NYU Langone Health ‘pressure tests’ telehealth protocols during COVID-19 pandemic
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For more than 2 years, NYU Langone Health has implemented telehealth services across all orthopedic subspecialties, leading it to be prepared for the postponement of surgical procedures and office visits during the COVID-19 pandemic.
“[Telehealth is] an opportunity to leverage both our expertise and the technology platform; but as the technology’s become more commoditized, ... it is the care model that distinguishes the ability,” Thomas J. Graham, MD, clinical professor of orthopedic surgery and associate chief of hand surgery at NYU Langone Health, told Healio Orthopedics. “We were fortunately working on that for a couple of years and then we got to pressure test it during the pandemic, and we could not be more pleased.”
Telehealth and the upper extremity
One area that favorably lends itself to telehealth is upper extremity injuries, with the virtual care visit following the basic tenants of the history and physical exam but adapted to the technology, according to Graham.
“We can see skin and nail changes, we can see wounds, we can see lumps and bumps, and all of those are vividly demonstrated just as if [the patient was] sitting in front of you,” Graham said.
He added patients can also provide images before or after their visit, whether in the form of an MRI sent to their electronic health record system or a photo from the patient’s cell phone. Graham noted range of motion is also assessed, with an innovation group at NYU Langone Health exploring ways to collect more sophisticated measurements, including the use of remote monitoring devices.
However, although surgeons can have patients perform a few of the provocative maneuvers for tendinopathies and nerve compression syndrome through telehealth, Graham said there are some sophisticated manipulative or provocative tests that are outside of that purview.
“While we are robustly using the technology, we are also studying it from a scholarly perspective so we can understand better how to do it, so we can make sure our protocols are gleaning the most information we can, helping the patient as much as we can and setting the standard on how this virtual health is being performed,” Graham said.
Lowered barriers
While use of telehealth in an orthopedic practice has a learning curve, Graham said that, as long as a practice has the available technology, the learning curve is low and surgeons “will quickly adopt a way to conduct ... the doctor-patient relationship just as before.”
“The technology has been commoditized, so they all have good picture and audio. They all have the ability typically to schedule, to build [and] to record the notes. They are all HIPAA compliant now and they are all integrated with the EHR,” Graham said.
He added that many of the regulatory barriers have also been relaxed, making it easier for physicians to see more patients, even those across state lines. However, Graham said it is important for orthopedic surgeons to “be cognizant of what is around the corner,” not only with regulatory guidelines, but also with the evolving technology and scholarly research.
“[Telehealth] should be part of everybody’s portfolio. It should be an arrow in everybody’s quiver going forward. We should not return to modest usage,” Graham said. “We have added another capability that patients appreciate and is working. So, let’s keep our fingers crossed that our elected officials understand that, and we will go forward with a heavily expanded armamentarium to render care.”
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