14:47 PM

A NJ Doctor’s Advice on Starting a Telemedicine Program: It’s Easier Than You Think.



Ninety percent of my office visits are now done virtually. Here’s what I’ve learned about making them work smoothly for patients and physicians alike.

When the COVID-19 pandemic hit, many physician groups had to quickly turn years of talking about telemedicine into implementing a virtual care program almost overnight. For those practices still considering or in the process of making the move, know this: It’s easier than you might expect.

At Summit Medical Group, we had been piloting a telemedicine program for a year within primary care but had conducted zero virtual patient office visits at my cardiology practice before the outbreak. Since then, about 90 percent of Summit Medical Group’s cardiology office visits (and about 70 percent across the whole Group) have been through a video or telephone consult. It took our department less than a week from the time we made the decision to adopt telemedicine as our new normal to our first office visit.

While telemedicine can’t be used to perform the full range of examinations on my heart patients, like a stress test or complete echocardiogram, virtual visits work remarkably well for a number of conditions. To make these visits as effective as possible, it takes a combination of patient engagement, technology and revised processes to make everything run smoothly. And most of the time, it does.

Here are some of my lessons learned:

Help patients through the journey.

While most physicians have some experience in a telemedicine environment, I would venture that most patients do not. But they are quick to catch on, if given the right information up front. One of my patients, an 80-year-old man, had never had a telemedicine appointment before. Sure enough, within a couple of minutes of our appointment time, armed with his smartphone, he and I were talking by video chat.

It’s important to set expectations for the visit. When your office calls to confirm an appointment, make sure to ask your patients about their devices, whether that be a smartphone, regular phone, tablet or computer, because the experience will be different depending on the device. Also, let them know how they will receive an invitation for the visit to begin. Usually, that’s sent by email or text so the patient can simply click a link and the telemedicine platform can automatically load.

Personally, one of the hardest things to figure out was when to send the invitation to join a visit. If I sent it too soon before I was ready, I learned that patients will often wait only one and a half to two minutes online before abandoning the visit. Make sure to have your chart in hand before sending the invitation.

What has been abundantly clear is that patients appreciate this new experience. The number of patients who have expressed gratitude for our office’s efforts to keep them safe while providing care has blown me away.

Take advantage of remote devices.

For years, cardiologists have used remote monitoring devices such as pacemakers to gather important patient data. But this crisis has made these technologies even more relevant.

Take a recent virtual visit: A patient scheduled an online consultation after experiencing heart palpitations. However, while on the video chat, he showed no symptoms. Fortunately, he was able to come into the office the next day to pick up a heart monitor (he had also been given the option of receiving the monitor by overnight mail). Two hours later, he again had an arrhythmia, which the monitor reported to me remotely. I was able to follow up with a diagnosis soon after.

Many patients today already have self-management tools at home they can use to report vitals directly to their physicians. Blood pressure cuffs, pulse oximeters and even some smartwatches can provide almost as much data in some cases as if the patient had presented in person.

Prepare all members of your staff.

The pandemic has forced our office to modify schedules, rotating staff in “platoons” for one week on, two weeks off to ensure we can be available to our patients in case a staff member gets infected. We’ve also had to change our processes to enable telemedicine.

We’ve learned that our staff is better able to prepare the patients for the visit if they have run through a simulated virtual visit themselves.

We’ve also found it helpful to create a formal script that informs patients about any necessary equipment they should have on hand. For my patients, that could mean a blood pressure cuff or medication list. They may also need to have weighed themselves prior to the visit, so we will remind them of that, too.

Coding and billing for the virtual visits have required adding only a modifier to established codes, as the Centers for Medicare and Medicaid and commercial payers like Horizon Blue Cross and Blue Shield of New Jersey have made it easy to provide virtual visits.

At Summit Medical Group, as we return to more in-person clinically essential care, we will continue to maximize our telemedicine platforms for care when patients want or require it.

Patients value the experience and increased access. And with the right preparations, physicians can obtain the data they need to provide effective care.

Reconfiguring your practice may seem daunting at first but you will learn so much, so quickly, that my best advice is to simply jump in and do it.