Telemedicine for Multiple Sclerosis

Even though the COVID-19 pandemic has posed many obstacles to people living with multiple sclerosis (MS), it has also expanded the use of telemedicine as a way to see your doctor. Through telemedicine, you can receive the ongoing care you need and deserve while also practicing social distancing and minimizing exposure to the virus.

Using Telemedicine as Part of Your MS Care

 

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About Telemedicine

The practice of telemedicine involves using technology to obtain medical guidance and care from a provider who is in a different location. Real-time, interactive communication with your doctor is accomplished through both the audio and video functions on your smartphone, computer, or tablet.

Telemedicine is also called synchronous telemedicine or virtual visits. It is a subset of telehealth. While the terms are sometimes used interchangeably, telehealth is more broadly defined as the use of any technology to communicate and support health care, including the use of remote monitoring devices.

For people living with MS, research available on implementing telemedicine into their care (while limited) is so far promising and encouraging. In one 2020 review study, long-term telemedicine management interventions were found to be beneficial, cost-effective, and satisfactory for both patients and their providers.

Another study found that regular telemedicine care improved clinical outcomes by reducing the severity of patients' MS symptoms.

Of course, more clinical studies are needed to sort out the upsides and downsides of telemedicine for MS. Nevertheless, this technology-driven model of care has been a welcome relief for many patients—especially those who have trouble accessing care due to MS-related disabilities and the pandemic.

Switching to Telemedicine

With the importance of social distancing during the COVD-19 pandemic, many MS doctors are offering, and even encouraging, telemedicine visits.

If you are considering switching to telemedicine from in-person visits (or using some sort of combination), your first step is to call your neurologist's office to see if this service is available and appropriate for your medical needs.

If telemedicine is available and your neurologist gives you the OK to proceed, your next step will be to check in with your insurance company to verify coverage and copay responsibilities.

If your doctor is not participating in telemedicine services, you may consider asking for a referral to a neurologist who is using it. Using another neurologist may be a temporary solution until your doctor implements telemedicine into their practice, and/or until the pandemic is over.

Besides receiving telecare from your neurologist, you may also be interested in receiving other forms of care (e.g., preventive care, mental health care, or rehabilitation care). Like neurologists, many mental health professionals, rehabilitation specialists, and primary care physicians are now offering telemedicine sessions.

If you do not have insurance or do not mind paying out-of-pocket, there are also private, online telemedicine companies, such as TeleDoc or Doctors on Demand, that provide around-the-clock medical services.

Getting Started

Telemedicine sessions are intended to be personal and private, just like in-person visits. In order to confirm privacy and be HIPAA-compliant, providers usually utilize a secure, easy-to-navigate platform to connect with you. These platforms may work on their own or through another common video platform like Zoom, FaceTime, Skype, or Google Duo.

Your neurologist or other healthcare providers will give you instructions for setting up your telemedicine platform on your phone, computer, or tablet. This is done prior to your visit, so that if technical issues arise, a person of support from the clinic or the telemedicine service can provide assistance.

Key instructional steps often include:

  • Ensure you have a device with a camera and a stable Internet connection. If using your phone, you should use Wi-Fi for your Internet.
  • Download the latest version of the telemedicine application or "app" (if not already on your computer or phone).
  • Read and sign a consent form online.
  • Test hearing (microphone needs to be on) and seeing (video needs to be on) before your appointment.
  • Provide the clinic staff with your phone number, in case technical difficulties arise.

While setting up a telemedicine platform is usually very simple and straightforward, please do not hesitate to ask a loved one, care partner, or neighbor for help. You want to feel as comfortable and as relaxed as possible going into your scheduled visit.

Tips for Maximizing Your Session

Like any in-person visit, you want to get the most out of your appointment, leaving no stone unturned.

To maximize your session, consider these preparatory strategies:

  • Make sure your device is fully charged.
  • Plan to have your session in a quiet, private room that is free of clutter.
  • Arrange child or pet care, if possible, to minimize any distractions during your visit.
  • So you do not forget, write down details about the symptom or concern you are planning on addressing with your doctor.
  • Anticipate (and consider the answers to) any potential questions your doctor may ask you—for example, how is your fatigue or other MS-related symptoms affecting your home and work life?
  • Wear comfortable clothes and shoes, as your doctor may ask you to perform certain physical maneuvers during the session (e.g., walking).

When It May Not Be Appropriate

Most parts of an in-person medical visit are possible during a telemedicine visit, including counseling, implementing a treatment plan, and reviewing your medical history, medications, bloodwork, and imaging results. Even aspects of the physical exam, including the neurological exam, can be technically feasible.

There are some instances, however, in which a telemedicine visit is not appropriate. A key example would be for a new diagnosis of MS.

Telemedicine visits are also not generally appropriate in patients with a symptom that requires a thorough physical or neurological examination, and/or for patients whose health status has significantly changed from prior visits.

For example, if you are experiencing a potential MS relapse, your neurologist will probably want to see you in person. Detailing the progression of your MS, whether that's by your neurologist or rehabilitation doctor, also requires an in-person visit.

If you aren't certain whether a telemedicine visit with your doctor is appropriate, it's best to call your doctor's office first. Preventing any delays in your care is important.

Navigating Follow-ups

As with any doctor appointment, follow-up is key to ensuring continuity and superior care. At the end of your telemedicine session, clarify with your doctor when you should follow-up, and whether that visit should be a traditional in-person visit, or whether another virtual visit is reasonable.

If your telemedicine appointment is not with your usual doctor (perhaps, you are seeing a specialist or different neurologist), ask the doctor to send you a summary of your visit and/or email, fax, or message that summary through MyChart (if applicable) to your personal doctor.

Once you receive the summary of your visit, you can relay it to your personal healthcare team by scanning and emailing it, or mailing it to your doctor's office.

If your telemedicine visit led to a major change in your care (maybe you were started on a new medication or prescribed a new form of therapy), it's best to call your personal doctor's office to share this information.

Common Barriers and Solutions

Most people are pleased with telemedicine, enjoying the lack of travel time and reduced cost. In addition, people perceive their virtual visits as the same as office visits in terms of quality and personal connection.

Still, telemedicine is a growing, evolving practice with a number of barriers that still need teasing out. Examples of such barriers and their potential solutions include:

  • Patients are not experienced and/or comfortable with technology. With consent, a family member or care partner can assist the patient in both setting up the technology and attending the virtual visit
  • Neurological impairments, especially hearing and vision problems, may make telemedicine visits challenging. Accessibility services, such as captioning on a separate screen, or an interpreter, may make the visit more successful.
  • Patients or providers may be late for the session or the session may be cut short. Having a contingency plan in place (e.g., a sooner follow-up appointment) if the session is short on time is a prudent idea.

There are also regulatory, administrative, and legal issues to consider with telemedicine. For instance, states and insurance companies have varying policies when it comes to reimbursement and prescribing practices.

There are also omnipresent concerns about the confidentiality and privacy of patient data, despite the use of supposed secure delivery platforms.

As healthcare practices and telemedicine companies work to sort out these logistics, it's best for you to remain proactive as a patient. Ask questions, raise your concerns, and in the end, do what is most comfortable and best for your health.

A Word From Verywell

In summary, telemedicine offers patients and their MS healthcare team a viable, alternative means for receiving and delivering care, respectively. As the practice of telemedicine progresses, let's hope it continues to remain beneficial and effective, which means placing patient care at the forefront.

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Article Sources
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