The doctor will see you now...how to prepare for your next telemedicine visit.

The coronavirus pandemic quickly changed our day to day lives and has given rise to an increase in doctor appointments being administered through telecommunication. This is particularly true for individuals who are managing a chronic illness since skipping a doctor's appointment or delaying a visit to the lab for bloodwork may not be an option for them.

Telemedicine platforms are a vital tool for many specialties including family medicine, gastroenterology, dermatology, neurology, and psychiatry is not only essential to deliver healthcare to patients but also to keep less critical patients out of urgent care centers and emergency rooms that are already struggling to care for COVID-19 patients with limited resources.

The US Department of Health and Human Services (HHS) defines telehealth as "the use of electronic information and telecommunication technologies to promote and support long-distance clinical healthcare..." This encompasses all modalities from videoconferencing, audio-only telephone calls, emails, text messaging, smartphone healthcare apps, and wearable sensors to transmit information.

New legislation has allowed HHS to relax telemedicine rules and improve physician accessibility. Medicare will now pay for 80% of services given via telehealth, including audio-only phone visits. Insurance billing guidelines and codes have been modified to allow healthcare providers to be compensated for these visits to some degree. Some plans are even waiving copays. These options are not just limited to physicians. Your physical therapist (PT)/occupational therapist (OT)/speech therapist (ST), psychologist (PsyD), therapist (LCSW), etc can also conduct telehealth visits with you. Contact your insurance directly ahead of time to ensure your visit is covered.

While technology savvy is embedded in the DNA of younger population, it is not quite as natural for many older folks to navigate these unchartered waters, particularly our elderly population who may have multiple conditions and need to see a doctor every few weeks to follow up on a diagnosis, get bloodwork done, or refill medications.

Follow these simple guidelines to best prepare for your upcoming telemedicine appointment:⠀

1. Get dressed and prepare as you would for an in-person visit. Block off the time on your schedule so you do not inadvertently have a conflict on your calendar such as a work call or are running an essential errand. Close the drapes or shades behind you to avoid backlight or sit in front of a light so your doctor can see you well.

2. Have your insurance information and any logistical information readily available. The nurse or office manager may call you ahead of time to update your records for insurance billing purposes. Your pharmacy, insurance or contact information (particularly work phone or email) may need to be changed.

3. Technology check. Charge your mobile device before the appointment starts or try to keep it plugged in. Make sure you set up in a location with a good internet connection. Download the technology/application your physician is using for the call ahead of time (Zoom, Skype, etc.). You may receive a call from the doctor's office ahead of time to help you get it set up.

4. Review your medication supply. Check to see if you have enough pills at home or if you need refills. It is a good idea to have a 30-60 day supply at home during the quarantine.

5. Have your medication list (including supplements) with you and have a list of questions you would like to ask. If you are keeping a symptom diary, have that next to you in case your doctor asks about it.

6. Have something to write on. You may wish to take notes during your appointment or need to document a measurement for your doctor. Have any items your healthcare provider may have asked you to bring to your appointment (for instance, a thermometer or blood pressure cuff).

7. Make sure you have plenty of space to move. Try to position yourself in or near a space where you can perform physical movements that can help your doctor evaluate the problem. Learn how to move your camera to make sure your entire face can be seen when you are on the call. For instance, a doctor or physical therapist may ask you to walk down your hallway to evaluate gait or ask you to straighten and bend your legs to check range of motion. It may be helpful to have a family member ready to help during the appointment, particularly if you have balance issues or need to move the camera.

8. Prepare to either leave your house to go to a laboratory for bloodwork if needed or the pharmacy to pick up any medications your doctor may prescribe. Bring your mask and gloves as a precaution if you have them and use them if you need to go into a building.

The pros of telehealth are abundant: no commute or parking issues at your doctor's office, appointments are less likely to run behind, and it is the safest option during a pandemic where social distancing is paramount. Many doctors who see elderly patients reflect that in some instances, seeing their patients, particularly their older ones, in their home environment is useful to determine their limitations or identify obstacles that may put them at higher risk for falls. Doctors also need to stay active and engaged with their patients and in some cases, need to keep their practices in business through telemedicine. This is the harsh reality of the pandemic for some.

If you have the opportunity to have a telehealth visit with your doctor, embrace it. As with any new technology, it gets easier with time and practice. Be well.