Telemedicine: What Adults with Congenital Heart Disease Need to Know

Telemedicine is the “wave of the future.” It is a way that you can see your healthcare provider without going into a physical office. Your healthcare provider can use remote technology to evaluate, diagnose, and treat you wherever you are. In order to participate in a telemedicine visit, you will need a telephone or computer that has a camera and microphone.

In the past, most telemedicine visits occurred for those who are in more rural areas or for people who lived far from their healthcare provider. This gave an opportunity for the provider to see if the patient needed to travel to have an in-person visit. With the COVID-19 pandemic, the use of telemedicine has increased. The expectation is that it will continue to grow.

Although often used interchangeably, telehealth has a broader meaning than telemedicine. It includes a wider collection of technology. These include things like transmitting electronic documents, such as X-rays or CT scans to another medical professional or asking you to transmit your pacemaker reading or glucose results to them. An online patient portal is another example of telehealth.

• You can call your provider’s office by telephone to schedule a telemedicine visit or schedule via the patient portal.
• Generally, after you make the appointment, the provider’s office will send you a secure internet link or app to use to join the telemedicine visit. Download the app before the appointment time. Sign on and be ready 15 minutes before the scheduled appointment.
• On the day of the appointment you will click that link and be connected to the provider via video and audio. The office may recommend you join the call 10-15 minutes early, as the provider may be early.
• Once the visit is over, they will automatically disconnect you and you will sign out from the browser.

You will need a computer, smartphone or tablet/iPad with a working camera and a microphone.  If you don’t have access to one of these, ask about having a phone conference with your healthcare provider.

• Complete all paperwork and/or answer any pre-visit questions online ahead of time.
• Check with your insurance company to see if your telemedicine visit will be covered, and if the copay will be the same as a normal visit.
• Be prepared, if necessary, with a list of your daily weights, O2 sats, BP and pulse readings, if those are things that you usually discuss with your doctor.
• If you are sick, make a list of your symptoms, how long you have had them, and what has helped them or made them worse.
• Have a list of all medications you take, along with doses, or have the bottles available to show the provider. If you need refills of any medications, have a list ready.
• Have a list of questions you have for the provider ready.
• Have a paper and pen ready to take notes.
• Make sure your computer/tablet/smartphone is fully charged and working correctly (video and microphone) and that you have adequate internet access.
• Find a quiet and comfortable place in your house or in your office to have the visit.
• Turn off or reduce all distractions as much as possible, so you can devote your full attention to the telemedicine visit.

• Keep in mind that everything may not run perfectly with the technology (computer). If you have technical issues, the healthcare provider’s office will work with you to help solve them.
• Your healthcare provider will have everything they need to conduct the visit in the manner that they would if you were in the office. They will have questions for you and will expect you to also have questions. You should be honest and open with them.

• Telemedicine visits cannot and should not be a replacement for an in-person visit to your healthcare provider’s office. You will need to see your provider when you need a physical exam, labs, EKGs, echocardiograms, exercise tests, etc.
• In between those visits—such as for routine follow-up visits or for visits to discuss lab and test results—a telemedicine appointment works well. If during a telemedicine visit, you and/or your healthcare provider believe you need an in-person visit, that will be scheduled.

• Follow-up visits for BP or diabetes management, etc.
• Medication refills
• Education
• Counseling appointments with a mental health provider
• Specialty care for patients in rural areas via the primary care provider’s office
• Screening for potentially contagious diseases such as COVID-19 or the flu

• During COVID-19, many insurers, including Medicare, have covered telemedicine visits.
• You can, however, expect to pay a copay just like you would for a visit in the healthcare provider’s office.
• Some insurers might waive the co-pay during the pandemic, but others may not. If you have questions, call the customer service phone number on your insurance card.

Routine labs, as well as certain tests, such as EKGs, CT scans, MRI’s, X-rays, etc., are important to have during the pandemic for the maintenance of your health. Ask the lab or clinic where you are having the test if they can offer you a first appointment in the morning, have mobile check-in, and if you can wait in your car and have them call you when you are ready to be seen. Ask them about social distancing, masks and disinfecting protocols in their buildings. As always, protect yourself by wearing a mask, maintaining social distance per CDC guidelines, and washing your hands.

If you require a physical exam, lab tests or other tests, you will need an in-person visit. However, many devices such as BP monitors, glucose monitors, pacemaker monitors, spirometers, oximeters, and digital thermometers can digitally transmit data to the healthcare provider’s office.

• Do not have to take off as many hours of work that you would have for a normal office visit.
• Do not have to travel to the appointment, fight traffic and pay for parking.
• If you have children, do not have to find childcare or someone to pick up your child(ren) from school or watch them at home.
• Less waiting time in the healthcare provider’s office.
• Less chance of catching another illness in the office.
• Better access to specialists who may be far away from where you live.

• Not all insurers cover telemedicine.
• May delay emergency treatment if you access a telemedicine visit first. Remember, healthcare providers using telemedicine cannot administer life-saving treatments or get lab tests done.
• Limits ability to do physical exam.
• Security concerns exist. There is a potential that your medical data can be hacked if you use a public network or unencrypted channel for your telemedicine visit.
• Breakdown of the patient/healthcare provider relationship if you use a telemedicine service and see a random healthcare provider.
• Technological issues if you are not computer literate, do not have a device, or do not have reliable internet services.

A patient portal is a secure website where you can access your medical records from your healthcare provider. You can also schedule and keep track of appointments; communicate with your healthcare team; see visit reports, labs and test results; and view your medications. To do this, you will need a computer or smartphone, internet connection, username, and password. If your provider doesn’t use a portal or keep it updated with test and lab results, you can call the office to get them. If you prefer not to use the portal or don’t have access to a computer or internet, you can also stay in touch with your provider by calling on the telephone.

It is very important to have a continuum of care, especially during this COVID-19 pandemic timeframe. This includes your ACHD healthcare team, as well as other healthcare providers you see. While it is much more difficult to see your providers in person, a telemedicine visit may help bridge the gap between your last in-person visit and your next in-person visit. Your healthcare providers can discuss all symptoms (if any) with you and work with you to plan next steps.

It is important to make sure that you stay as healthy as you can and that if further health problems arise, they be diagnosed and treated as soon as possible.