Imagine that a family member is in hospice care and cannot make it into the doctor’s office for a much-needed visit. However, because of telemedicine, she can virtually “see” her doctor to go over medications and questions in the comfort of her own home. Telemedicine has changed the way health care is delivered to patients and has been especially helpful in ensuring physician and patient safety during COVID-19.

In this Q&A with Vidya Szymkowiak, MD, we discuss the importance of telemedicine, how it has changed during COVID-19, and how it is used in less-traditional cases.

Q: Can you share an experience using a video visit with a long-term patient at the end of their life?

A: One of my first telemedicine visits was with one of my first patients, whom I had been following for the last 17 years. She was 86 and had spent a fair amount of time in the hospital or at a nursing facility for the six months prior. During her final hospitalization in early March, she and I discussed changing our approach to her care and considering hospice as an option. We used telemedicine for the discussion because she was weak and was unable to see me in person, especially during the pandemic. I arranged a video visit between us, her family, and a hospice nurse. I was able to see her and she was able to see me. We’d been working together for 17 years, so to say our goodbyes was important. She knew that I was still involved in her life and was able to look me in the eyes to get closure.

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Approaching hospice can be confusing and difficult. For example, I was able to go through all of her medications with her and her family and assess her needs. This conversation would never have happened without telemedicine. There is no way I could have had an office visit with an elderly, fragile hospice patient, multiple family members, and her hospice nurse without telemedicine. It has been a game-changer to realize that it enabled me to provide better care with the ability to have her hospice nurse and her family on hand. They helped gather some of that data that we then could use to make medical decisions.

Q: Before COVID-19, what was your initial view on telemedicine? How has COVID-19 changed your view on telemedicine?

A: Because of COVID-19, our worldview on how we deliver and practice care has completely changed. Before the pandemic, I was used to patients coming in, sitting in my waiting and exam rooms, and talking to them directly. COVID-19 forced us to change the way we delivered care so that nobody was put at risk. I started doing telemedicine visits but, for as enthusiastic as I am about it now, I was not one of the first people to champion it. It quickly became apparent to me that telemedicine would be a valuable tool to reach and maintain contact with patients, and to provide care that we would not have been able to provide before.

Q: How do your colleagues feel about telemedicine? Do you think that it is a universal view?

A: A cornerstone of delivering medical care used to be laying eyes and laying hands on an individual. But with how the world works now, patients don’t necessarily have time or the ability to come into the office. I think a lot of my colleagues, physicians, and other providers would not have been as enthusiastic about telemedicine had we not been forced to use it. Now, I think it’s been an absolute blessing for us and a lot of patients.

Q: How did your patients initially feel about using telemedicine? How do they feel about telemedicine now?

A: The biggest barrier was really the technology, and a lot of patients needed some hand- holding at the beginning in terms of how to download the app and set up their MyUPMC accounts. Our office staff took the lead — so once we were able to get people enrolled and the initial setup done, patients really liked it. They know it can save them so much time, and I’m still able to provide them with the care they need.

Q: How do you think telemedicine has changed, and how have your patients benefited from it during COVID-19?

A: Telemedicine has been around for a while, but the uptake has been very slow among physicians and patients. Because of COVID-19, we have had to adapt. Having video and being able to look a patient in the eye, you get a pretty good assessment of somebody who is upset, in distress, or short of breath. It has been gratifying to see how much information patients can provide to me in terms of medical decision-making without physically coming in.

Q: What are some roadblocks or gaps in telemedicine that you are experiencing or noticing? How do you think broadband impacts the delivery of care for your patients?

A: Internet access is an issue. My staff and I can help patients get comfortable with the technology they already have at home, but we cannot provide them with broadband access or give them a device to use. Especially for elderly patients, I think having a simple, easy to use, internet-enabled device that they don’t need a whole lot of instruction on is going to be helpful. In a substantial portion of clinical encounters, I think telemedicine is a medically appropriate replacement for the traditional face-to- face health care delivery model, especially with elderly patients and transportation issues. They don’t need to walk across parking lots or try to get up on an exam table. Being able to consistently and predictably provide care is important. I think people are more willing to take 10 to 15 minutes to follow up with you, versus the multiple hours it would take to physically come into the office and conduct care that way.

Q: What changes or improvements in telemedicine would you like to see?

A: There were technology glitches here and there at first, so I think making sure telemedicine works on multiple platforms is important. The other thing we have started to do is have patients who don’t have access to technology come to the office so they can “see” a specialist located in Pittsburgh. For example, they can come to my office and we can set up a telemedicine appointment for them with a provider that is remote. We are using technology in our office to give patients access to tertiary care or specialty care in other areas of the city or even the world.

Q: What do you think the future of telemedicine looks like?

A: I believe telemedicine is here to stay. Physicians and providers have found that it’s a very reasonable and appropriate way to provide care, and patients are going to demand it.

Q: How do you think UPMC has been adapting to telemedicine over the years, especially during COVID-19?

A: UPMC has been at the forefront of using technology to assist in providing medical care. I think telemedicine is something we need to continue providing in the future because it’s a vital tool, and I hope that government agencies will continue to include it as part of their covered services.

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