Telerheumatology: Origins, Current Practice, and Future Directions

Foreword
Preface
	References
Contents
Contributors
Chapter 1: Introduction
	Reference
Chapter 2: Telerheumatology: A Historical Perspective
	Introduction
	Key Historical Events and Concepts
	The Father of Telemedicine…No…the Father of the Division of General Medicine
		Interview Between Jay Sanders, MD, and Christine Peoples, MD
	References
Chapter 3: Overview of Synchronous and Asynchronous Modalities
	Definition of Synchronous vs Asynchronous Telemedicine
	Advantages and Disadvantages of Synchronous Visits
	Advantages and Disadvantages of Asynchronous Visits
	Applications of Both Synchronous and Asynchronous Telemedicine: A Mental Model
	Asynchronous Use Cases of Telemedicine: Traditional Asynchronous Use Cases
	New Modalities of Asynchronous Visits
	Synchronous Use Cases of Telemedicine
	Future Applications of Both Synchronous and Asynchronous Modalities
	References
Chapter 4: The Role of eConsults
	Origins of eConsults
	Benefits of eConsults in Other Specialties
		Decreasing Unnecessary Visits and Wait Times
		Improve Turnaround Time
		Cost Savings
		Address Health Disparity
		Fill Educational Gaps
		Adaptability
	eConsult Experience in Rheumatology
		Referral Triage in Rheumatology
		Potential Benefits in Rheumatology
	Considerations When Starting an eConsult Program
		What Is Your Goal?
		Who Are Your Stakeholders?
		What Is Your Timeline?
		How Will eConsults Fit into Your Practice Setting?
			Understand Your Referral Breakdown
			Decide What Is Appropriate for an eConsult
			Determine What “Type” of eConsult Works Best
		Who Will Perform eConsults?
		What Are eConsult Billing and Documentation Requirements?
	What Are Implementation Barriers of eConsults?
	eConsults in Rheumatology
		Reasons for eConsults
		What Makes a High-Quality eConsult?
		What Makes a High-Quality eConsult Reply?
		Educating with eConsults
	Inpatient eConsults
	Challenges for Rheumatology eConsults
	References
Chapter 5: Equipment, Technology, and Support
	Introduction
	Types of Telehealth Visits
	Video Conferencing Devices
	Internet
	Platforms
	Security
	Additional Hardware and Peripherals
	Improving the Call Interaction
	Conclusion
	References
Chapter 6: Telepresenter Training and the Virtual Physical Exam
	Telerheumatology Visits at a Telehealth Center
	The Virtual Physical Exam
	References
Chapter 7: Documentation, Licensing, and HIPAA Compliance
	Documentation
	Licensing
	HIPPAA Compliance
	Conclusions
	References
Chapter 8: Legal and Regulatory Primer for the Practice of Telemedicine in the United States
	Introduction
		Definitions
		Four Common Models of Telehealth Arrangements
	Provider Licensure
		Background
		General Rule and Exceptions
		Practice of Medicine vs. Provider-to-Provider Consultations
	Patient Privacy and Data Security
		Background
		Federal Law (HIPAA) and State Law
		General Rule and Other Considerations in the Practice of Telemedicine
	Patient Consent in the Digital World
		Background
		Patient Consent in the Practice of Telemedicine
	Reimbursement
		Background
		Medicare Requirements
		Waivers to Medicare Requirements in Response to COVID-19
		Other Payers
	Conclusion
	References
Chapter 9: Best Practices for Billing and Coding
	Introduction
	Telerheumatology Prior to the COVID-19 Pandemic
	Synchronous Audio and Visual E/M Encounters
	Synchronous Audio-Only E/M Encounters
	E-Visits
	Virtual Check-Ins
	Interprofessional Telephone/Internet/Electronic Health Record Consultations
	Modifiers and Place of Service (POS) Add-Ons
	Considerations in Billing Telerheumatology by Nonphysician Health Professionals
	Considerations in Billing with Commercial and Medicare Advantage Payers
	Telerheumatology Billing and Coding as the COVID-19 Pandemic Continues
	Summary and Conclusions
	References
Chapter 10: Determining the Value of Telerheumatology
	Introduction
	Defining Telerheumatology Through Application of a Telemedicine Taxonomy
	Defining the Value of Telerheumatology
	The Economics of Telerheumatology and the Impact of the COVID-19 Pandemic
	Methods of Health Economic Analysis: A Brief Introduction
	Health Economic Assessments of Telerheumatology: A Strategic Survey of the Available Literature
	Implications of the Limited Available Health Economic Evaluation of Telerheumatology
	Stakeholder Perspectives on the Value of Telerheumatology: Value Is in the Eye of the Stakeholder
		The Patient Perspective
			Subjective Outcomes: The Patient Experience of Telerheumatology
			Patient Out-of-Pocket Costs
			Optimizing the Patient Value Experience of Telerheumatology
		The Clinician Perspective
			Subjective Outcomes: The Clinician Experience of Telerheumatology
			Clinician Costs
			Optimizing the Clinician Value Experience of Telerheumatology
		Objective Outcomes: The Clinical Effectiveness of Telerheumatology
		Why Patient and Clinician Value Assessments Are Often Discordant
		The Health Plan and Societal Perspectives: Telemedicine Coverage at the Crossroads
			Legitimizing Health Plans’ Telemedicine Coverage Decisions
			Telemedicine, Health Policy, and Data-Driven Decision-Making
	The Path Forward: Demonstrating the Value of Telerheumatology
		Developing a Standard Methodologic Framework for Value Assessment in Telerheumatology
		Interpreting Value Outcomes Across Telerheumatology Stakeholder Perspectives
		Novel Approaches to Value Assessment Applied to Telerheumatology
			When Health Economic Analysis Meets Value-Based Healthcare: The VBHC-QALY
			Three-Variable Health Economic Analysis: Adding the Patient as the Z-Axis
	Conclusion
	Appendix: Adjudication of Three-Variable Health Economic Analysis by Octant of Result
	References
Chapter 11: Measuring Disease Activity and Functional Capacity in Telerheumatology
	Introduction
	Patient-Reported Outcomes Measurement Information System (PROMIS)
	Rheumatoid Arthritis
	Spondyloarthritis
	Systemic Lupus Erythematosus
	Osteoarthritis
	Fibromyalgia
	Gout
	Approach for the Future
	References
Chapter 12: Rheumatology Telementoring: The ECHO Model
	Introduction
	Rheumatology Telementoring
	The Rheumatology TeleECHO Session
	Evaluation
		Primary Reasons for Participation in this Activity
		How Case Presentations and Didactic Formats Address Your Needs
		How Participants Use ECHO Learning with Their Own Patients
		Application of Rheumatology Concepts to Everyday Practice
	Summary
	References
Chapter 13: Rural Health Care and Telerheumatology
	Rural Populations and Health Disparities
	Rheumatology Workforce Distribution
	Models of Rheumatology Care for Rural Populations
	Benefits of Telerheumatology for Rural Populations
	Barriers to Telerheumatology in Rural Populations
	Conclusions
	References
Chapter 14: Telerheumatology and the Chronic Care Model
	The Unmet Need
	The Chronic Care Model
		Healthcare Organization
		Community Resources
		Self-Management Support
		Delivery System Design
		Decision Support
		Clinical Information Systems
	Smartphones and Telemedicine
		Wearables
	Management of Acute Flare-Ups: Teleurgent Care
	Telemedicine: Proposed Models/Methods
		Real-Time Telemedicine
		Remote Patient Monitoring/Tele-monitoring
		Store-and-Forward Telemedicine/Asynchronous Telemedicine
	SOPs for Telemedicine
	Teletriage
	Challenges in Telerheumatology
	Patient Mental Health
	The Way Forward
	References
Chapter 15: Telerheumatology and the Department of Veterans Affairs
	Historical Background
	Overview of VA Telehealth Environment
		Modalities
		Technologies
		Initiatives and Research
		Legislation
	Summary of the Telerheumatology Medical Literature Based on Data from the VA
	Patient Perspectives on VA Telerheumatology: An Observational Study
		Overview
		Materials and Methods
		Results
		Conclusion
	Summary
	References
Chapter 16: Review of the Evidence for Telerheumatology
	Introduction
	Characteristics of Telemedicine Described in Research Studies
	Studies Through July 2015
	Recent Studies
	Discussion/Future Directions
	Conclusions
	References
Chapter 17: Satisfaction with Telerheumatology Care: Patient and Clinician Perspectives
	Introduction
	Patient Perspectives About Telerheumatology
		Overall Satisfaction with Telerheumatology
		Benefits of, Barriers to, and Concerns About Telerheumatology
		Factors Influencing Perceptions About Telemedicine
	Provider Satisfaction
		Overall Provider Satisfaction with Telerheumatology
		Benefits of and Barriers to Telerheumatology from the Rheumatologists’ Perspective
	Change in Perception of Telerheumatology in the Era of COVID-19
	Conclusion
	References
Chapter 18: Telerheumatology During the COVID-19 Pandemic and Beyond
	Introduction
	Telerheumatology Prior to the COVID-19 Pandemic
	Telerheumatology During the COVID-19 Pandemic
		Similarities and Differences in Telemedicine Use Across Regions
			Africa
			Egypt
			Asia
			China
			Hong Kong
			India
			Middle East
			Singapore
			Australasia
			Europe
				Germany
			Italy
			Netherlands
			Norway
			Poland
			Spain
			United Kingdom
			North America
				United States of America
			South America
				Colombia
	Beyond the Pandemic
		Disadvantages of Telerheumatology
		Moving Forward
	References
Chapter 19: Private Practice and Telerheumatology
	Improving Access for Rural and Remote Patients
	The Australian Health System
	Early Federal Government Incentives
	2020 Motivated and Stimulated
	Challenges We Faced
	Embracing the Changes in 2021
	References
Chapter 20: Pediatric Telerheumatology
	Introduction
	Pediatric Rheumatology Workforce Shortage Statistics
	Pediatric Rheumatology Telemedicine Literature Review
	Unique Perspectives for Pediatric Rheumatology Telemedicine
	Future Aspects
	References
Chapter 21: Telerheumatology with Learners
	Introduction
	Best Practices for Incorporating Learners into Outpatient Telemedicine
		Workflows for Learners in Faculty-Led Telemedicine Clinic
		Best Practices for Teaching in Telerheumatology Clinic with Learners
		eConsults with Learners
	Telerheumatology and the ACR Core Curriculum
	Conclusions
	References
Chapter 22: Patient Perspectives and Narratives
	Defining Terms: Patient Perspective and Telerheumatology
	The Patient Perspective of Telerheumatology
		Patient Satisfaction with Telehealth and Telerheumatology
		Access to Telerheumatology
		Telerheumatology and Patient Measurement of Health Outcomes
	Patient Preparation for a Telerheumatology Visit
		Video Call Through Zoom, Skype, or Other Platform
		Telehealth Center
		Telephone or Audio Only
		Technology
		Environment
		Mindset
		Questions that Patients Have About Telerheumatology
	Patient Narratives of Telerheumatology
	Conclusion
	References
Chapter 23: Future Directions and Innovation
	Internet Access
	Augmented Physical Exam
	The Digital Medical Assistant
	Patient-Reported Outcomes and Co-charting
	In-patient Rheumatology Telemedicine Consultation
	Telerheumatology Triage
	References
Index