Please consider Zoom for Healthcare if you haven’t already landed on a telehealth platform. It is device and operating system agnostic, and many patients are already using it for other reasons (e.g., distance learning for their children). Solo practitioners and small groups are able to purchase licenses on a onesie-twosie basis though resellers like LuxSci, which brings the cost down.
Many thanks to Julie Rohovit, Ph.D., Joe Curtis and the whole gang at the Center for Practice Transformation for spinning up this webinar on very short notice. ✸
I’ve been doing telehealth for a few years. Now everyone wants in due to the coronavirus pandemic. My partner, John Sutherland, Ph.D., and I have been furiously spinning up mental health and addiction clinicians at Allina Health. We transitioned at least 75 providers this week and more will soon follow.
This post will provide some practical advice for those new to telehealth. It comes straight from the trainings that John and I have delivered in recent days.
Keep it Simple I use a number of telehealth platforms including Vidyo, Epic Warp Drive and Zoom for Healthcare. I recommend Zoom for Healthcare if you need to get up fast and don’t have an IT department supporting you. It’s literally purchase and practice. Patients just need the Zoom app, which is device and operating system agnostic (and free!). Make sure you get a Business Associate Agreement to achieve HIPAA compliance (although a safe harbor [waiver] exists during the current public health emergency).
Be Professional I remind providers that they are health professionals, not creepy basement YouTubers. The following are small touches that make a big difference
Minimize environmental distractions. Under the current circumstances, that might include your kids and dog
Look into your camera often. That’s where your patient is, not elsewhere on your screen (even if that’s where they appear to be)
Documentation Payment for telehealth requires that certain elements appear in your visit documentation. The following is the header of my charting templates, where *** are elements that are populated for each encounter
Date of Service: ***
Start Time: ***
End Time: ***
Type of Service: Evaluation and management (E/M)
Type of Encounter: Telehealth [or: Virtual health]
Mode of Transmission: Secure, synchronous, real-time audio and video communication via Vidyo
Originating Site: *** [patient location — city and state]
Distant Site: Minneapolis, Minn.
Basis for Service: Virtual health, in my judgment, is an appropriate and effective means for providing this service secondary to the current COVID-19 pandemic and the need for social distancing. I have previously seen the patient for traditional in-office care and consider their mental status, including the absence of imminent danger, amenable to virtual care
A virtual visit is an online appointment that supports social distancing, that is, unnecessary, in-person contact with others. These visits occur via Zoom for Healthcare, a secure, HIPAA-compliant platform.
Please consider converting your existing in-office appointments to virtual visits. ✸
But nicotine never really went away. If anything, it metastasized into more insidious social problems.
Teens have been trading traditional combustible cigarettes for “vaping.” Use of cigarettes and smokeless tobacco declined between 2011 and 2015. This was basically offset by a sharp increase in the use of e-cigarettes (1.5% to 16%) and hookahs (4.1% to 7.2%). The net net was no change in overall tobacco use (24.2% vs. 25.3%).
With this context in mind, I was in studio yesterday to shoot the third installment of Hazelden’s What You Need to Know series. Opioids and Meth packages are already available for purchase. Nicotine & Vaping, Alcohol and Cannabis packages can be preordered.
Methadone, the first evidence-based treatment for opioid addiction, appeared way back in 1965. In the years that followed, “methadone clinics” popped up in large cities that could financially support them. But most patients—especially those in greater Minnesota—were unable to access this potentially life-saving care.
The U.S. Food & Drug Administration attempted to remedy this health disparity by approving Suboxone in October 2002. The hope was that family physicians, internists and psychiatrists would prescribe it in their clinics, thereby creating broad access to addiction care.
About a year ago, Allina Health decided to take a different tack. We came up with a simple access strategy:
Addiction medicine specialists treat patients for opioid addiction via telehealth
Specialists transfer care to local primary care providers once patients are stable
Primary care providers can always consult with addiction medicine specialists or return patients to us if there are struggles
The first provision addresses primary care providers’ concerns about treating active substance abusers. The second feature ensures that addiction medicine specialists always have capacity for new patients. The last design feature is how primary care interacts with every other medical specialty—cardiology, nephrology, endocrinology—when it comes to chronic disease management.
And it worked!
Our pilot program at New Ulm Medical Center, a critical access hospital, was a resounding success. We’re presently working to scale it to Allina’s entire service area. We’re also launching virtual visits next week, which will allow patients to be seen via their own smartphone or tablet.
Laura Moldan, Claire Olson, Jamie Penkert and Mindy Eichstadt; nursing staff at New Ulm Medical Center
The addiction medicine specialists are still located in a large city many hours from patients but distance is no longer a barrier to receiving care. ✸
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Postscript. I received a good question about the Ryan Haight Act. Our program is exempt from the in-person medical evaluation requirement as New Ulm Medical Center is a DEA-registered hospital. Please consult your compliance department or personal attorney about your particular clinical circumstances.
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Postscript. We launched virtual visits today (February 24th) as planned. The first patient lives near the Iowa border, two hours from both New Ulm Medical Center and the Twin Cities. The virtual visit saved him roughly four hours of driving for a 30 minute visit.
Peder Schweigert, the general manager of Marvel Bar, will also be in studio. He’s been a bartender for 15 years and about four years ago decided to stop drinking alcohol.
I’m occasionally asked if I have a personal history of addiction. I don’t but stopped drinking by my mid-30s before sober curious was a thing (I’m currently a week short of 50, so I’ve been “dry” for at least 15 years).
Some sober curious factoids appear below.
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“Would I be happier without booze? More productive? Would I feel more confident? What would it be like to never have to face another deadline half hungover? Would I be thinner if I didn’t drink? Look younger? Would I have less sex? More sex? Would the sex be better? Would I have anything to talk about at parties? Where would the glamour go? Would people think I was boring? Exactly how boring would I/life become? … I have termed this questioning as getting Sober Curious”