HealthJune 09, 2020

Nutritional counseling and mobile telemedicine: Are you up to date?

By: Roxanna Guilford-Blake

COVID-19 is driving a surge in virtual care. When it comes to nutritional counseling and mobile telemedicine, are you up to date?

The use of mobile telemedicine has been growing over the last several years. Is it one of your nutrition counseling strategies? It should be.

Providers and patients have warmed to telehealth, but payors have been slower to embrace it, and regulations have slowed its growth. But the coronavirus pandemic has forced innovation, and telehealth use is expanding dramatically. As doctors and other providers limit face-to-face encounters to comply with social distancing guidelines, telehealth tools are going mainstream. According to the 2020 Medscape Physician Compensation Report, in fact, remote patient engagement is up 225% in light of COVID-19. Telehealth, in its various iterations, allows providers - doctors, nurses, diabetes counselors, dietitians - to connect with patients during this pandemic while keeping everyone safe.

How can physicians not already on board integrate telehealth into their practices? Ryan William Stidham, MD, an assistant professor at the University of Michigan Medical School, discussed this topic in his presentation "Nutritional Counseling in the Digital Age: Telemedicine and Mobile Apps," now available for CME credit through AudioDigest.

What is telehealth?

Telehealth comprises a broad spectrum of services, but it loosely refers to healthcare where the patient and the doctor are in separate locations - everything from a phone call to specialized machines on either end. Because there's no standard nomenclature, it may be called telemedicine, mobile telemedicine or, occasionally, e-health. It can encompass everything from a simple phone call to sophisticated video encounters with a specialist. "Do they mean something different? Not really," Dr. Stidham says.

He does share a few distinctions within telehealth. For example:

  • Synchronous care refers to real-time interaction between the provider and patient in the same place or at the same time. Video visits and telephone calls would fall into this category.
  • Asynchronous care, aka "store and forward," refers to interactions not conducted in real time. This is often used to inform patients and to collect information. It's still two-way, but it's not in real time.

Patient adoption won't be a problem. Dr. Stidham cites a survey of patients with inflammatory bowel disease that found an overwhelming preference for video visits. In fact, most patients considered a video visit as similar or superior to in-office consultation. Dr. Stidham even warns that you should be discreet about letting patients know you offer telehealth services; everyone will want a video visit.

The encounter with the patient is "super simple," he says. "The back end is the hard part."

To listen to the full lecture, visit AudioDigest.

Mobile telemedicine: Thinking ahead

Dr. Stidham addresses several operational issues you need to consider before turning to telehealth, especially video visits. Among them:

  • How will you schedule patients?
  • How will you train for video visits?
  • Who should patients call if they have a problem?

Another important consideration is the video platform. Be sure to choose one that's HIPAA-compliant. According to the American Medical Association, during the pandemic, the government has relaxed its standards to include other face-to-face apps, such as Skype, but that's just temporary. Dr. Stidham offers insights into which ones to choose.

He touches on other concerns, including reimbursement and licensing. Will payors reimburse for nutritional counseling delivered via telehealth? If so, how much? What are the Medicare requirements? And speaking of regulatory issues, does your license allow you to practice across state lines?

It's time to improve the use of telecommunications technology in clinical practice, and nutritional counseling is an ideal place to start. We know that nutrition counseling plays a huge role in chronic disease management for an array of conditions, including diabetes, HIV/AIDS, cancer and Crohn's. After listening to this lecture, you'll have a better grasp on how to make those services more accessible by integrating telehealth into your practice.

Roxanna Guilford-Blake
Lippincott Journals
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