How to Incorporate Telehealth into Your Clinical Practice During These Difficult Times
Jonathan D. Windram, BSc (Hons), MBChB, MRCP; Justin T. Tretter, MD; Ami Bhatt, MD, FACC
The COVID-19 pandemic has changed our lives in ways that we did not envisage just over a month ago. At the time of writing, over 170,000 people have lost their lives worldwide and 4.5 billion people are under quarantine to slow the pandemic.[1] In addition to the acute burden COVID-19 is placing on our emergency rooms and intensive care units, we are also having to adapt our outpatient clinical practice to delay any non-urgent in-person visits in an attempt to limit exposure to patients and providers. As health care providers we find ourselves rapidly transitioning from the normal clinical visit in person to telephone or telehealth visits when appropriate. How do we do this effectively? What tips and tricks are there to performing a telehealth visit well? And with this increasing comfort and experience with telehealth, are we recognizing there may be an increased role for telehealth which outlives this pandemic?
Dr. Windram, Editor of the Adult Congenital Heart Disease (ACHD) Learning Center, had the opportunity to pose these questions and more to Dr. Ami Bhatt, an early adopter of the use of telehealth medicine in ACHD. Dr. Bhatt is the Director of the ACHD program at Massachusetts General Hospital and has been using telemedicine as a routine part of her clinical practice for several years in addition to conducting research in the field (Figure 1,2).
Dr. Bhatt’s presentation and the subsequent discussion was recorded as a vodcast for Heart University (www.heartuniversity. org) and is freely available for the reader to watch on its component site, the ACHD Learning Center (Figure 3). While the discussion focused on the Adult Congenital Cardiologist, it can be generalized to both the pediatric and adult cardiologist, all of whom are attempting to rapidly incorporate telehealth into their practice today.
Summary of the Highlights from Dr. Bhatt’s Talk and a Portion of the Discussion that Followed
Telemedicine, be it by phone or video conference, has become the standard of care during the COVID-19 crisis, as it keeps both physicians and patients with complex cardiac disease safe from exposure and allows for continuation of care.
Conducting a telehealth visit with a patient in their home creates a relaxed environment. This changed dynamic fosters better patient education and aids shared decision-making.
Telemedicine allows for a more patient-centric approach, improving access and overall quality of care.
For the physician, it reduces no shows, improves adherence to care plans and increases clinic capacity. It promotes continuous care rather than the sometimes episodic care we experience in our regular face-to-face clinics.
For the patient, telemedicine is convenient. It decreases the time and cost expended on clinic visits.
Wireless and wearable technologies, such as digital heart rate and blood pressure monitoring enhance the telemedicine encounter. Further development of these technologies may aid incorporation of telehealth into routine clinical practice.
The inpatient clinic visit remains the mainstay of patient care with its ability to provide a thorough clinical examination and detailed cardiac imaging. The incorporation of telemedicine can enhance comprehensive patient care.
To read the full article, please go to the June 2020 Issue of CCT.