Transcription:

Melanie Cole, MS (Host):   As a result of this pandemic and with the advancement of technology, we’ve seen incredible changes in the way patients and providers are able to manage healthcare. Welcome to Shepherd’s Center Radio. I'm Melanie Cole, and today we’re discussing preparing for your telemedicine appointment. Joining me is Dr. Angela Beninga. She’s the chief medical informatics officer at Shepherd Center. Doctor, it’s such a pleasure to have you join us today. During the COVID pandemic there's been this big shift to telehealth. How have you and your team been evolving care for your patients during this pandemic and how has it transformed the way you offer care?

Angela Beninga, DO (Guest):    Absolutely. The pandemic has definitely created a need to shift how we deliver and how we connect with your patients. All of us as healthcare providers want to remain safe ourselves and keep our staff safe, but we also want to minimize exposure of our patients to any viruses or any potential illnesses. So that’s been no exception here at Shepherd Center. We quickly had to put together a telehealth platform so that we could reach out to our patients. It’s been a part of our strategic planning for several years, actually, to get a telemedicine telehealth platform in place. Our patients have a lot of mobility issues. So getting to and from appointments can be challenging for many of them, and we also service a pretty significant geographic area. So approximately 50% of our patients are outside the Georgia region. So it can be difficult to get even to Atlanta for those visits. Anyone who lives in Atlanta knows sometimes it’s just as difficult to get around Atlanta. So it’s been a part of our plan to really provide this service to our patients. With the pandemic, we had to encourage that process a little bit faster and get that on the books so that we could reach out to our patients and not have interruption of care. And also give them access to their healthcare providers so that when they're at home sheltering in place wanting to minimize their exposure to emergency rooms and urgent cares we could still reach out to them and have meaningful interactions to help manage their ongoing issues as well as address any issues that came up during this time period.

Host:   Dr. Beninga, this pandemic seems to be really encouraging healthcare systems to be creative and innovative in their ability to develop essential non-COVID are as you just said. So when is it appropriate to schedule a telehealth appointment?

Dr. Beninga:   Well, I think that’s changing. It depends. Who knows what it’s going to look like six months from now. In the current state, it’s important to protect the health of our patients as well as our staff and our providers. So right now it’s gone from a luxury thing to almost a necessity to really keep everyone safe and keep this pandemic as much in check as we can. So as long as you can have a meaningful interaction with your healthcare provider, I think now is probably a great time to be able to use that as a primary source of your interaction with your physician or other medical providers. For a lot of our patients who are seen either maybe once a year or seen more regularly than that, many of the things that we’re dealing with are chronic issues that maybe would benefit from a physical example. But really a big portion of that is just a conversation between you and your healthcare provider talking about how medications are helping to treat your issues, what other symptoms you may have, either have worsened or new symptoms that you didn’t have before. A lot of an office visit is really just a conversation between the healthcare provider and the patient, and we can still do all of that in a telehealth model.

Host:   So then how would you like patients to prepare for an appointment? I think the big question everybody’s asking about the use of telehealth these days is does it require tech savvy? What kind of device is good to use? Little phones make a little picture so you can't really see each other that well. Do you need to have like an iPad or a good laptop? Tell us about the tech savvy? What do they need? Is this hard to do?

Dr. Beninga: Sure. Over the last few months I've interacted with patients in a telehealth platform ranging in age from 16 to over 80 years of age and a complete wide range of comfort level with technology. The nice thing about technology is that it’s gotten easier to navigate. So the platform that we’re using is called ExamMed. It’s an Atlanta based company. Part of the reason we picked that company was that it was very user friendly. So the patient doesn’t have to sign up for any membership. They don’t have to download an app onto any device? It’s really just a link sent to them either through text message or an email. All they have to do is click on that link and then it brings them into a virtual exam room. From that perspective, it should be very easy. There’s always some issues with maybe broadband access and if somebody’s got a weak Wi-Fi signal. Really any device—a tablet, a laptop, a cell phone—anything that has a camera and a microphone works great for these visits. The technology is easy enough. If you can do a facetime visit with your grandkid, you can absolutely have a telehealth visit with your healthcare provider.   

Host:   So doctor, what have been some of the challenges? This came upon us pretty quickly. How have your team worked through some of these challenges? What have you seen as far as patient outcomes in the way they’ve liked using televisits?

Dr. Beninga:   To say we’ve had this sense of urgency seems like an understatement now. It was something we really went into overdrive to try to get into place. Obviously in the beginning it was trying to minimize the effort that the patient needed to have so that we could facilitate that encounter easily with them. We’ve learned a lot of stuff over the last three months and are continuing to make adjustments and to help improve both the platform and just the experience from the patients. I think for the most part the feedback I've gotten from patients has been positive. There’s always the technology piece of it and can you see me, can you hear me that all of us are dealing with now. If you're having virtual meetings, there's interruptions. There's dogs, there's kids, there's all sorts of stuff going on in the background. But actually that’s been kind of fun to get to see people in their own home environment. So I don’t necessarily see that as a negative. I think patients are anxious about getting out and going out into the community, going to facilities, just leaving their home for obvious reasons these days. So most of the feedback I've gotten has been positive that they can stay in their home. They can stay in an environment they feel safe and still be able to have that interaction with their healthcare provider.

Now, of course, it’s limited. I can't do a physical exam. If there's things I need to see if there’s somebody who can be with the patient while they're having that visit. So if we need to look at skin issues or range of motion or just different things where having somebody sort of work as the camera man in the office visit to be able to facilitate at least somewhat of a visual exam, for me that’s always helpful. That’s probably been the biggest limitation is that there are certain hands on exam findings that can be difficult to facilitate in a virtual platform.

Host:   I certainly agree with you. Now on the other side of the coin. If you were to say some unexpected benefits this has offered, what would those be?

Dr. Beninga:   I would say, for me especially in the beginning, it was so interesting and fun to get to see patients in their own environment. You get to see their home. You get to see family members you’ve never before. You get to meet their family pets sometimes or neighbors. I think people are more comfortable in their own environment. So that anxiety, that white coat syndrome, going to the doctor’s office, having to go through the stress of our patients to get ready, get up, travel to either Atlanta or travel to Shepherd Center. By the time they get here, it’s already been a big process versus just being able to log in and have that interaction with your healthcare provider. Patients are just more relaxed. They're a little bit more themselves. That’s been really fun for me to get to see people in that environment. One, more just comfortable with our interaction, but two getting to see their environment a little bit has been some days interesting but most of the time very fun.  

Host:   Isn’t that great how we’ve all really had to evolve and be creative? So tell us a little bit about what you see, doctor, happening in the future. Do you think this is something that you guys are going to now initiate and kind of keep going even after the pandemic because people are responding so very well to it?

Dr. Beninga:  Absolutely. Like I said before, this has been part of our strategic planning for years trying to facilitate improving access to our patient population who has mobility difficulties whether they're down the street or they're across the country. It can be very challenging for them to get to a doctor’s appointment. We’ve wanted for a long time to be able to offer something like this. To be able to connect to them in an easier manner. So I definitely believe this will stay. I think it will continue to evolve as we find out what works and what doesn’t work. The other piece of that is during the pandemic, a lot of the regulations for insurance companies and access and who you can talk to have been rolled back. So having telehealth visits is much easier now from a regulatory standpoint where you're not restricted by state licensing and things like that. So hopefully moving forward some of those regulations will remain loose so that we can continue to provide this service without having to jump through a lot of hoops to get access to our patients. I think it’s definitely here to stay. I'm sure it will look very different five years from now as it does today. I have no doubt that we’ve been able to show that patients for the most part get just as good of care as they do in person. It definitely cuts down on the stressors for patients to have to get to and from the facility. It cuts down on the amount of money they’ve got to spend whether it’s gas or transportation costs or having care givers that they have to pay to come with them for assistance. I think it makes sense both from a care perspective for the patient as well as a financial perspective for the patient as well as hopefully for the insurance companies.  

Host:   What great information and thank you so much doctor for joining us and really telling us about telehealth and preparing for a telemedicine appointment at Shepherd Center. That concludes this episode of Shepherd Center Radio. For more information on a telemedicine visit at Shepherd Center, please visit shepherd.org to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Shepherd Center podcasts. I'm Melanie Cole.