New frontier: Telemedicine is here to stay

If you need an indicator that health care at home is here to stay, look no further than Cole Nardi’s title: Director of Telemedicine at Rochester Regional Health.

Telemedicine – or telehealth – allows health care providers care for patients without an in-person office visit via technology tools like video visits.

The American Medical Association estimates that before the COVID-19 pandemic’s widespread arrival in March 2020. telehealth represented less than 1% of the total health care volume in the United States. In March 2022, 22% of Americans had utilized some type of telehealth services in the past four weeks, according to U.S. Census Bureau Household Pulse Survey data.

Telehealth boomed during the pandemic out of necessity, but today local health care providers and the technology experts who support them are seeing the service continue due to a myriad of factors including better comfort with the technology and increased benefits for patients, providers and support staff alike.

Rochester Regional Health: More patient-led technologies

At Rochester Regional Health, Nardi leads the team that makes the technology of telemedicine possible for its patients and providers, like on-demand video visits.

The large health system began piloting on-demand video visits before the pandemic to employees and their families, but in March 2020 quickly amped up and broadened its video visit reach. By the close of 2020 Rochester Regional Health had logged over 230,000 video visits between patients and providers, Nardi said.

This March Rochester Regional Health launched a new service called Express Care, which offers patient-initiated on-demand video visits for non-emergency issues. The service is available from 9 a.m. to 9 p.m. during the week and 9 a.m. to 5 p.m. on weekends. Anyone with the HIPPA-compliant app MyCare through Rochester Regional Health can utilize Express Care.

The way it works: You open your app, choose “On Demand Video Visit – RRH Express Care” from the menu and wait in the queue for an available local provider from Rochester Regional Health. You can choose between a general video visit or a TytoCare video visit.

TytoCare is a small, handheld digital device with attachments – like an otoscope – that lets health care providers guide patients through medical exams remotely. It can capture heart sounds, lung sounds, body temperature, heart rate and videos and images of the inner ears, skin and throat. These high-quality readings, sounds and images are immediately sent to the provider on the other end of the screen for evaluation.

Rochester Regional Health has begun giving TytoCare medical exam kits to select, qualifying patients from some of its pediatric, primary care and internal medicine practices, along with a quick start guide and materials to help them learn to use the device. The kits are also available for purchase on the Rochester Regional Health website and are Health Savings Account / Flexible Spending Account eligible.

“It’s a pretty intuitive tool,” said Ryan Peterson, a physician assistant with Rochester Regional Health, who notes the biggest challenge of TytoCare is convincing some patients it actually does what it’s touted to do. Some patients have a hard time believing such technology actually exists and is accurate but are amazed once they trust it.

Peterson says that the ability to use TytoCare opens up more opportunities for patients to access care without barriers like finding childcare, inclement weather and other obstacles for those that may have a hard time leaving the home.

Leslie A. Dintruff, a family nurse practitioner with Rochester Regional Health, is one of the providers whose primary patient care role is telemedicine via Express Care. She calls the program “pretty unique” in this region and views it as an excellent way to streamline care for patients with providers from this area (as opposed to some telemedicine apps which are staffed with providers outside of the area who do not have access to patients’ medical records.)

Finger Lakes Health: Asynchronous care amps up

In July 2019 Lifecare Medical Associates in Seneca Falls – part of Finger Lakes Health – began trialing video appointments for their patients who range in age from newborn to over 100.

“At first people were skeptical,” said Dr. Elizabeth Osborn, MD, a family medicine physician at the practice. “Once the pandemic hit, the uptick in users was really fast and people were very grateful it was an option.”

Now, people expect the technology to be there, Osborn said, and a good number of her patients prefer video visits when they need to be seen outside of their annual in-person wellness check due to the flexibility and ease of access.

“It’s the way healthcare is going and we have to adapt, be proactive and innovative to offer the best healthcare we can to our patients,” Osborn said. “A lot of concerns can be handled on a video call. It’s actually amazing how much information you can get from a video visit.”

Another way the practice uses technology to enhance the patient experience is via asynchronous care, which Osborn says has “become a bigger part of our practice in the past two years.” The term refers to self-service abilities for patients that are not real-time with their health care providers, such as sending a message and photo with a non-urgent question within the patient portal.

Online pre-check-in for an appointment is another example. Not only can it decrease the amount of time a patient needs to spend filling out forms in the office waiting room, but it has helped considerably with the workflow for office staff, Osborn notes.

Trillium Health: Technology increases access

At Trillium Health — a Community Health Center that provides equitable, judgment-free and affordable care for all people — the ability to use telehealth has greatly reduced barriers to healthcare, like childcare, transportation and geographic distance, according to Dr. Sarah Bolduc, the organization’s chief medical officer.

Trillium operates five sites throughout Rochester, offering services that include: a Transgender Center of Excellence, primary care, pediatrics, gynecology and harm reduction.

Some patients at Trillium’s Transgender Center of Excellence live up to two and a half hours away or are at colleges out of state and the ability to check in with their healthcare providers virtually removes the travel barrier.

Other patients may live close by, but don’t want to use their paid time off to drive to Trillium, be seen and then drive home or back to work – preferring instead for a quick virtual visit during their lunch break.

Bolduc notes that some patients accessing mental health services with Trillium seem to do better with video visits and find it easier to connect with their providers by screen.

“A big part of what we do is meet patients where they’re at,” Bolduc explained and technology helps them do that.

Overall, Bolduc says telehealth can often lead to greater access for all patients.

“If it’s done well it’s a lot more efficient for everyone including the providers and the office staff,” she said. “Increasing efficiency can increase access because you’re saving time and can connect with more people.”

Caurie Putnam is a Rochester-based freelance writer.