Peer Review: What Spine Specialists Need From a Telemedicine Platform

Leading spine specialists weigh in on what to look for when choosing a new telemedicine platform for your practice

Welcome to another edition of Peer Review. Have you ever wished you could pick the brains of some of the best and brightest spine specialists in the world? Us too. That’s why we created Peer Review. Every month we ask a question that pertains to your practice, and our Editorial Board members share their thoughts.

Telemedicine platforms for spine specialistsDoes your telemedicine platform stack up?

This month’s question:

The pandemic has driven many medical professionals to embrace telemedicine. If you’ve added telemedicine capabilities to your practice (or if you were an early adopter), what did you look for in a telemedicine platform? What features were important to you as a spine specialist? Do you feel that your chosen solution has met all your criteria, and if not, what’s missing? What has been the most challenging part of adopting a telemedicine platform? If you haven’t (or haven’t yet) added telemedicine, why don’t you feel it’s important to your practice?

Theresa Marko, DPT:

Theresa Marko DPTTheresa Marko, DPT

In the beginning, I was looking for something simple and easy to set up that was HIPAA compliant and low cost.

Having good screen resolution with the picture so I am able to see as clear as possible to visualize the body and possibly dysfunctions [was the most important aspect].

Mostly I feel my platform has met my criteria. I wish it integrated with my scheduler and instantly sent out the location web address. The platform I use is the same web address for every patient, but just has a secure waiting room.

The most challenging aspect was that I had not had it set up before! So it was all new.  How the sessions would be performed as well as the scheduling and billing aspect of it.

Definitely feel it is SO important to practice moving forward to allow for a hybrid model.  This model will help reduce barriers to care and increase access.  Increased access for people who have mobility deficits, live in an isolated area, lower socioeconomic areas, limited transportation, working parents, parents with no childcare, emergency situations, and so much more. This is the now.

 

Jeffrey Wang, MD:

Being at USC, I had to default to the system used by our university hospital, so I did not have much of a choice. However, we were authorized to use facetime or other platforms during the shutdown.

For me, the ease of use, for both me and my staff, and perhaps more importantly, for the patient. There was definitely an age-related difference in some patients being able to use this easily, and this is likely due to more familiarity with technology platforms in general. 

Jeffrey Wang, MDJeffrey Wang, MD

The ability for my staff to sign on and participate, was key, both for our teaching program, as well as integrating our plans and communicating our televisit. The ability for our residents/fellows and physician assistants being on the visit, was great.

The ability to share my screen and thus, show imaging studies on my computer to the patient, via them looking at my screen, was essential for spine cases, especially being able to help our patients understand the problems in their spine.

The main issues we faced were:

  1. Patients not having fast internet at their home
  2. Patients not understanding the buttons on the screen on their end
  3. Being able to see who was in the waiting room and ready to be seen, before connecting with them
  4. Having my staff being able to connect remotely with the patients to prepare them for the visit with me

These are all essential for a good telehealth visit.

 

Lali Sekhon, MD:

My criteria for a telemedicine platform were:

  1. Reliable
  2. Cross-platform
  3. Cheap
  4. Easy for patients to access

Lali Sekhon, MDLali Sekhon, MD

I use doxy.me  It’s ok. It’s relatively cheap and easy for patients to use without signing up. I love screen sharing. We use cable fiber internet in the office and it is super-fast but we are limited by the patient’s internet speed.

Ultimately telehealth is limited by lack of a physical examination. I need to lay hands on patients to rule out hip and shoulder pathology, assess strength, reflexes etc. 

 

Don Corenman, MD, DC

My practice has changed in complexion since the onset of Covid19. Previously, about half of my patients would come from out of state but since the onset of the pandemic, that ratio has changed due to the undesirability of airplane travel. Currently, 90% are from a drivable distance (from one to two states away) for a personal visit.

Telemedicine has become a much larger part of my practice due to both convenience (due to distance) and safety (lack of personal exposure). I must say that I find this to be somewhat personally dissatisfying as I pride myself on meeting the patient personally and educating them on their disorder. 

Donald Corenman, MD, DCDonald Corenman, MD, DC

Since I am in the category for higher risk, I screen all my in-person patients for Covid19 with a requirement for a negative test within 5 days to have them qualify. If they cannot obtain a test, I use my physician’s assistants to a greater extent now as the PAs are not in the high-risk category and are certainly well-qualified to perform a thorough physical examination.

Interestingly, now about half my patients prefer the phone or telemedicine in lieu of a personal visit and even without a physical examination, we formulate the correct diagnosis about 95% of the time, based upon our diagnostic injection results. Of course, any surgical candidates are seen in person.

 

Reginald Q. Knight, MD

We have embraced the telemedicine platform with mixed success. In rural healthcare patients can travel long distances to receive care. Telemedicine communication with established patient can provide added convenience when reviewing recent test – MRI, CT scan, where additional physical examination is not a priority. 

Reginald Q. Knight, MDReginald Q. Knight, MD

Our challenges have been primary patient comfort with digital technology, availability of Wi-Fi capability in rural communities, and technology allowing real-time sharing of screens with high resolution digital information. The most challenge aspect of our use in rural communities is the lack of hard wiring or fiber optic Wi-Fi.

On the basis of overall patient satisfaction, our use of telemedicine is here to stay.

 

Have a question for the SpineUniverse Editorial Board? Tweet us @SpineUniverse and your question may be featured in an upcoming Peer Review!

Updated on: 07/29/20
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