key: cord-254595-by2j7byz authors: Rao, Sandesh S.; Loeb, Alexander E.; Amin, Raj M.; Golladay, Gregory J.; Levin, Adam S.; Thakkar, Savyasachi C. title: Establishing Telemedicine in an Academic Total Joint Arthroplasty Practice: Needs and Opportunities Highlighted by the COVID-19 Pandemic date: 2020-04-23 journal: Arthroplast Today DOI: 10.1016/j.artd.2020.04.014 sha: doc_id: 254595 cord_uid: by2j7byz The COVID-19 pandemic has prompted rapid restructuring of the healthcare system in an effort to stop the spread of the virus and to treat patients who are acutely ill with COVID-19, while continuing to provide outpatient care for the remainder of patients. To help control spread of this pandemic, many centers have boosted telemedicine capability to care for patients who would typically be seen in person in outpatient settings, including total joint arthroplasty clinics. We review key components relevant to the establishment and effective use of telemedicine, focused on patient education, practice logistics, technological considerations, and sensitive patient health information–associated compliance factors, which are necessary to provide care remotely for total joint arthroplasty patients. Telemedicine uses audiovisual technological aids to help care for patients [38] and has 12 historically been used to provide care for patients in rural and low-resource settings. [50, 67] 13 Telemedicine involves a range of technologies, including "smartphones," computer tablets, 14 mobile applications, and video conferencing, to allow healthcare providers to evaluate, diagnose, 15 monitor, treat, and educate patients "virtually." [24, 67] Telemedicine is currently the fastest 16 growing sector of healthcare. [7, 38] Although only half of U.S. hospitals use telemedicine, primarily for radiology physician- To slow the spread of COVID-19, the U.S. Centers for Disease Control and Prevention (CDC), 34 in conjunction with state and local governments, has implemented social distancing and 35 quarantine rules. [43] The CDC has also recommended changing outpatient practice patterns. Specifically, they advise to "reduce unnecessary healthcare visits" and "explore alternatives to 37 face-to-face triage and visits." [15] A major challenge during this crisis is to keep patients and 38 the healthcare team safely distant while providing patients with effective and efficient care. Telemedicine is a logical solution to help address this challenge. Orthopaedic surgeons who primarily perform total joint arthroplasty (TJA) of the hip and 41 knee treat a predominantly outpatient population that is at high risk for complications and death 42 from 44, 54] Most patients of adult reconstruction clinics are older than 60 years, 43 and many have comorbidities that put them at high risk of contracting severe acute respiratory 44 syndrome coronavirus 2 (SARS-CoV-2) if exposed. [65] Therefore, an effective and efficient 45 TJA telemedicine practice may enable providers to continue delivering care while preventing 46 unnecessary exposure of at-risk patients to the outpatient clinic during this pandemic. Telemedicine presents challenges for providers and patients, necessitating a 48 comprehensive analysis of a practice and its patients to determine the best way to implement a 49 telemedicine workflow. Providers cite poor information technology (IT) platform design and 50 "information overload" with regard to the chosen system as barriers to use. The differences between synchronous and asynchronous telemedicine encounters determine not 115 only the necessary IT infrastructure, but also the billing and coding options for the encounter. All individuals who will interact with patients through the telemedicine portal must be trained. technological practice tools, such as computer-assisted surgery and robotics. Despite the fact that telemedicine decreases wait times, reduces or eliminates travel, and lowers 174 costs for TJA patients, it has not been universally adopted. [27, 48, 64] Obstacles to widespread 3. Practices and providers should be educated about the benefits of telemedicine, as well 283 as factors essential to its adoption. These topics include costs and components of telemedicine platforms, information on documentation, reimbursement guidance, tips to 285 improve telemedicine workflow efficiency, and liability and privacy considerations. 286 4. Patients should be educated about the use and benefits of telemedicine, and they should 287 be assessed for their technological competency and willingness to use telemedicine. The benefits of telemedicine are considerable, especially when access to in-person clinical care is 289 limited, such as during a natural disaster or pandemic. Telemedicine can lower healthcare costs 290 and improve access to care, especially for patients in rural or underserved areas. In appropriately 291 selected patients, telemedicine produces similar outcomes to those of in-person visits. During 292 crises such as the COVID-19 pandemic, when healthcare access is limited and mobility is 293 impaired, telemedicine allows providers to continue delivering quality patient care while 294 avoiding unnecessary risks to themselves, the care team, and their patients. Coronavirus Prepardness and Response Supplemental Appropriations Act, HR 6074, Accessed on Review of telemedicine projects in 17 Total hip arthroplasty in the older population Patients' 410 Satisfaction with and Preference for Telehealth Visits Why communities of practice succeed and why they fail Barriers and Facilitators for Sustainability 415 of Tele-Homecare Programs: A Systematic Review American Community Available at oig.hhs.gov/oas/reports/region5/51600058.pdf. Accessed on Ten Cate O. Competencies 455 required for nursing telehealth activities: A Delphi-study Evidence Brief: Video Telehealth for 458 Primary Care and Mental Health Services. VA ESP Project #09-199 Patient preferences for direct-to-462 consumer telemedicine services: a nationwide survey Telemedicine: Opportunities and Developments in Member 465 States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for 466 eHealth Series Characteristics of and Important Lessons From the Coronavirus 469 Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases 470 From the Chinese Center for Disease Control and Prevention e-Health readiness assessment factors and measuring 472 tools: A systematic review Telemedicine in clinical setting No funding was received in support of this work.We would like to thank Rachel Box, Jenni Weems, and Kerry Kennedy for their editorial assistance.