Page 26 - Delaware Medical Journal - July 2017

Using Telemedicine for Orthopaedic Follow-Up
Alfred Atanda Jr., MD
M follow-up was in August 2014. I had performed an anterior cruciate ligament reconstruction on a 17-year-old male
named Tom, who lived about 90 miles from our hospital. A week later, during a casual conversation with his father, I learned that Tom was doing well recovering at home, but was having trouble adjusting his postoperative brace. Tom’s dad asked if I could “FaceTime” with Tom and show him how to adjust it.
I agreed, and after showing Tom how to use the brace, we talked for a few minutes. I asked Tom about his pain, and he bent his knee and let me see his wound through the phone’s camera. At the end, Tom said he would see me later that week for his in-person, postop appointment.
But I soon realized that it wasn’t necessary for Tom and his father to drive 90 miles for me to do in person what I had just done on FaceTime. He seemed comfortable, he had reasonable range of motion, and his wound looked great. I could email or fax him the paperwork, and we’d be done.
During that same year, our hospital created a telemedicine division within its innovation center. This administrative initiative encouraged physicians, physician assistants, nurse practitioners, and nurses to
use telemedicine to evaluate and treat patients whenever possible. Telemedicine, as they explained it, uses information technology such as videoconferencing to provide health care remotely.
I quickly realized that many other patients could receive the same kind of care I provided to Tom. I wanted to learn how I could use technology to treat more of my patients. I met with the telemedicine coordinator to get set up, and I have been delivering service remotely ever since.
FOR ESTABLISHED PATIENTS
Most people probably think of telemedicine in an on-demand sense, such as the technology popularized by apps like Teladoc, MDLive, and Doctor on Demand. In contrast, I primarily use telemedicine for established, scheduled patients. Typically, I already have a relationship with the patient and his or her family, and a physical exam is often not necessary.
Telemedicine works very well to evaluate patients for encounters focused on information transfer. Simple follow-ups, routine post ops, surgical discussions, wound checks, and MRI/ lab result reviews can all be handled through telemedicine. I rarely use telemedicine to evaluate brand new patients, unless they have already been seen and physically examined by a clinician in our practice.
Telemedicine visits may be scheduled within an electronic medical record in the same way that in-person visits are scheduled. I can integrate visits within my regular clinic hours or schedule them for after-hours, when children are home
from school and parents are done working. This provides extra clinic is open and staff is available.

to FaceTime and can be used for videoconferencing between two individuals. As a physician, I can invite patients to download the app and link them into my “video chat room.” This platform not only enables me to evaluate patients, but also to invite participation by other clinicians such as primary care doctors, athletic trainers, and physical therapists. This is helpful because I can evaluate patients while they are at physical therapy or in their training room at school and get real- time feedback from their therapists and trainers about their progress.
The second platform is formally integrated into our clinic template and can only be used to interact with scheduled patients. It requires that patients enter insurance and demographic information and is very helpful at administrative tasks such as co-pay collection.

patients and interact with health care professionals in various clinical scenarios. I personally prescreen all telemedicine patients to ensure their appropriateness for this type of visit. Once they agree, they are consented for the visit and scheduled with our normal orthopaedic scheduler.
For both patients and physicians, the only hardware requirement for telemedicine visits is a device with Internet access, a camera, and a microphone. Laptops, desktops, tablets, phones, and carts or kiosks can be used. Devices with these requirements are very common, ensuring access for most patients.
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Del Med J | July 2017 | Vol. 89 | No. 7