The spread of Coronavirus is making telehealth a more viable option for patients to receive routine healthcare through virtual doctor appointments.

NORWAY — As the coronavirus has crept into the state and begun its spread, Maine has had to change how it approaches work habits, routine errands and recreational pursuits.

The doctor’s office is now a place to avoid – for both social distancing and to preserve personal protective equipment and medical supplies.

An alternative type of care service is emerging that has been around for several years but not highly utilized. It is the practice of “telehealth.” Telehealth may become a practical healthcare option for those who live in rural areas as well as the elderly for whom transportation is an obstacle.

“Telehealth care is an option for anyone with cellular reception and a phone or a tablet with video,” said Dr. David Kumaki of Western Maine Oxford Hills Internal Medicine Group in Norway. “It involves a remote medical care appointment. A patient can use it to interact with his primary care physician’s office for routine care. It also can facilitate a remote appointment with a specialist without the patient having to drive to Portland or even further to Boston.”

In the latter case, the patient would be be present in his PCP’s office, with either the physician or a physician’s assistant on hand to provide assistance with vital signs, lab or other reports and records.

Kumaki said that WMH has utilized the practice in a limited capacity for some time and more recently begun building a new system to expand its use.

But the sudden threat of coronavirus has made telehealth a safer way for providers to interact with their patients. WMH is expediting a basic, interim process focused on adult primary care. Kumaki said testing of the system is nearly done and will become available to WMH patients soon.

Work on the original platform continues and Kumaki expects it will be launched later in 2020.

Until now telehealth has had trouble finding its footing as an option for routine care. The challenge for providers is finding a telehealth platform that can integrate with the provider’s electronic health record (EHR) platform, so that telehealth becomes part of the routine rather than a special event.

“Integrating patient records on a system between providers and their patients is key,” said Eric Wicklund, senior editor of the industry newsletter mHealthIntelligence. “The less integrated the platform, the more work required to update records, which undermines its long term usefulness.”

The Centers for Medicare & Medicaid Services (CMS) have only provided reimbursements for telehealth only when the person receiving the service resided in a designated rural area and only when the patient left his home and went to a clinic, hospital or other approved medical facility for the service.

But in response to the threats posed by COVID-19, last week the federal government waived limits to make it easier for people to seek routine care, and keep at-risk populations home while enabling access to medical care.

“Virtual doctor’s visits can be helpful, but you do lose the benefits of personal contact and physical examination,” Kumaki said. “There have been technical challenges as well with government restrictions on its use.”

With or without video capabilities that are soon to come with Western Maine’s telehealth system, Kumaki says that people residing in Oxford Hills should use the phone as their first point of communication with their doctor, especially until the COVID-19 public health crisis is contained.

“For routine care while social distancing, we want to start with a conversation,” he said. “We can do triage over the phone, asking questions and assessing what kind of care is appropriate. For an acute problem we will want the patient to be seen. For a non-emergency we may be able to help resolve concerns right then. And for potential coronavirus-related illness we will direct the patient on the best way to get appropriate care.”

Once the current health crisis passes, Wicklund says, successful adoption of  telehealth to continuing, routine care requires that medical record of virtual doctor’s visits have ideally been logged at the time of the visit rather than added in later by the care provider, a nurse or a scribe. This is particularly vital for patients with chronic care needs or adverse reactions to certain drugs.

“As healthcare providers embrace new telehealth services to address the coronavirus pandemic, they should remember one thing,” stresses Wicklund. “Capture and store all the data.”


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