This book details the practice of telerheumatology. Telemedicine is defined as the delivery of healthcare and the exchange of healthcare information across distances. Following, telerheumatology is the delivery of rheumatology care through telemedicine. There exists an increasing demand from patients, caregivers, and healthcare systems for access to academic specialists through telemedicine. This has been the case for the past several years and the demand has only increased with the ongoing COVID-19 pandemic. There is currently a lack of rheumatologists in rural areas and that is expected to spread to a general lack by 2025. Telerheumatology offers an excellent and timely solution to fill these gaps and provide care.
Telerheumatology care has been shown to be feasible and quite effective. The current COVID-19 pandemic has thrust the concept of telemedicine into the spotlight. However, not all telerheumatology care is the same and there exists many nuances and differences when examining telerheumatology care across the United States and the world. After comprehensively reviewing the origins of telerheumatology, this work defines in detail the current practice of telerheumatology, along with the specific impact of the COVID-19 pandemic and all applications of telerheumatology. Expert authors also provide a detailed roadmap for providers to initiate, sustain, and grow a telerheumatology program. The book concludes by covering future directions of telerheumatology, including areas for expansion, improvement, and innovation.
After reading this work, the editor and all the contributing authors hope that it will inspire, provoke thought and discussion, and lead to increased adaptation of providing telerheumatology care by rheumatologists and rheumatology providers.
Author(s): Christine Peoples
Publisher: Springer
Year: 2022
Language: English
Pages: 357
City: Cham
Foreword
Preface
References
Contents
Contributors
Chapter 1: Introduction
Reference
Chapter 2: Telerheumatology: A Historical Perspective
Introduction
Key Historical Events and Concepts
The Father of Telemedicine…No…the Father of the Division of General Medicine
Interview Between Jay Sanders, MD, and Christine Peoples, MD
References
Chapter 3: Overview of Synchronous and Asynchronous Modalities
Definition of Synchronous vs Asynchronous Telemedicine
Advantages and Disadvantages of Synchronous Visits
Advantages and Disadvantages of Asynchronous Visits
Applications of Both Synchronous and Asynchronous Telemedicine: A Mental Model
Asynchronous Use Cases of Telemedicine: Traditional Asynchronous Use Cases
New Modalities of Asynchronous Visits
Synchronous Use Cases of Telemedicine
Future Applications of Both Synchronous and Asynchronous Modalities
References
Chapter 4: The Role of eConsults
Origins of eConsults
Benefits of eConsults in Other Specialties
Decreasing Unnecessary Visits and Wait Times
Improve Turnaround Time
Cost Savings
Address Health Disparity
Fill Educational Gaps
Adaptability
eConsult Experience in Rheumatology
Referral Triage in Rheumatology
Potential Benefits in Rheumatology
Considerations When Starting an eConsult Program
What Is Your Goal?
Who Are Your Stakeholders?
What Is Your Timeline?
How Will eConsults Fit into Your Practice Setting?
Understand Your Referral Breakdown
Decide What Is Appropriate for an eConsult
Determine What “Type” of eConsult Works Best
Who Will Perform eConsults?
What Are eConsult Billing and Documentation Requirements?
What Are Implementation Barriers of eConsults?
eConsults in Rheumatology
Reasons for eConsults
What Makes a High-Quality eConsult?
What Makes a High-Quality eConsult Reply?
Educating with eConsults
Inpatient eConsults
Challenges for Rheumatology eConsults
References
Chapter 5: Equipment, Technology, and Support
Introduction
Types of Telehealth Visits
Video Conferencing Devices
Internet
Platforms
Security
Additional Hardware and Peripherals
Improving the Call Interaction
Conclusion
References
Chapter 6: Telepresenter Training and the Virtual Physical Exam
Telerheumatology Visits at a Telehealth Center
The Virtual Physical Exam
References
Chapter 7: Documentation, Licensing, and HIPAA Compliance
Documentation
Licensing
HIPPAA Compliance
Conclusions
References
Chapter 8: Legal and Regulatory Primer for the Practice of Telemedicine in the United States
Introduction
Definitions
Four Common Models of Telehealth Arrangements
Provider Licensure
Background
General Rule and Exceptions
Practice of Medicine vs. Provider-to-Provider Consultations
Patient Privacy and Data Security
Background
Federal Law (HIPAA) and State Law
General Rule and Other Considerations in the Practice of Telemedicine
Patient Consent in the Digital World
Background
Patient Consent in the Practice of Telemedicine
Reimbursement
Background
Medicare Requirements
Waivers to Medicare Requirements in Response to COVID-19
Other Payers
Conclusion
References
Chapter 9: Best Practices for Billing and Coding
Introduction
Telerheumatology Prior to the COVID-19 Pandemic
Synchronous Audio and Visual E/M Encounters
Synchronous Audio-Only E/M Encounters
E-Visits
Virtual Check-Ins
Interprofessional Telephone/Internet/Electronic Health Record Consultations
Modifiers and Place of Service (POS) Add-Ons
Considerations in Billing Telerheumatology by Nonphysician Health Professionals
Considerations in Billing with Commercial and Medicare Advantage Payers
Telerheumatology Billing and Coding as the COVID-19 Pandemic Continues
Summary and Conclusions
References
Chapter 10: Determining the Value of Telerheumatology
Introduction
Defining Telerheumatology Through Application of a Telemedicine Taxonomy
Defining the Value of Telerheumatology
The Economics of Telerheumatology and the Impact of the COVID-19 Pandemic
Methods of Health Economic Analysis: A Brief Introduction
Health Economic Assessments of Telerheumatology: A Strategic Survey of the Available Literature
Implications of the Limited Available Health Economic Evaluation of Telerheumatology
Stakeholder Perspectives on the Value of Telerheumatology: Value Is in the Eye of the Stakeholder
The Patient Perspective
Subjective Outcomes: The Patient Experience of Telerheumatology
Patient Out-of-Pocket Costs
Optimizing the Patient Value Experience of Telerheumatology
The Clinician Perspective
Subjective Outcomes: The Clinician Experience of Telerheumatology
Clinician Costs
Optimizing the Clinician Value Experience of Telerheumatology
Objective Outcomes: The Clinical Effectiveness of Telerheumatology
Why Patient and Clinician Value Assessments Are Often Discordant
The Health Plan and Societal Perspectives: Telemedicine Coverage at the Crossroads
Legitimizing Health Plans’ Telemedicine Coverage Decisions
Telemedicine, Health Policy, and Data-Driven Decision-Making
The Path Forward: Demonstrating the Value of Telerheumatology
Developing a Standard Methodologic Framework for Value Assessment in Telerheumatology
Interpreting Value Outcomes Across Telerheumatology Stakeholder Perspectives
Novel Approaches to Value Assessment Applied to Telerheumatology
When Health Economic Analysis Meets Value-Based Healthcare: The VBHC-QALY
Three-Variable Health Economic Analysis: Adding the Patient as the Z-Axis
Conclusion
Appendix: Adjudication of Three-Variable Health Economic Analysis by Octant of Result
References
Chapter 11: Measuring Disease Activity and Functional Capacity in Telerheumatology
Introduction
Patient-Reported Outcomes Measurement Information System (PROMIS)
Rheumatoid Arthritis
Spondyloarthritis
Systemic Lupus Erythematosus
Osteoarthritis
Fibromyalgia
Gout
Approach for the Future
References
Chapter 12: Rheumatology Telementoring: The ECHO Model
Introduction
Rheumatology Telementoring
The Rheumatology TeleECHO Session
Evaluation
Primary Reasons for Participation in this Activity
How Case Presentations and Didactic Formats Address Your Needs
How Participants Use ECHO Learning with Their Own Patients
Application of Rheumatology Concepts to Everyday Practice
Summary
References
Chapter 13: Rural Health Care and Telerheumatology
Rural Populations and Health Disparities
Rheumatology Workforce Distribution
Models of Rheumatology Care for Rural Populations
Benefits of Telerheumatology for Rural Populations
Barriers to Telerheumatology in Rural Populations
Conclusions
References
Chapter 14: Telerheumatology and the Chronic Care Model
The Unmet Need
The Chronic Care Model
Healthcare Organization
Community Resources
Self-Management Support
Delivery System Design
Decision Support
Clinical Information Systems
Smartphones and Telemedicine
Wearables
Management of Acute Flare-Ups: Teleurgent Care
Telemedicine: Proposed Models/Methods
Real-Time Telemedicine
Remote Patient Monitoring/Tele-monitoring
Store-and-Forward Telemedicine/Asynchronous Telemedicine
SOPs for Telemedicine
Teletriage
Challenges in Telerheumatology
Patient Mental Health
The Way Forward
References
Chapter 15: Telerheumatology and the Department of Veterans Affairs
Historical Background
Overview of VA Telehealth Environment
Modalities
Technologies
Initiatives and Research
Legislation
Summary of the Telerheumatology Medical Literature Based on Data from the VA
Patient Perspectives on VA Telerheumatology: An Observational Study
Overview
Materials and Methods
Results
Conclusion
Summary
References
Chapter 16: Review of the Evidence for Telerheumatology
Introduction
Characteristics of Telemedicine Described in Research Studies
Studies Through July 2015
Recent Studies
Discussion/Future Directions
Conclusions
References
Chapter 17: Satisfaction with Telerheumatology Care: Patient and Clinician Perspectives
Introduction
Patient Perspectives About Telerheumatology
Overall Satisfaction with Telerheumatology
Benefits of, Barriers to, and Concerns About Telerheumatology
Factors Influencing Perceptions About Telemedicine
Provider Satisfaction
Overall Provider Satisfaction with Telerheumatology
Benefits of and Barriers to Telerheumatology from the Rheumatologists’ Perspective
Change in Perception of Telerheumatology in the Era of COVID-19
Conclusion
References
Chapter 18: Telerheumatology During the COVID-19 Pandemic and Beyond
Introduction
Telerheumatology Prior to the COVID-19 Pandemic
Telerheumatology During the COVID-19 Pandemic
Similarities and Differences in Telemedicine Use Across Regions
Africa
Egypt
Asia
China
Hong Kong
India
Middle East
Singapore
Australasia
Europe
Germany
Italy
Netherlands
Norway
Poland
Spain
United Kingdom
North America
United States of America
South America
Colombia
Beyond the Pandemic
Disadvantages of Telerheumatology
Moving Forward
References
Chapter 19: Private Practice and Telerheumatology
Improving Access for Rural and Remote Patients
The Australian Health System
Early Federal Government Incentives
2020 Motivated and Stimulated
Challenges We Faced
Embracing the Changes in 2021
References
Chapter 20: Pediatric Telerheumatology
Introduction
Pediatric Rheumatology Workforce Shortage Statistics
Pediatric Rheumatology Telemedicine Literature Review
Unique Perspectives for Pediatric Rheumatology Telemedicine
Future Aspects
References
Chapter 21: Telerheumatology with Learners
Introduction
Best Practices for Incorporating Learners into Outpatient Telemedicine
Workflows for Learners in Faculty-Led Telemedicine Clinic
Best Practices for Teaching in Telerheumatology Clinic with Learners
eConsults with Learners
Telerheumatology and the ACR Core Curriculum
Conclusions
References
Chapter 22: Patient Perspectives and Narratives
Defining Terms: Patient Perspective and Telerheumatology
The Patient Perspective of Telerheumatology
Patient Satisfaction with Telehealth and Telerheumatology
Access to Telerheumatology
Telerheumatology and Patient Measurement of Health Outcomes
Patient Preparation for a Telerheumatology Visit
Video Call Through Zoom, Skype, or Other Platform
Telehealth Center
Telephone or Audio Only
Technology
Environment
Mindset
Questions that Patients Have About Telerheumatology
Patient Narratives of Telerheumatology
Conclusion
References
Chapter 23: Future Directions and Innovation
Internet Access
Augmented Physical Exam
The Digital Medical Assistant
Patient-Reported Outcomes and Co-charting
In-patient Rheumatology Telemedicine Consultation
Telerheumatology Triage
References
Index
