A: The decreasing demand for in-office care caused an acceleration of telemedicine adoption in eye care. Regulatory bodies made it easier for providers to adapt by lowering the barriers of technology adoption, and payers allowed simple coding for reimbursements. Ten months later, with infection rates on the rise, it is more important than ever to continue patient care utilizing telemedicine.

With that said, here is a look at some of the information to consider before partnering with one or more technologies. (See "Additional Considerations" below.)

TYPES OF TELEMEDICINE

Telemedicine is comprised of four types of services:

1. Synchronous. This is live video and audio via video-conferencing software, either separate or part of a particular platform.
2. Store-and-forward. Also known as asynchronous, this offers health history and/or image storage and transmission to a health care provider for consultation, diagnosis and treatment.
3. Remote patient monitoring. Also referred to as RPM, this collects chronic care vitals, such as blood sugar for diabetes, that are transmitted for monitoring purposes.
4. Mobile health. Also known as mHealth, this uses wearables and applications that monitor virtually anything via a supporting health care senso-

TELEMEDICINE REGULATIONS

Both Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) took action to make it easier for doctors, including optometrists, to provide telemedicine services, in the wake of the COVID-19 pandemic. The Final Rule is slated for this month for a 6% decrease of specific reimbursements that will go into effect for 2021. That said, the uptick of COVID-19 cases will most likely extend the waivers into 2021, so check CMS.gov for the Final Rulings.

HIPAA COMPLIANCE

Even though HHS and CMS have waived this requirement until the end of 2020 (this month), telemedicine should be a long-term strategy, given the uptick in COVID-19 cases and patients becoming used to the choice. Once patients have become accustomed to options to receive their care, they may opt for providers who offer a streamlined experience. Eventually, a HIPAA requirement for the protection of protected health information, or PHI, will be a requirement. (For additional information on HIPAA security guidance, visit hhs.gov/hipaa/for-professionals/security/guidance/index.html .)

EASE OF USE

This is a must to maximize patient adoption and utilization of the platform. Key features, such as online booking, communications tools and payment portals make it easy and, therefore, enticing for patients to schedule telemedicine appointments. I suggest you consider a web-based platform, so your patients can connect easily through a web browser on a mobile device and/or desktop computer. As some of these platforms require downloading a specific application, I recommend making sure you have instructions on your practice’s website and answering service, so patients can be prepared for their appointment.

The telemedicine platform should make patient care easier for the provider, along with the patient. Having the ability to access essential clinical information in a picture archiving and communication, or PAC, system for managing chronic eye diseases, such as glaucoma, may be an essential requirement for your practice. In addition, having interoperability with your EHR may be advantageous for billing and coding if you plan to conduct a lot of telemedicine visits. Having these items may require researching a platform that specializes in ophthalmic care vs. a generic platform that may only have capabilities of screen sharing.

PRACTICE WORKFLOW

The platform should increase workflow to maximize a continuous revenue stream. Having the ability to configure and customize certain settings within the platform could be advantageous for group practices and practices that need to maximize efficiencies. It is important to have a platform that has customizable settings that keep track of how patients prefer communications, such as email and texts, among other notifications. Some of these features may not be on a free or trial version, but rather on an upgradable feature that is part of a higher monthly fee. Having the ability to track and monitor your patient experiences allows you to have analytical insight into how a telemedicine platform is performing. Usually, follow-ups and tweaks need to be made to optimize the experience for both doctors and patients.

WHAT DO YOU NEED?

As there are many technologies to choose from, it is important to assess the needs of your patients and practice. This requires research and planning to implement change management for all stakeholders. You may find some telemedicine solutions have many features that are nice-to-have, but not need-to-have. Focus on how to extend the care and reach of your practice to continue care with your patients. Also, use the American Telemedicine Association (americantelemed.org ) as a resource of best practices, regulatory information and an opportunity to network. OM

DR. ROGOFF has a background in data analytics, holistic eye care and business management. He is the Senior Product Manager of Disease Management for Carl Zeiss Meditec, Inc., leads the Optometric Advisory Council for Versant Health and serves as the Education Chairperson for the Maryland Optometric Association. Please forward any questions to info@eye-exec.com.