CJN.ORG | CLEVELAND JEWISH NEWS | 35
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Telehealth A Cleveland Jewish News Special Section
Patient engagement increases when using telehealth BECKY RASPE | SPECIAL SECTIONS STAFF REPORTER @BeckyRaspeCJN firstname.lastname@example.org |
ince the beginning of the COVID-19 pandemic, telehealth has been a safe and easy way to see a health provider when going in person isn’t an option. According to Jesse Ohayon, CEO of Doctegrity, which is fully operated online and based in Dallas, and Dr. Boris Royak, executive director of ARC Psychiatry in Beachwood, the availability of telehealth appointments has led to increased patient engagement. “We have noticed an increase in patient engagement, both from Ohayon established patients and new,” Royak noted. “With the ease of telehealth, patients have the convenience of receiving care while in the comfort and safety of their own homes. The ease of attending multiple appointments has reduced our number of cancellations. We have courtesy calls 10 minutes before a patient’s scheduled appointment to Royak assist using the telehealth service if they need it, and it also serves as a reminder for the appointment.” At ARC Psychiatry, Royak noted patients have been coming in a steady flow and they continue to accept new ones at all three of their offices in Beachwood, Westlake and Canton. “We have also added several providers to our practice to accommodate the increase and expand on our specialties and offered services,” he added. Ohayon said Doctegrity is a little different from the normal provider. As some providers help their doctors get their offices online, he explained Doctegrity is kind of like “Uber for doctors.” Patients can explain they’re feeling sick, list their symptoms and get connected to a doctor to write a prescription or discuss the next steps. Because of their model, Ohayon said engagement was already good, but the pandemic has increased patient requests. “For us, they don’t have to go anywhere at all, people can basically just use any smartphone, dial in and just call us,” he explained. “We can call them back and talk through their issues. At the end of the day, because we’re using board-certified physicians, they’re seeing the same quality of service that they would at an office or emergency room.” Ohayon said Doctegrity was originally used in emergencies – like it’s 2 a.m. and someone is sick and you can’t make it to the doctor’s office. Explaining it was more of a convenience factor and a way to save money since
the service is charged by a monthly fee, the pandemic has initiated a shift in the way patients use the service. “Since the pandemic, people have had a lot of concerns about going out and seeing a doctor in person,” he said. “People still get sick with things other than COVID-19, so the need is there. But, we do get COVID calls too – people having questions about the care and their general concerns of going to a medical facility of office during the pandemic as there is increased risk in contact.” Many providers are using increased engagement as an opportunity to interact with patients in new and unique ways, Royak said. “Our providers use a safe and secure telehealth platform to connect with our patients so we can continue offering exceptional care during the stay-at-home order,” he said. “We’re thankful this option was available and easy to adopt so that we never had to turn away patients seeking care.”
And the innovation of telehealth is also a positive to many providers. “Being innovative in health care during the pandemic is extremely important,” Royak stated. “The pandemic has affected everyone differently. Some patients may have adapted quickly to the technology overhaul that seemed to happen overnight. For others, the increased use of technology may have triggered various levels of anxiety. We feel it is important to be adaptive and think of creative ways to provide care for all patients.” Ohayon added, “When we have patient consultations over telemedicine, we really focus on our doctors having not a good bedside manner, but a good web-side manner. It’s a bit of a different experience of it – we’re not there to take your temperature or feel if your skin is cool or clammy. So, we ask a lot more questions than a normal visit and seeing how everything is going. This allows people to seek advice from their doctors, too.”
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AUGUST 28, 2020
Telehealth constantly changing, addressing issues BECKY RASPE | SPECIAL SECTIONS STAFF REPORTER @BeckyRaspeCJN email@example.com |
he success of telehealth during the COVID-19 pandemic brought with it new issues. According to Dr. Jennifer Hohman, executive vice president of NOMS Healthcare and family physician in Fremont; Laurie Mandel, founder, and family and psychiatric nurse practitioner at Concierge Treatment Centers of Ohio in Beachwood; and Jane Eigner Mintz, CEO, chief clinical strategist and senior supervising interventionist at Realife Intervention Solutions, LLC in Beachwood, the benefits don’t erase the disparities. “Since the pandemic’s inception, providers are
using telemedicine to maintain contact with patients,” Hohman said. “The disparity we have noticed is the lack of technology among some patients. This often stems from a lack of access due to income or the ability – especially in our seniors. We quickly recognized the importance of finding alternatives to face-to-face care that do not compromise the quality of care delivered.” While these issues affect a portion of the population, changes made in respect to the pandemic have helped bridge the care gap a little. “What has happened that was that the HIPPA requirements were waived, and now we can use different modalities,” Mandel said. “So before this, there was a lot of technology that wasn’t HIPPA compliant. Many of
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them now have more technology put in so you have to admit someone into the room and can’t randomly access conversations. That allowed us to use programs like Google Meet, Zoom, FaceTime and Duo, or free apps like Doxy.me.” One of the issues that could come out of using different programs for Hohman visits lies in skill, Mintz said. “There is a learning curve to get on Zoom or this and that, but most people are reasonably technologically proficient,” she stated. “When you send someone a link and all they have to do is click it, it’s pretty miraculous. The learning curve is not as steep as people think it is.” But addressing issues of access and ability comes down to a market Mintz question, Mintz said. “I work in a market that doesn’t really have a gap that needs to be bridged,” she said. “Clients have people in their camps that know how to use technology or they already know how to use it. If you work in a community of regular people that don’t have access to technology then I think it would be really different. There are issues of disparity and access there. We have to give everyone equal access to technology if we expect them to have equal access to these opportunities. As a person who cares about other people, it must be addressed as a whole.” Mandel noted another issue in access comes with age, and how older adults tend to shy away from technology. “For those who are not technologically competent or comfortable, it is just not going to work,” Mandel said. “My mother is 85 and she has taken the initiative to learn as much as she can, but a lot of people are not comfortable with that. It’s about making it as easy as possible for people and I supposed they’d have to be educated if they are unsure.” Mintz said, “When I look at populations of people who don’t have access to technology or technology has passed them by, the biggest mistake they make is letting technology pass them by. This is something that can be corrected if you’re interested, but the mindset is different. I think a lot of people are driven to not be left behind and that is my message to people – no matter your status, go and learn to use technology.” To bridge that gap, Hohman said her office has been scheduling in-person visits for those who can’t get on board with telehealth visits or don’t have access. Patients are checked in by telephone before coming in and patients stay in separate rooms during their visits while mask-wearing is required. But, the lessons being learned right now are clear – telehealth is here to stay. The lessons we are learning now will help continue to develop best practices, the providers said. “I’ve been following telemedicine for years and it took this to just basically explode it out of the water,” Mandel said. “Obviously, it is not for everything but if used properly and with the right technology in the right setting with the right patient, it has its place.” Hohman said, “Telehealth is here to stay – as it should be. Our younger generations are used to this type of technology and want to use it. Our providers need to adapt and embrace this technology.”
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Preparation key for children’s telehealth appointments BECKY RASPE | SPECIAL SECTIONS STAFF REPORTER @BeckyRaspeCJN firstname.lastname@example.org |
onths into the COVID-19 pandemic, telehealth appointments have become a common fixture in health care. As many adults have experience using Zoom and FaceTime for work and personal calls, the switch wasn’t too jarring. But for children, especially those that still struggle at the doctor’s office, the switch to virtual appointments can be difficult. Linda Lange, speech-language pathologist and assistant director of speech-language services at the Cleveland Hearing and Speech Center in Cleveland; Britt Nielsen, pediatric psychologist at MetroHealth and an associate professor of psychiatry at Case Western Reserve University in Cleveland; and Dr. Brian Zack, medical director for telehealth at University Hospitals in Cleveland and pediatrician at Pediatricenter in Bainbridge Township, suggested parents and health care providers work together to engage and prepare kids for their telehealth appointments. “One thing is to set up a designated environment at home, have a well-lit room and have the computer or device in a stationary spot,” Lange said. “With children over the age of 4, they can be at the table. With younger kids, we’re usually on the floor. But set up the environment at home and have a glass of water nearby if they get thirsty.” Nielsen said preparation depends on the child’s age, developmental level and attention span. For parents, it also depends on the type of appointment. “If it is a medical appointment, some kids will be more comfortable with the idea if it is a bit more conversational,” she explained. “But parents can set kids up for success by making sure they understand the purpose of the visit, as sometimes we don’t take video sessions as seriously as face-to-face ones. Let the child know what to expect, especially as younger kids and some adolescents have trouble verbalizing things. Have the child think about what they want to talk about so they can come up with some language ahead of time.” Allowing children to prepare for their appointment ahead of time allows them to control their level of stress, Zack said. Beyond that, it’s on the provider to also establish a rapport with the patient before talking about their health. “It’s not uncommon at all to have anxious patients,” he stated. “I have a routine where I help kids feel at ease by making a joke or two, asking questions that are easy for them to answer or ones that are not purely about medicine to get them engaged and feeling comfortable. Get them as engaged as possible instead of just having them sit next to their parent. I also try to allow the parent and child to control the narrative with open ended questions so they feel in control of the story.” Neilsen said, “Having those preparatory conversations helps the child know what to expect and guides their behavior a little bit. If they don’t know why they’re in front of the camera, they might just think it is another conversation and not know the and real purpose of it.” Knowing how your child prefers to approach an appointment is critical, Lange said. “Parents can even work in a reward, like a Popsicle or something, because that is what we do in the office as well,” she said. “Parents should also be present with their child if they’re under 10 years old. This shows children that the parents are engaged. If there is no way they will sit in front of a screen for 30 minutes, decide if we need the last five minutes to just be with the parents. Depending on the child, sometimes kids are read to go right at the beginning or they need to be warmed up to the idea.”
And if parents are struggling getting their child acclimated to virtual appointments, the providers had advice. “Just talk about it ahead of time and explain how this will work and do some practicing,” Zack said. “You also want to make sure you have a good connection. It’ll amplify a child’s unsteadiness if they think I can’t hear them or if they can’t hear me. It isn’t just to make sure the appointment doesn’t get interrupted.” Lange stated, “Think positively. It can work better than you expect. Let the provider know what your kid likes and enjoys, so we can screen share and mix those interests into the session. Communication with the provider with
what you think will really engage them is key. It makes the appointment go smoother.”
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