By Teresa Bartlett, MD, SVP Medical Quality, Sedgwick
Although telemedicine has been around for more than 50 years, the explosion in technology, the expanded interconnectivity, the social acceptance of video chat as a part of everyday living, and the continuing need to remove barriers to healthcare access have accelerated interest in telemedicine as a medical delivery platform. While there are various facets to the delivery of virtual care, telemedicine is commonly thought of as a videoconference between a patient and physician. It is best known for its convenience of care and elimination of travel time needed to reach a physician’s office.
In last week’s post, we provided an overview of basic telemedicine concepts. Today, we will expand this discussion and explore how telemedicine can be applied more specifically to workers’ compensation injuries and conditions. Being aware of these alternatives and knowing the right questions to ask will enable organizations to capitalize upon telemedicine as an extended source of convenient and effective care.
Initial telemedicine options were centered on bringing healthcare services to patients in remote areas and serving patient populations where providers were in short supply. Telemedicine also became a way for physicians to conduct medical consultations and bring specialty expertise to areas where there was none.
Telemedicine is not an appropriate means of treatment for severe or serious injuries or illnesses. However, it is an efficient and effective way to treat many minor ailments and is readily used in specialty practices such as dermatology, radiology, psychiatry, and pediatrics.
The success achieved by these and other specialty areas has opened the door to telemedicine being used to treat work-related injuries and conditions. Telemedicine is most appropriate for treating common workplace injuries such as sprains, strains, and abrasions. Telemedicine can be effectively used to provide initial injury diagnoses, rechecks and monitoring. The platform can also be used to assist injured workers with some forms of physical therapy as well as address varying emotional and behavioral conditions.
Telemedicine programs can be structured in a number of ways depending on an employer’s needs and objectives. Sedgwick launched its telemedicine offering at the beginning of June. Under this model, telemedicine is offered as an extension of its clinical consultation services.
When an injury or illness is reported at the workplace, a call is made to a clinical consultation nurse. On the front end, the nurse expresses care and concern relating to the unexpected workplace incident. Additionally, the nurse will ask a series of questions to determine the extent of the injury and what type of care is best suited in any given situation. For example, the nurse may recommend self-care, offer telemedicine as an alternative, or suggest an in-person consultation at the physician’s office.
Telemedicine offers convenient and effective treatment. A virtual visit eliminates the travel and wait time associated with a physician office visit. Using technology, the treating physician can listen to the accident description, assess the affected body part, observe range of motion, and identify any limiting conditions. A treatment plan can be constructed whether it entails ordering diagnostic tests, arranging a consultation with a specialist, recommending physical therapy, or sending an e-prescription to a nearby pharmacy.
The ultimate objective is to secure fast and appropriate care for the injured worker. Should there be delay, hesitation, or concern expressed by the injured worker, more traditional alternatives of treatment at a nearby medical facility are offered.
One of telemedicine’s most notable advantages is convenience. As an example, a worker who is injured at a remote manufacturing facility can receive an expedient consultation and diagnosis in a virtual setting. Videoconference capabilities provide an excellent way for a physician to monitor an injured worker’s progress and observe movement. Rechecks can be very effective using this technology, particularly when there is an established relationship between the injured worker and the treating physician.
Telemedicine can also transcend geographical boundaries. Using telemedicine, a treating physician can access a medical specialist when appropriate. For example, the injured worker might benefit from talking with a specialist should an expert opinion be needed from an orthopedist in the case of a sprain or a dermatologist in the case of a rash. An office visit or diagnostic tests can be ordered and arranged depending on the injury or condition.
Additionally, telemedicine can streamline care and provide for more efficient delivery of services. A workers’ compensation telemedicine program should be staffed with occupational medicine specialists who understand the workplace setting and resulting injuries. They should be aware of workers compensation nuances such as OSHA requirements, return to work objectives, and individual requirements of state reports of injury. In designing any program, it is particularly important to minimize an injured worker’s wait time. A well-structure program that delivers quality care and a positive experience can reduce unnecessary visits to the emergency room or urgent care facility.
Further, some physicians and injured workers report higher satisfaction when using telemedicine. When injured workers are assured fast and reliable access to high quality physicians, many feel more empowered and take a more active role in the recovery process. Effective care is an essential component of a productive life style and return to work and leads to high satisfaction and lower cost for employers.
In terms of challenges and considerations, there is a cost to the healthcare provider to ensure the right technology components are in place to produce a seamless telemedicine experience. An employer must have a dedicated space or be able to provide a private area for the injured worker to have a meaningful, open, and honest exchange with the telemedicine physician. Additionally, injured workers must have access to a mobile device or computer and a comfort level in using this technology.
As alluded to earlier, a telemedicine program must be structured to minimize wait time. Injured workers need to have priority access to consult with a treating physician, and they must be assured that an accurate diagnosis can be made in a virtual setting.
The injured worker must have confidence that the telemedicine platform is a safe and secure environment to discuss the injury or condition with the treating physician. Medical histories and co-morbidities are often discussed in these early consultations. They must feel that privacy will be securely maintained. Health Insurance Portability and Accountability Act (HIPAA) compliance is essential in designing these programs
In summary, telemedicine is becoming increasingly popular as a virtual alternative to treat and care for injured workers. It can be an effective and efficient care delivery platform and a strong extension to an existing clinical consultation services program. Telemedicine is another means to improve injured worker access to patient centered care.
About Teresa Bartlett, MD
Dr. Bartlett joined Sedgwick in January 2009 as senior vice president, medical quality. She began her business career by joining a large automotive manufacturer. She spent 20 years managing large self-insured, multistate workers’ compensation programs as well as the WSIB Canadian program. This involved PPO and IME network development and management and claim and litigation management. The short-term disability (STD) program that Dr. Bartlett managed was union negotiated. She developed an evidence-based medical substantiation process, which saved millions of dollars and reversed the escalating STD trend. The long-term disability program was ERISA-based and was also supported by the evidence-based medical substantiation process. In conjunction with these programs, Dr. Bartlett developed a benchmark fraud detection system, which included both provider and employee fraud for both the United States and Canada.
The scope of her expertise spans more than just occupational and non-occupational claims programs; Dr. Bartlett managed the occupational physicians within 32 manufacturing facilities. This involved a detailed understanding of safety and OSHA programs and required leadership to secure the necessary manufacturing support for the sophisticated return and retain at work process. This team won the Corporate Health Achievement Award from ACOEM in 2005 for the Development and Implementation of a Best Practice Clinical Model.
Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of nearly 15,000 colleagues in some 275 offices located in the U.S., Canada, U.K. and Ireland. Sedgwick facilitates financial and personal health and helps customers and consumers navigate complexity by designing and implementing customized programs based on proven practices and advanced technology that exceed expectations. Sedgwick’s majority shareholder is KKR; Stone Point Capital LLC, La Caisse de dépôt et placement du Québec (CDPQ) and other management investors are minority shareholders. For more, see www.sedgwick.com.