Telemedicine, or telehealth, is the use of two-way communication technology to provide health care services. While its use has been limited in the past, the U.S. Department of Health and Human Services (HHS) began encouraging providers to offer telehealth services more widely in March as a safer way to deliver health care during the COVID-19 pandemic. While telemedicine cannot be used for every aspect of rheumatoid arthritis care, it can be an effective, convenient, and valuable way to access your health care provider.
The treatment of rheumatoid arthritis — a chronic inflammatory disease — requires frequent visits to a rheumatologist. Routine checkups are important in preventing disease progression and complications. For that reason, telemedicine has become a key part of RA care during the COVID-19 pandemic.
Virtual RA appointments are most beneficial for certain aspects of rheumatoid arthritis care.
Of the myRAteam members who’ve had telemedicine visits, most report positive experiences. Some say their doctors spend more time with them and actively engage in their care. Others are grateful for the ability to visit with a rheumatologist from the comfort and safety of their own homes.
“I had my first virtual visit last month. It went very well. I was able to discuss my concerns and could see and converse with my doctor,” shared one member. Another appreciated not leaving home: “I didn’t have to drive to my doctor or get dressed in any particular way.”
Getting medication refills via telemedicine is another big plus. “My doctor’s office is great and will refill my meds with no visit of any kind, as long as the risk of an in-person appointment is high for me,” explained one myRAteam member.
Virtual visits also reduce fear and worry for some myRAteam members. “My stress level went down 100 percent knowing I can stay in where it's safe!” posted one member.
But telemedicine is a big change, and not right for every situation. As one member explained, “I’ve had several appointments now online. Some worked well, others haven't.”
Although doctors can’t perform a hands-on examination, they can assess your condition using several virtual techniques. These include:
They may also assess disease activity by having you fill out a questionnaire called RAPID3 prior to the exam. This, among other measurement tools, helps doctors assess inflammation and disease progression without taking bloodwork.
How frequently you’ll need to be seen virtually depends on disease severity and whether additional tests or treatments are required. Some people may need to physically visit a laboratory or hospital for blood work and imaging studies, prior to a telemedicine appointment. Others may be asked to come to an in-person appointment after a virtual assessment of their condition.
Aside from hands-on physical exams, rheumatologists can’t give injections or infusions via online visits. Guidelines from the American College of Rheumatology, revised in May, note that the risk versus benefit of infusions is unique to each person. Talk to your doctor about the best options for you.
“My doctor doesn't recommend that people on biologics and infusions make office visits. So, I'll be doing a virtual visit,” said one member of myRAteam.
While remote visits are safe and effective, there are some limitations. With a little preparation, you can ensure your telemedicine appointment is effective and useful. Here are some tips to help make your telehealth meeting successful:
If you live with extended family or roommates, it may be difficult to find a private or quiet space in your home. Consider conducting the appointment in a parked car or garage, if you have access to one. Before the meeting, check to make sure you have a stable internet connection in this location.
A health care appointment can only be effective when you are honest and open about the symptoms and side effects you are experiencing. This is just as important during a telemedicine appointment as an in-office visit.
Being open with your health care provider is the only way to get the care you need to stay your healthiest and feel your best. Many people are uncomfortable talking about their health problems, even with doctors. They may feel embarrassed or as though they are complaining or being bothersome. Since telemedicine is providing a new way to connect with health care providers, it can be an opportunity to change this habit and begin sharing full details about your condition with those whose job it is to take care of your health.
Here's a checklist of questions about pain symptoms a doctor may ask you during your telemedicine visit.
Some people may have concerns about using telemedicine for the first time, especially if they’re generally uncomfortable using technology.
Keep in mind that technical difficulties are normal, even for those who are experts. Be patient and do not panic if the video freezes or the sound cuts out for a moment. You may need to repeat yourself or ask your health care providers to repeat themselves at times. If technical issues arise, your health care provider will work with you to resolve them.
If you’ll be using a video meeting platform (such as Zoom, Skype, FaceTime, or Google Hangouts) with which you are not familiar, consider practicing with a friend or family member in advance of the appointment. This will help you build familiarity and confidence with the technology.
The doctor’s office will generally email you a link to register for the virtual visit or an app you can download. The app will connect you to a patient portal where you will be able to speak “face-to-face” with your doctor at your appointment time.
Before your meeting, look up your doctor’s phone number. Keep it handy in case audio, video, or internet connection fails on either side. Confirm with the doctor’s office that this is the correct number to call back in case of technical difficulties. If they need to see you in person to examine swollen joints or range of motion, ask about rescheduling the appointment.
Prior to the COVID-19 public health emergency, the Health Insurance Portability and Accountability Act (HIPAA) tightly controlled the ways technology could be used to share health information. On March 17, 2020, the HHS waived penalties for potential HIPAA violations against health care providers using “everyday communications technologies” as long as they are serving people “in good faith” during the COVID-19 emergency.
The privacy and security of your health information depends largely on which technology platform you’re using for telemedicine. Direct phone calls and texted photos are easier to secure than other forms of technology. If you have been using your health care organization’s portal to share information with your doctor, this platform is just as secure as ever. If you have concerns about sharing particularly sensitive information with your doctor over a video communication platform, consider asking whether you could have a traditional phone call instead, or follow up a video appointment with a phone call to share any especially private information.
In some cases, copays or other costs associated with telehealth appointments are the same as those for in-person visits. Some commercial health insurance companies are waiving copays for telehealth appointments. America’s Health Insurance Plans (AHIP), an organization representing insurance providers that cover hundreds of millions of Americans, has provided an alphabetized list of its members that have taken actions to address COVID-19 safety. The list includes several providers that are waiving telehealth copays or expanding access to telehealth. Call your health insurance supplier to find out how they are covering telemedicine appointments.
During the public health crisis, the federal government has temporarily lifted restrictions to allow people using Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to more easily access expanded telemedicine services. Similarly, federally qualified health centers and rural health clinics have been cleared to provide telehealth.
For those on Medicare, in most cases telemedicine will cost the same amount as if they received the services in person. Note that the Medicare Part B deductible applies.
Telemedicine is proving indispensable as a way to access health care while avoiding the risk of infection during the coronavirus pandemic. As people with RA and their health care providers become familiar and comfortable with telehealth technology, it may prove useful in the future, even after the pandemic has come to an end.
“I’ve had good experiences with the virtual visits. I think this will be the future for our doctor visits,” shared a member of myRAteam.
Hopefully, expanded access to telehealth will become a trend that improves health care for people living with RA.
Have you used telemedicine appointments to access health care for RA or other inflammatory arthritic conditions? Share your experiences in the comments below or post on myRAteam.