The coronavirus disease 2019 (COVID-19) pandemic rapidly ushered in the era of telehealth, a modality that previously had limited use for epilepsy visits. At the American Epilepsy Society’s AES2020 virtual conference, Marvin A. Rossi, MD, PhD, provided tips for optimizing telehealth for patients with epilepsy (Table).

“The good news is that nearly everyone has access to at least a cellphone or landline and therefore qualifies for some level of telehealth as defined by CMS [Centers for Medicare & Medicaid Services],” Dr. Rossi told AES2020 attendees.1,2

While HIPPA-compliant audio-video hardware is preferred for telehealth, “it is not absolutely necessary if the video link is used in good faith and if nothing better is available for connecting the patient with the provider,” noted Dr. Rossi, who is associate professor in the Department of Neurological Sciences at Rush University Medical Center, Chicago, IL. “This means alternative communication software apps [eg, FaceTime, Skype, Messenger] can be used.”2

Additionally, if video or audio quality is downgraded or the call drops entirely, a mix of a video link with a telephone call can be used for more stable audio or switching to a telephone-only call is permitted and can be billed as a video visit.


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“Such fluidity gives providers the flexibility of providing necessary services even outside of clinic hours,” Dr Rossi said.

The fluidity also benefits rural hospitals and rural residents, who are among the most vulnerable populations during economic downturns and the COVID-19 pandemic. “Although smartphones, tablets, laptops are commonplace, many rural residents still don’t have access to such devices, don’t know how to use these technologies, or lack adequate bandwidth due to the stress placed on our digital communication infrastructure by this pandemic,” Dr Rossi noted.

Dr Rossi’s tips for putting telehealth into practice are summarized in the Table. Whether telehealth is provided by video visits or phone calls, prepping for the live encounter is critical. However, this preparation time is among the biggest obstacles to overcome, he said.

Table. Tips for Telehealth Use for Epilepsy Visits1

StepPractice Tip
Prep for the visit– Send the patient instructions ≥1 day before the visit
– Ask the patient to lower background lighting, minimize background noise, charge device battery, and assess bandwidth (if possible)
– Staff should test connectivity and remain available for troubleshooting
– Obtain patient consent and past medical, surgical, and social history
– Reconcile medications
– Document review of systems
– Automate a signal to the provider when the patient is in the virtual waiting room
Visit note and examination– Include a statement indicating the service was performed via telehealth and document patient consent Indicate the location of the patient
– Maintain the structure of the in-person clinical note template
– Complete the physical examination early in case the video feed is lost
– Vitals can be recorded using the patient’s home equipment or smartwatch and scale
– Perform a neurological examination at some level as medically necessary
– Document any examination components not completed because of telehealth limitations

For phone visits, document the following:
– Patient-initiated contact and consent
– Patient’s concern
– Provider’s response and method of contact
– Details of the encounter to establish medical necessity
– Total time spent with the patient
– The nature of the call was not tied to an in-person or telehealth office visit or procedure that occurred within the past 7 days
Cognitive and mood measures– Brief standardized cognitive measures can be completed by the patient immediately prior to the visit
– Mood surveys can be captured on the patient’s smartphone or device and can be routed and uploaded into the EMR
– If mixed reality or virtual reality tools are available for cognitive testing, scores can be routed and uploaded into the EMR
Remote neurostimulator device programming– VNS and RNS devices can be interrogated and programmed remotely with a nonprovider placing the interrogation wand
CMS billingVisit the AED Telehealth Quick Guide
Finalize the encounter– Document key points observed or requested by the attending clinician
– Document plan of care requiring medical decision making
– Document total time spent with the patient

“The COVID-19 pandemic has not only brought epilepsy-related healthcare challenges not seen in more than a century, but it also has accelerated a digital transformation,” Dr Rossi concluded. “This crisis has underscored the importance of equity of access and the digital divide that must be overcome. The good news is that all the patient requires is a standard phone to access specialized healthcare resources.”

Dr Rossi disclosed the following relationships: Community Development Block Grant, Foglia Family Foundation, Adelaide Cervantes Epilepsy Fund, and UCB Pharma.

References

1.  Rossi MA. Tips and tricks for telehealth visit in epilepsy. Presented at: AES2020; December 4-8, 2020.

2. Centers for Medicare and Medicaid. Medicare telemedicine health care provider fact sheet. March 17, 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

This article originally appeared on Clinical Advisor