Atlanta Telemedicine in the COVID-19 Era

Deborah Millians of Athens was feeling the pinch of social distancing. With her 11-year-old son Charles in need of a follow-up urology appointment regarding complications from an overactive bladder, an in-office visit proved daunting. It would call for an hour-plus trek to Atlanta and pulling her child away from school work, among other logistical challenges.

Using the family computer, she and her son engaged in a first-time telemedicine visit with Dr. Edwin Smith of Georgia Urology. The result, she says, not only proved safe and convenient during the current COVID-19 epidemic, but surprisingly effective.

“The doctor communicated directly to Charles over the computer, telling him things he’s responsible for,” she recalls. “The instructions seemed to get through to him better that way, instead of just hearing them from me. And he’s doing his part.”

Many Atlanta area healthcare practices are continuing to do their part thanks to telemedicine. While COVID-19 is at the forefront, other healthcare needs don’t simply go away. According to some medical professionals, depending on a patient’s need, telemedicine offers a practical solution and reliable alternative.

“With the arrival of the pandemic, many of us were thinking what in the world are we going to do?,” says Dr. Smith. “And then you get to work figuring out what the alternative course will be. Telemedicine was the obvious answer. We, like so many other physician practices, have really embraced it and tried to continue to deliver care just through a different platform.”

As Atlanta’s largest urology group with 50 doctors and 30 locations, Georgia Urology sees patients for a wide range of conditions, including prostate disease, kidney stones, overactive bladder disorder, sexual dysfunction, and more. The practice has made it possible for most visits to be virtual at this time. However, Georgia Urology will still have a doctor in the office to see urgent or emergency problems for both adults and pediatrics.

Although Georgia Urology has been using telemedicine on a limited basis for the past year, other practices, such as those in the pain management space, weren’t legally allowed to do so in Georgia.

That all changed last month once the coronavirus pandemic was declared a national emergency. In the case of a public health emergency, Section 1135 of the Social Security Act allows specific regulations to be waived. When this took place, it included the removal of certain restrictions regarding telemedicine.

“So part of the 1135 waiver, which came down from the Centers for Medicare & Medicaid Services, is the federal government saying we should and can now be doing telemedicine, and actually be reimbursed at the same rate as an in-clinic visit,” explains Dr. Jordan Tate of Alliance Spine & Pain Centers.

The change found many local practices scrambling to add or enhance their telemedicine efforts. “So there’s been a steep learning curve to figure out how to roll out telemedicine in our practice,” says Dr. Tate, “what platform to use, and what’s going to make the most sense for our staff and patients. Trying to get that going has required members of our staff and administration to work overtime.”

Like many practices, the staff of Atlanta Allergy & Asthma are able to utilize the telemedicine module already built in their electronic medical record system. “It’s a secure module, so we didn’t have to go out and purchase any new hardware or software,” says Dr. Howard Silk of Atlanta Allergy & Asthma. “We did have to make a lot of technical changes, but we had it rolled out in less than a week from the time we started the process.”

Alliance Spine & Pain Centers also uses telemedicine through its electronic medical record system. Once the patient is on the appointment schedule, a nurse or medical assistant contacts the patient, gets pre-exam information, and makes sure the patient is set up to engage in a telemedicine conference with the provider. With the help of the Healow app, the patient and physician can have a two-way video session on a computer, smartphone or tablet.

If the patient doesn’t have the Healow app, they can still participate with web access. Once they receive the email reminder for the televisit on their smartphone, they can click on a link to join the appointment directly from their device. The virtual visit will then be launched from the phone’s browser.

Telemedicine, however, brings its own brand of challenges. For Dr. Smith, going into a virtual exam room is a little bit different than the norm.

“I’ve found the preparation has to be that much more detailed,” Dr. Smith explains. “You’re not shuffling through papers. You’re looking at X-rays through the Internet and using dual monitors. You’re making sure you do everything you can for a virtual visit to capture the essence of a real visit.”

The patient side can come with its own brand of hurdles. Technologically-challenged individuals often stumble when using computers or smartphones. Some patients have laptops, but don’t have webcams. Others own flip phones instead of smartphones. Some only have landlines. For the latter, phone call appointments are sometimes permitted, but not prefered.

“We’ve spent time educating patients on how to participate in a virtual visit,” says Dr. Nok Keomahathai of Alliance Spine & Pain Centers. “It was a challenge for several days, but now we have a system, and I think it’s going very well.”

In general, telemedicine in the COVID-19 era has been receiving kudos from physicians and patients alike. “Several of our doctors are now doing almost entirely telemedicine,” Dr. Silk says. “What’s interesting to me is the patients are actually very appreciative, especially since people these days are wary of leaving home and potential exposure in healthcare facilities. The patients I’ve seen are thrilled that we’re offering this as an option.”

According to Dr. Smith, it’s becoming clear some patients can have a more complete visit with telemedicine. However, other visits may not be quite as comprehensive as a physician would prefer.

“Even if it’s not an absolute complete visit, you are able to give advice, make plans for the future, and continue moving a patient’s care forward,” Dr. Smith says. “And I think that adds value as well.”

Many physicians agree the increase of telemedicine during the COVID-19 crisis will likely lead to more frequent use in the post pandemic era. Previous concerns regarding telemedicine and some of the more strict regulations may fall by the wayside.

In the meantime, patients such as Deborah Millians’ son Charles will continue making use of the service whenever possible. “It felt personal and interactive,” Millians says. “Georgia Urology’s treatment has been great, and its telemedicine falls in line with everything I’ve come to expect in the practice.”