struggle, so do their health-care providers—many of whom suffer from long COVID themselves after fighting on the front line as intensive care units and morgues exceeded capacity.

Long COVID presents varying and unpredictable symptoms and has no known cure, so with very little information, health-care providers are facing an uphill battle when it comes to providing adequate care to these patients. The absence of a standard set of interventions leaves caregivers vulnerable to liability risks stemming from misdiagnoses—either by not recognizing that the patient has long COVID or by diagnosing long COVID when, in fact, the patient has another serious disease.

Medical errors do happen; in fact, diagnostic error is the No. 1 cause of serious harm, making it the top concern for

preventing patient injury. In light of these findings, patients need to present clinicians with the full range of symptoms and ask for comprehensive diagnostic tests to be run in order to identify if it’s long COVID or another ailment.

In return, health-care providers need to bring experts from varying fields together. Forming a strong multidisciplinary care team, communicating clearly and often with patients, keeping detailed chart notes, conducting exploratory testing, following up frequently with the patient and proactively referring to specialists are all essential elements of effective long COVID care.

If a patient suspects they suffer from long COVID or presents a variety of symptoms after having COVID-19, their assembled care team—which often starts at the office of their primary care provider—should first rule out a separate underlying illness. Health-care professionals need to find a balance whereby they maintain, when appropriate, a high index of suspicion for long COVID, without letting long COVID become a catchall diagnosis.

Knowing that long COVID can present as more than 200 symptoms affecting 10 organ systems, health-care providers find it challenging to pinpoint which ailments, if any, were a direct result of COVID-19. With so many individual symptoms, patients may see a range of specialists, calling for a high degree of collaboration between providers.

That there are other ailments masquerading as long COVID emphasizes the importance of seeing patients quickly and providing a thorough evaluation. Common long COVID symptoms like chest pain and heart palpitations could also be the presentation of some other, more emergent condition. As frustrating and debilitating as long COVID can be, it can mask worse diseases that might lead to costlier medical bills and a more rapid decline in a patient’s health—as well as a higher chance for litigation against physicians if these diagnoses are missed.

When signs of long COVID emerged in the summer of 2020, many doctors were skeptical. Even now—two years later—skeptics remain. Consequently, many patients feel that medical professionals are failing them. In the early 1990s, given limited research, some health-care providers did not yet believe that chronic Lyme was a real disease. Similar doubts have been expressed about long COVID. When health-care providers struggle with doubts about long COVID, they should remember that COVID-19 can result in something other than short-term symptoms or death. There’s another scenario—a third category of COVID-19 patients—and we need to accept that reality.

This work first appeared in The New York Daily News and online at www.nydailynews.com.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

KID’S EMERGENCY ROOM EXHIBIT

Since 2012, the Pensacola Children’s Museum has been the premier Northwest Florida site for hands-on educational learning for children. From birthday parties to storytime with friends, thousands of children have walked through the doors of the Children’s Museum to play, learn and explore. The museum seeks to provide relevant exhibits and activities that will allow our children to be prepared, educated and productive citizens of our community. Throughout the years, our exhibits have taught visitors about shopping at the grocery store, building and engineering, Pensacola maritime history and Indigenous American history. The newest addition to the PCM, the Escambia County Medical Society Foundation Kid’s Emergency Room, will teach children about doctors visits and will remove the fear and stigma of many common procedures. Join us in supporting the newest Pensacola Children’s Museum exhibit and help us educate future generations of museum visitors.

Individual Sponsorship Opportunities

PROVIDER GUIDE

$500 per listing

50 “providers” will be included on the electronic provider guide in the PCM Emergency Room.

STETHOSCOPE SPONSOR

$1,000 per listing

Your name will be listed on one of ten stethoscopes in the PCM Kids Emergency Room.

LAB COAT SPONSOR

$3,000 per coat

Your name will be listed on one of ten lab coats in the PCM Kids Emergency Room.

Individual/Corporate/Family Sponsorship Opportunities

AMBULANCE SPONSOR $20,000

DOLL SPONSOR $15,000 PHARMACY SPONSOR $10,000 LABORATORY SPONSOR $10,000

X-RAY/CAT SCAN SPONSOR $10,000 REGISTRATION/ WAITING ROOM SPONSOR $10,000

COUNT ME IN TO SUPPORT THE ESCAMBIA COUNTY MEDICAL SOCIETY FOUNDATION KIDS EMERGENCY ROOM!

NAME _____________________________________________________________ ADDRESS ___________________________________________________________ PHONE _____________________________________________________________ EMAIL ______________________________________________________________

I WANT TO (CHECK ALL THAT APPLY):

___Support financially with a contribution of $_______. ___Volunteer on Design Committee. ___Volunteer on Fundraising Committee.

FOR ADDITIONAL INFORMATION OR QUESTIONS, CONTACT:

Erica Huffman

Escambia County Medical Society Foundation director@escambiacms.org

Robin Zimmern

University of West Florida Historic Trust rzimmern@uwf.edu