Telehealth and lupus
Telehealth -- also called telemedicine -- is the practice of providing health-related services and patient care using technology, as opposed to in-person appointments.
There are typically three categories of telehealth:
- Real-time video telehealth, which involves the patient and their provider communicating with video-conferencing technology.
- Store and forward telehealth, which involves the provider sending medical information -- such as x-rays, lab results, or prescriptions -- to another provider for a consultation or interpretation.
- Home monitoring telehealth, which involves the use of medical devices in the patient’s home to collect data (like weight or blood pressure) to be sent to the provider so they are able to remotely monitor the patient’s health status.
How can telehealth be useful to people with lupus?
The use of telehealth has expanded for some time because of the growing acknowledgement of its helpfulness in treating patients who are unable to travel for medical reasons or would normally have to travel long periods of time to get to their appointment. It has become particularly important during the coronavirus (COVID-19) pandemic, when many patients, particularly those with chronic diseases, are at heightened risk of both contracting coronavirus and experiencing more severe and potentially life-threatening symptoms.
Telehealth can ensure people with lupus are able to hold their regular appointments, as well as express concerns to their providers without leaving the safety of their home. This minimizes the potential for exposure to viruses, like the new coronavirus. Telehealth can also be helpful for people with lupus during a flare that makes it difficult for them to leave their homes comfortably.
Telehealth can be convenient for patients by minimizing wait times in offices. For providers, it can allow them to see their patient’s home environment, giving them the ability to point out any potential hazards to the patient’s health within their home.
How does telehealth work?
How telehealth will work for you varies on what your provider offers. Generally, if your provider offers telehealth appointments, you will need either a cell phone or computer with a webcam and internet capabilities to interact with your provider face-to-face. Providers may offer general check-ups, as well as answer any questions or concerns you have about your treatment over telehealth. You may be asked to perform certain medical-related actions that you would in an in-person appointment, such as indicating and showing which parts of your body are causing you pain. They may also use telehealth to go over lab results and other medical data with you.
After your appointment, your doctor should send over notes, prescription instructions, and any other important information to you for your records.
For more information, talk to your providers and insurance company about your telehealth options.
How do I know if my provider offers telehealth options?
Speak to your provider about whether they are able to offer you telehealth options and under what circumstances. Ask them for details on how their telehealth system works and what consent forms you are required to sign in order to participate.
Does my insurance cover telehealth options?
Each insurance company has their own policy on telehealth, so it is important to reach out to your insurance to find out what they cover. For those with medicare, most telehealth services cost you the same amount it would if you got the service in person. Doctors and health care providers under Medicare are able to use telehealth insurance to treat COVID-19 -- coinsurance and deductibles apply, but some health care providers are reducing or waiving the fee for telehealth visits. Medicare is also temporarily allowing home infusions for Benlysta to ensure uninterrupted treatment during the coronavirus pandemic.
How do rheumatologists decide which appointments can be done via telehealth and which must be done in-office?
This varies based on both the health care provider, as well as the patient. Because of the coronavirus, some health care providers may want to minimize patient contact to protect their loved ones or themselves -- particularly if they are in high-risk groups. They may elect to see patients only via telehealth, while others may remain open to both in-person and telehealth appointments, based on the patient’s comfort level. Others might elect to only see emergency patients or patients who require procedures in person, while seeing the rest of their patients via telehealth.
Talk to your health care provider about what their telehealth policy is to understand what’s available to you.
Will my doctor be able to address all my concerns and properly examine me?
Many appointments can be just as rewarding and informative over telehealth. But your health care provider may wish to see patients in-person if a physical examination would make a big difference in treatment decision-making. For example, in a patient who has both lupus arthritis and fibromyalgia who is having pain and fatigue, the doctor may wish to see that patient in person to perform a physical examination and an ultrasound.
Your doctor should determine which appointments they need to see you in-office for and which ones can be just as effective using telehealth.
Is telehealth HIPAA compliant? Will my privacy be protected?
For telehealth visits, most physicians use technology that is complies with the Health Insurance Portability and Accountability Act (HIPAA) (such as doxy.me, Zoom for Healthcare, Thera-LINK, Therenest, SimplePractice, Vsee, GoToMeeting, and Doximity). But not all health care providers and patients have access to these resources and must rely on other communications (such as FaceTime, Skype, or telephone conversations) if they are to have a telehealth appointment.
The coronavirus pandemic has created extreme circumstances that heighten the need for telehealth appointments -- particularly among groups that may not have access to HIPAA-compliant technology, such as the elderly. The United States Department of Health and Human Services (HHS) and the Office for Civil Rights have acknowledged that by waiving their enforcement of previous strict HIPAA requirements to allow non-compliant platforms, such as FaceTime and telephone conversations, to be used for the purposes of a telehealth appointment. But purposeful violations of HIPAA, such as sharing patient information outside of health care necessity, is still enforced.
What is the ideal place and way to set up my video conferencing technology in my home to ensure the most productive appointment possible?
It is recommended that you choose a quiet location with minimal noise and possible interruptions (such as other family member conversations, pets, and loud machinery). The location should have a light source that is directed towards you and not behind you or directly onto your webcam. You should also make sure you have a bright light source, such as your smartphone or a flashlight, in case you need to shine light on a particular part of the body for the health care provider to be able to see it better.
If you need to show any body parts during the telehealth appointment, make sure to wear appropriate clothing that is easy to remove during the exam (such a sleeveless shirt if you have to show skin on your arm).
How can I prepare for a telehealth appointment?
Preparation for a telehealth appointment is very similar to preparing for a regular in-office appointment. You should:
- Test your camera and microphone to ensure they are functioning properly
- Make a list of topics and questions you want to discuss with your provider
- Maintain a list of all medications and supplements you take, as well as their dosages
- Ask your provider if your caretaker can join the appointment so they remained informed and you have in-home support
- Have a pen and paper handy to write down instructions from your provider
- Ask the provider if there is a chat box available with the video platform -- if so, this is an excellent place to ask your provider to type in any terms that you are not familiar with
- If you have a blood pressure machine and thermometer at home, check your blood pressure, heart rate, and temperature before the visit so you can give it to your provider at the beginning of the telehealth appointment