That’s because Gov. J.B. Pritzker’s stay-at-home order and federal policy changes resulting from the coronavirus pandemic have prompted more hospitals, doctors and therapists to develop systems that allow them to do digital consultations.
“We’ve been wanting to offer this to our patients for years,” said Dr. Michael Schifano, and obstetrician-gynecologist and CEO of Heartland Women’s Healthcare, which has locations in Shiloh, Waterloo and 14 other cities in Southern Illinois and Missouri.
“The hold-back was that the insurance companies didn’t want to pay for this. It took a crisis for them to step up and meet the needs of patients.”
On March 19, Pritzker signed an executive order requiring health-insurance companies and Medicaid to cover services by in-network providers via telephone or video technology at the same rate as in-person visits for as long as his Gubernatorial Disaster Proclamation is in effect. That includes those related to mental health and substance abuse.
The idea is to keep patients at home, reducing their risk of exposure to coronavirus, which causes the respiratory disease COVID-19. They can consult with doctors using a variety of apps on smartphones, tablets, laptops or desktop computers.
It’s believed that the temporary expansion will have lasting effects and that telehealth will remain as a widely-available option long after the pandemic ends.
“I definitely think I will be doing more of this,” said Nancy Friesen, a clinical psychologist with a private practice in Belleville. “In the future, it could be particularly helpful if I’m going on vacation. I can have more access to people who can’t tolerate long periods of time between visits because they don’t have enough support.”
Going digital with dermatology
Dr. Deanna DuComb, 70, a dermatologist in Carlyle, has been dealing with measles, chicken pox and other infectious diseases throughout her 40 years in practice. She has exam rooms with “negative-pressure” ventilation that prevents contaminated air from escaping.The coronavirus hasn’t stopped DuComb from seeing patients with ulcers, boils, wounds or infections that require in-person examinations.
“You can’t do a culture over the phone,” she said.
But DuComb also is doing digital consultations with patients who have mild rashes or need prescription refills for acne or stress that can cause skin problems. She gives verbal instructions then follows up with mailings to make sure people understand their diagnoses and treatments.
The system works, but it’s not perfect, DuComb said.
“When they’re looking at their camera (on a smartphone or laptop) and showing me their face and their cheek and their forehead, that takes time. I can walk in a room and see it instantly.”
DuComb mainly uses Whatsapp or FaceTime apps, which don’t have security features required by the Privacy Rule of the federal Health Insurance Portability and Accountability Act. She can do it because the U.S. Department of Health and Human Services Office for Civil Rights announced March 17 that it would wave penalties for such HIPAA violations during the pandemic.
Beyond telehealth, DuComb has made other changes in her office. Staff members do phone screenings before scheduling appointments to make sure patients don’t have fevers, coughs or other symptoms, and they take temperatures when people arrive.
Appointments are spaced out, and patients are quickly led to exam rooms. Chairs in the waiting room are stacked in a corner. Toys and magazines have been removed.
“The idea is to not keep patients in the waiting room with other people,” DuComb said.
Permanent option for patients
Schifano, 55, also has made coronavirus-related changes, but he’s banking on the belief that telehealth is here to stay now that people have seen it in action. He recently installed HIPAA-compliant software to make it a permanent part of his ob-gyn practice.In the past six weeks, staff at 16 locations of Heartland Women’s Healthcare have been doing up to 100 digital consultations a day.
“Probably a good half of (patients) need to come into the office, especially toward the latter half of the pregnancy,” Schifano said. “We still need to take their blood pressure. We need to do ultrasounds and check the baby’s heart counts, things that we can’t do over the phone. But questions about a rash or dietary concerns, we can certainly do that over the phone.”
In some cases, Schifano said, the telehealth option can lead people to seek help sooner rather than later, allowing doctors to determine if problems are serious enough to warrant in-person visits and, in some cases, keep them from getting worse.
Telehealth also has led to expanded hours at Heartland to accommodate people with inflexible work schedules. It’s offering digital appointments from 7 a.m. to 9 p.m. Monday through Friday and 9 a.m. to 4 p.m. Saturday and Sunday.
At appointment times, patients receive text messages on smartphones or emails on laptops. They click on links and, within seconds, they’re connected to doctors.
“We have to remind people to be careful driving,” Schifano said. “We’ve had several patients want to call and do it in their cars with a hands-free option. They can kill two birds with one stone. They’re on their way to Walmart to pick up toilet paper, and they’re taking care of their doctor’s appointment.”
Schifano sees telehealth as a godsend for people in rural areas with a shortage of doctors because they don’t have to make so many trips to big cities for medical care.
Moving from couch to laptop
Friesen, 49, has long used computer software to handle scheduling, records and billing for her psychology practice, but only recently did she begin taking advantage of its telehealth function due to COVID-19.“It’s HIPAA-compliant and encrypted at both ends,” she said. “It’s encrypted at the receiver’s end and the sender’s end. It’s designed for mental-health professionals. It’s not as likely to be hacked (as Zoom meetings). It protects the privacy and security of patients.”
Friesen uses psychotherapy to treat adults with depression, anxiety and relationship issues. She normally meets with them in her Belleville office, which has a couch and two comfy chairs.
Now Friesen is offering teletherapy sessions. She still goes into the office, but patients can use digital devices at home or in yards, cars or parks.
“Sometimes people are reluctant to talk to me at home,” she said. “They’re like, ‘I really don’t know if I can do this because I don’t think I have enough privacy to have a conversation with you because people in the other room will hear what I say.’”
Friesen’s session load has increased in the past six weeks, which she attributes to widespread stress, fear, grief and isolation caused by the coronavirus and stay-at-home order.
One disadvantage of teletherapy is that it’s harder for psychologists to pick up on body language and other non-verbal clues to how patients are feeling, Friesen said. She gives the example of eye contact. Some people don’t know where to look when communicating via laptop or tablet because cameras are in different places.
Friesen would prefer to meet with patients several times, get to know them and develop working relationships before going to teletherapy.
“But after you get over the initial adjustment of it, I would say that my work with people feels the same as if they were sitting with me in my office,” she said. “It doesn’t really seem that different. We’re having the same conversations, and we’re talking at the same level of depth about some of the challenges that people are facing, and I think that’s a good thing.”
©2020 the Belleville News-Democrat (Belleville, Ill.) Distributed by Tribune Content Agency, LLC.
