“The role of telehealth in rheumatology will continue to grow whether we like it or not. Patient expectations to utilize telehealth services will linger, so I think it’s important that we plan now, as part of a good business strategy to manage what our telehealthcare will look like post-pandemic,” Dr. Phillips concluded.
Rural Rheumatology
Telehealth may be a viable way to provide rheumatology care to patients who live in rural areas that not only lack a rheumatologist, but many other physicians, said Christine Peoples, MD, clinical assistant professor of medicine and director of the telerheumatology program at the University of Pittsburgh Medical Center (UPMC), which currently cares for patients in three rural Pennsylvania communities: Everett, Seneca and Hermitage. Patients visit a small teleconsult center in their community, where a registered nurse (RN) works with the rheumatologist in Pittsburgh to perform the physical examination over a secure video connection.
“In rural areas, primary care is also changing. There is a workforce shortage and primary-care providers are retiring. There’s a lack of recruitment to these areas, and clinics, community health centers and hospitals are closing,” Dr. Peoples said. In January 2016, UPMC’s rheumatology teleconsult centers began conducting and billing for remote visits, and the program now performs more of these appointments than any other internal medicine specialty in the network.
The scheduling and check-in processes are exactly the same as in-person visits, said Dr. Peoples. Each teleconsult center is staffed and includes a telepresenting RN whom she has trained. At check-in, all rheumatoid arthritis patients fill out a RAPID3 questionnaire, which the nurse scans and sends to her in Pittsburgh. If needed, UPMC orthopedists based at the regional hospitals can perform arthrocentesis injections. “The elephant in the room is the physical exam. We can do a lot by visual inspection, and seeing the patient on different types of cameras, or with different lighting and patient positioning.” The nurse places patients’ hands against different backgrounds to make them easier to see.
UPMC now offers a telehealth elective to its rheumatology fellows, where they train to care for patients in different locations using traditional secure video, telephone and home video over a four-week rotation.
“They can see both new and follow-up patients and have their precepting with me. Thus far, we have had one fellow rotate through, and both the patients and our fellow really enjoyed the experience,” Dr. Peoples said.
Pandemic Paradigm Shift
Demand for telerheumatology services at UPMC has grown steadily since its launch, but the pandemic changed many aspects of the program.
