7 minute read
Getting the most from telehealth. Help for online appointments
Health care online
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Getting the most from telehealth
BY SANDRA STRIEBY
Like so many things, health care went virtual in the early days of the COVID-19 pandemic. Online appointments have pros and cons, but overall they’ve proven popular, and are likely to outlast the health emergency.
Visits by phone or computer may be referred to as telemedicine; telehealth; or remote, video, or online care. Telemedicine and telehealth are two of the most common terms. According to the National Institutes of Health, “Telemedicine refers specifically to online doctor visits, while telehealth also includes health-related education services like diabetes management or nutrition courses and health-related training.” This article will use the term “telehealth,” reflecting the varied types of care available in the Methow Valley.
Popular and practical
Telehealth is readily available in the Methow — it’s offered by
How to schedule a telehealth appointment
• Confluence Health: through the MyChart system or by calling (509) 663-8711. • Family Health Centers: through the call center at 1-800660-2129 or with a receptionist. • Okanogan Behavioral HealthCare: call 1-866-826-6191 or use TTY relay at (509) 826-2113. • Washington Department of Health (for COVID-19 consultations): visit https://doh.wa.gov/emergencies/covid-19/ treatments/free-telehealth or call 1–800–525–0127 and press #.
Online help available to get started
Confluence Health uses MyChart for online telehealth. Here is the opening part of the procedure. For the full PDF, visit www.confluencehealth.org/documents/content/ MyChart-Video-Visits-for-Patients.pdf FHC uses Athena Telehealth for online telelhealth. Here is the opening part of its procedure. For the full PDF, visit https://myfamilyhealth.org/wp-content/uploads/ 2020/10/Athena-Telehealth.pdf
Confluence Health, Family Health Centers (FHC), and Okanogan Behavioral Healthcare (OBHC) as well as several private practitioners. Naturopathic care, counseling and movement education are all available online from local providers.
Telehealth use skyrocketed at the start of the pandemic. In most areas of care, use has since leveled off, although it remains much higher than it was pre-COVID. Melodie White, chief operations officer at FHC, reports that “Before the pandemic, we did not use telehealth as a regular visit type.” At the start of the pandemic, she said, “We went to all telehealth visits for several weeks, and then continued doing telehealth once we opened up to in-person visits.” White said that about 15% of FHC visits are now via telehealth.
Dr. Becket Mahnke, chief medical information officer at Confluence Health, said that virtual visits jumped from “essentially zero before the pandemic” to well over 20,000 in April 2020. Mahnke now estimates that about 5-10% of Confluence visits are virtual, not including behavioral health. Confluence recently expanded telehealth provider hours to meet demand from patients in the Methow Valley.
In the area of behavioral health, telehealth use has continued to grow. Confluence Health saw an increase from under 1% of visits in 2019 to 73% in 2020 and 81% in 2021. OBHC was using telehealth before the pandemic, and has seen remote visits grow more than four-fold since 2019, according to Carolbelle Branch, OBHC director of communications.
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Telehealth is a good choice for many, but not all, non-emergency visits. Tracy Corgiat, vice president of primary care at Confluence Health, said that “for the right health concern, telehealth can be an incredibly effective way for patients to seek care. Telehealth is great for behavioral health visits, nutrition and diabetes counseling, medication follow-ups, and new health conditions that don’t require hands-on physical examination, to name a few.”
There are also circumstances in which it doesn’t work as well.
“Some patients are stressed out by technology and only want to see a provider in the clinic,” said FHC’s White. “Some symptoms are hard to assess without a provider listening to a patient’s lungs, or moving a limb to see what triggers pain, for example.” Branch noted that telehealth “can be less effective with our youngest clients” whose attention spans don’t yet accommodate long sessions of screen time.
When it’s the right fit, telehealth has many advantages. OBHC’s Branch said that “Telehealth is very useful in an area like Okanogan County where residents are widely spread across remote areas and may be unable to access in-person services. That could be due to remote location, transportation limitations, child care availability, when providers are outside the area, or other situations.”
FHC’s White agreed that being able to receive care without traveling is a benefit, noting that telehealth “requires less time [away] from work [and is a] great option for people who don’t want to drive in the snow.” And, she said, it “limits exposure to infection.”
In addition, telehealth lets patients and care providers see each
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other unmasked. That can make the interaction more productive, especially in behavioral health sessions, where subtle visual cues can be important.
Being prepared
Telehealth visits may be by phone or through a computer, tablet, smartphone, or other device that allows a video as well as audio connection. As noted above, a visual connection can be an important part of a health care session — so much so that, according to Branch, “OBHC is currently developing rooms set up specifically for telehealth sessions” to ensure the best-quality connection.
There are also times when a phone-only session may be ideal — for instance, when a patient simply needs to renew a prescription. Regardless of the means of connection, telehealth sessions are private and confidential — providers use secure connections and adhere to privacy and security standards as they would with in-person appointments. Sessions with Spanish-speaking providers are available, as are interpretive services for other languages.
In some ways, preparing for a telehealth visit is similar to preparing to see a provider in person. Branch suggests that people “Think about their concerns and questions in advance … they may want to make notes of those to be shared with the provider.”
In addition, she recommends being prepared to let the provider know about any medications you’re taking. You may want to have the meds on hand so you can show them to the provider.
The technical elements of the visit will also require some planning.
Confluence, FHC and OBHC all emphasized the importance of having a good phone or internet connection, and testing the connection in advance. According to Dr. Mahnke, Confluence’s telehealth platform “allows patients to do a ‘technology check’ before their visit to ensure all is working properly for the optimal experience.”
Confluence also offers a video visit tip sheet at www.confluencehealth.org/documents/content/MyChart-Video-Visits-for-Patients.pdf. FHC has telehealth instructions at https://myfamilyhealth.org/wp-content/uploads/2020/10/Athena-Telehealth.pdf, and White said that “We can do a test session with one of our staff to make sure the patient knows how to use the app … and connect to the telehealth visits.”
Branch suggested that clients find “a quiet, comfortable and private place where they can talk uninterrupted, and where they can feel safe about an honest and open interaction with the provider.” For video visits, good lighting is important. Branch recommended “a well-lit area where there is good lighting on their face so the provider can see and get to know them. Turn off or avoid any lighting from behind, which creates a silhouette with the face in darkness.”
If you’re using a device other than a phone, be sure it has a microphone and speakers, said White.
Finally, said Branch, “Let the provider know what about telehealth worked well and what did not, so [client and provider] can work together to come up with solutions and make sure their sessions are productive.”
If you don’t have a good connection or the needed equipment, Room One has a private room with Zoom capability and a phone that can be reserved at no cost by calling (509) 997-2050.
Is it covered?
Telehealth coverage varies among insurance providers and specific insurance plans, so it’s a good idea to check with your insurer to find out about coverage and costs. Medicare coverage for telehealth expanded during the pandemic, and in July the U.S. House of Representatives passed legislation that would extend the expanded coverage until 2024.
The bill has been sent to the Senate Finance Committee for consideration. As with other coverage, checking with insurance providers is the best way for Medicare recipients to know what’s covered.
An exception to the above is telehealth consultations for COVID-19, which are “available to everyone, regardless of insurance status, with no out-of-pocket costs,” according to the Washington State Department of Health.
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