COVID-19 and promise of telemedicine
I am an orthopedic surgeon in private practice in Monterey, California and the Clinical Innovation Officer of Sitka. For the past 5 years I have been refining my ability to manage my spine surgery patients using asynchronous video messaging technology developed by Sitka.
Unlike traditional telehealth — which frequently requires doctor <> patient dialog, the services that I provide often involve reviewing complex information sets such as MRI and CT scans. These “information rich messages”, delivered by Sitka (with its amazing integrated tools for reviewing DICOM images, PDFs, and anything that can be displayed on my computer screen) have become a mission critical part of how I practice medicine. In contrast to my practice before Sitka, my patients are now much better educated, engaged, and appreciative of the care that I deliver.
For the past 5 years, I have also been viewed by my partners in Neurosurgery, Orthopedics, Physical Medicine and Rehabilitation, and Pain management, with a mix of curiosity and skepticism. In the absence of applicable codes for this activity, I have given all of this work away for free. In the last 12 months, that has been over 800 reviews of MRI scans, CT scans, lab work, and the results of operations. All of it delivered and read on a HIPAA secure platform with remarkable success. More than 90% of the messages I create are watched, most of them about 10 times, and they are shared with family and friends nearly 100% of the time.
While Sitka has delivered huge returns on the investment of my time in terms of a better practice of medicine, the lack of reimbursement has been a barrier for my partners. I do enjoy the best ratio in my practice of time in clinic (and for a surgeon LESS is definitely more) to the number of elective cases that I perform, and I give all the credit to Sitka in terms of my ability to perform more than 300 elective spine cases a year with only a day and a half in clinic.
COVID-19 has changed all of that. In the last two weeks, my phone has been lit up by other providers who are suddenly anxious about how they can continue to practice when their waiting rooms were suddenly transformed from pools of opportunity into pools of risk. In a world of constantly changing protocols and expectations for social distancing, everyone is wondering how to future proof their medical practices if they are unable to see a full day of 30 patients face to face.
I’m hoping the current administration is going to relax the rules on documentation and reimbursement in order to allow physicians to use whatever tools they have available to maintain the continuity of the doctor patient relationship. Having been in the space for a long time, I know that telemedicine can achieve the same results as social distancing — logarithmically decreasing the chances of viral transmission while still facilitating many of the key components of medicine: diagnosis, counseling, treatment options, and prescribing.
We’ve shared examples of our asynchronous messaging solution many times in our evolution as a company, but I know that they will have new resonance when you consider the alternative of a clinic with a COVID-19 mandated “CLOSED until further notice” sign at the entrance.