The 2019 coronavirus disease (COVID-19) pandemic quickly ushered in the era of telehealth, a modality that had previously had limited use for epilepsy visits. At the American Epilepsy Society’s AES2020 virtual conference, Dr. med. Marvin A. Rossi Tips for Optimizing Telemedicine for Patients with Epilepsy (Table).
“The good news is that almost everyone has access to at least one mobile phone or landline network and therefore qualifies for a degree of telehealth defined by CMS [Centers for Medicare & Medicaid Services]”Said Dr. Rossi to the participants of AES2020.1,2
While HIPPA-compliant audio-video hardware is preferred for telehealth, “it is not strictly necessary if the video link is being used in good faith and nothing better is available to connect the patient to the provider,” said Dr. Rossi Associate Professor in the Department of Neurological Sciences at Rush University Medical Center, Chicago, IL. “This means alternative communication software apps [eg, FaceTime, Skype, Messenger] can be used. ”2
If the video or audio quality is degraded or the call is completely interrupted, a mix of a video connection with a phone call can be used for more stable audio, or switching to a phone-only call is allowed and may be billed as a video visit.
“This fluidity gives providers the flexibility to provide the required services outside of the office hours,” said Dr. Rossi.
The fluidity also benefits rural hospitals and rural dwellers, who are among the most vulnerable populations during the economic downturn and COVID-19 pandemic. “Although smartphones, tablets and laptops are the order of the day, many rural residents still do not have access to such devices, do not know how to use these technologies, or do not have sufficient bandwidth due to the strain on our digital communication infrastructure from this pandemic”, Noted Dr. Rossi.
Dr. Rossi on the practical implementation of telehealth are summarized in the table. Whether telemedicine is provided through video visits or phone calls, preparation for the live encounter is vital. However, this preparation time is one of the greatest obstacles to be overcome.
Table. Tips for Using Telemedicine During Epilepsy Visits 1
| step | Exercise tip |
| Prepare for the visit | – Send patient instructions ≥ 1 day before the visit – Ask the patient to turn the backlight down, minimize background noise, charge the device battery, and rate the bandwidth (if possible). – Employees should test connectivity and be available for troubleshooting – Get patient consent and past medical, surgical, and social history – Balance medication – Document review of systems – Automate a signal to the provider when the patient is in the virtual waiting room |
| Visiting note and exam | – Include a statement stating that the service was provided via telemedicine and document the patient’s consent. Include the patient’s location – Maintain the structure of the personal clinical note template – Complete the physical exam early in case the video feed is lost – Vitals can be recorded with the patient’s home equipment or with a smartwatch and scale – Do a neurological exam at a specific medical level – Document all exam components that were not completed due to telehealth restrictions When making phone calls, document the following: |
| Cognitive and mood measures | – Brief standardized cognitive measures can be carried out by the patient immediately before the visit – Sentiment polls can be captured and forwarded on the patient’s smartphone or device and uploaded to the EMR – If mixed reality or virtual reality tools for cognitive testing are available, scores can be forwarded and uploaded to the EMR |
| Remote neurostimulator device programming | – VNS and RNS devices can be queried and programmed remotely, with a non-provider placing the query stick |
| CMS billing | Visit the AED Telehealth Quick Start Guide |
| End the encounter | – Document the most important points observed or requested by the attending physician – Document care plan that requires medical decision-making – Document the total time you have spent with the patient |
“The COVID-19 pandemic has not only brought epilepsy-related health challenges that have not occurred in more than a century, but has also accelerated digital transformation,” concluded Dr. Rossi. “This crisis has highlighted the importance of equality of access and the digital divide that needs to be bridged. The good news is that all the patient needs is a standard phone to access specific healthcare resources. ”
Dr. Rossi announced the following relationships: Community Development Block Grant, Foglia Family Foundation, Adelaide Cervantes Epilepsy Fund, and UCB Pharma.
References
1. Rossi MA. Tips and tricks for telemedicine visits for epilepsy. Presented at: AES2020; December 4 to 8, 2020.
2. Centers for Medicare and Medicaid. Medicare Telemedicine Healthcare Provider Fact Sheet. March 17, 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
This article originally appeared on Clinical Advisor
