Telehealth Primer For Cardiology Fellows

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This is the first installment of a two-part series about telehealth and addresses fundamentals. Part two will address best practices when providing telehealth services.

What is telehealth?

The terms "telemedicine" and "telehealth" are often used interchangeably, and broadly refer to the entire spectrum of activities used to promote long distance clinical care. Many examples of telehealth are already familiar to cardiologists and Fellows in Training (FITs).

Remote monitoring has long been a staple in cardiology with implantable devices to record heart rhythm and pulmonary artery pressure, and its role is expanding with the increasing utilization of smartwatches and other devices. However, few are aware that cardiologists in Seattle can round in a CCU in rural Montana with the help of local nurses and advanced practice providers, as well as remote access to medical records, monitoring equipment, digital cameras and stethoscopes for in-person evaluation.

The goals of telehealth programs include providing patients and their caregivers with improved access to general and specialist care in their home, local clinic or hospital; high-quality care at the right place and right time; a better, more convenient experience for patients and clinicians; and appropriately matching supply and demand for finite clinical services.

Telehealth platforms typically fall into two main categories: direct-to-patient and provider-to-provider platforms.

  • Direct-to-patient or direct-to-consumer platforms include synchronous ("real-time") video visits equivalent to an in-clinic face-to-face visit, remote patient monitoring, patient-initiated second opinion review and secure electronic messaging.
  • Provider-to-provider or provider-to-facility platforms include remote covering clinicians using video, EHR and monitor data to provide ICU or inpatient care at a distance, clinician-initiated video clinic visits with a distant specialist, and asynchronous ("store and forward") transmission of health records to specialists for consultation

Why should FITs care?

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Telehealth has arrived, and cardiology has always been at its vanguard. None of us should be caught unaware or we risk being left behind, as telehealth continues to transform health care. Active users of telehealth already include many academic institutions, private health systems and the VA health system.

In 2018 alone, the VA health system served more than 700,000 veterans with more than 2.2 million telehealth visits. Carolyn Clancy, executive in charge of the VA Health Care, noted that "by 2020, all VA clinicians will be required by their job descriptions to be available to provide telehealth services."

According to Kaiser Permanente CEO Bernard Tyson, of the 100 million patient encounters with Kaiser physicians in 2017, 52 percent were via a virtual visit. While reimbursement is commonly cited as a barrier to implementation, more than 30 states have mandated that there be equal reimbursement for services provided in-person or remotely via telehealth.

Where are the telehealth opportunities?

Fellows already can get involved in telehealth moonlighting opportunities through telehealth and staffing companies. I have practiced telehealth for more than three years as a hospitalist, rounding on patients in rural Texas from my living room in North Carolina. Once I am a board-eligible/board-certified cardiologist, I plan to provide additional tele-cardiology services.

When deciding on the opportunity, consider whether you want to practice inpatient or outpatient. Telehealth is here to stay, and its role in health care is increasing. As future cardiologists, we owe it to ourselves and our patients to become proficient in this new mode of health care delivery.

Stay tuned for part two: Best Practices for Providing Telehealth Services.

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This article was authored by Jedrek Wosik, MD (@jedrekwosik), cardiology and clinical informatics Fellow in Training (FIT) at Duke University and the Duke Clinical Research Institute in Durham, NC.