The RealTime Clinic phone app, guided by Buddy the Buddha, is one example of a virtual platform physicians and patients can use for telehealth. The coronavirus crisis is quickly mainstreaming the practice of doing doctor visits by phone or video. (Courtesy of RealTime Clinic)
After decades of working as a physician in various models of healthcare — from Kaiser Permanente to county and VA hospitals, to private practices to small clinics in Guam, India and Vietnam — Dr. Mai-Phuong Nguyen started her own telehealth practice Karuna Healthcare Consultants in 2016.
Telehealth — defined by California Telehealth Resource Center as the “collection of means or methods for enhancing healthcare, public health and health education delivery and support using telecommunications technologies” — includes consulting with medical care providers by phone or video chat.
Historians of telehealth often cite an 1879 article that proposes caring for patients over the telephone to reduce unnecessary office visits.
“In my first week of medical school at USC, they taught me that history is 80% of the diagnosis, and in my 25 years as a physician, I’ve found that to be true,” said the Huntington Beach-based Nguyen. “The physical is helpful, but a good clinician can do a lot over telehealth.”
Dr. Mai-Phuong Nguyen of Huntington Beach has been championing telehealth for almost a decade. (Courtesy of Mai-Phuong Nguyen)
But she couldn’t convince her patients, especially not in the immigrant communities of Little Saigon. At the time, insurance didn’t cover telehealth, so most couldn’t understand why they would pay money out of pocket and not actually see a doctor in person.
It wasn’t until last year that she found a partner in Garden Grove’s 360 Healthcare, a small physician-led organization where she now works doing a combination of telehealth and house visits.
Similarly, since brothers Vic and Dr. Mike H. Merjanian founded the Newport Beach-based Titan HST (Titan Health & Security Technologies Inc.) in 2012, they have had the platform to virtually connect people who need healthcare to physicians who can provide it.
But at the time, because there wasn’t yet a demand for telehealth among patients or medical providers, the Merjanians quickly pivoted to marketing it as an emergency communications system.
They partnered with school districts (including Newport-Mesa Unified), large sports venues and city governments to offer an app to use during medical emergencies.
It wasn’t until last year that they felt the general public might be ready for tMed, their new app that it not for one-off emergencies but for day-to-day checkups and consultations.
Telehealth apps like tMed 2.0 help patients correspond with their physicians from the convenience and safety of their own homes, especially important during the coronavirus crisis. (Courtesy of Pediatric Therapy Network)
Nowadays, telehealth is a buzzword, and there are many conference like VSee’s annual Telehealth Secrets conference, where innovators in technology and medicine collide to dream up the future of healthcare.
Mai-Phuong Nguyen learned about the conference from RealTime Clinic’s Nehal Swami, who helped Nguyen build her Karuna website.
Swami remembers watching his father start a telehealth component to his practice in rural Oklahoma in the early 2000s. As a busy physician, he rarely saw his kids, and he wanted an efficient way to manage his schedule without compromising his patients’ care.
At the time, the technology wasn’t there.
“But now you can have a Tesla in space,” says Swami. “Technology isn’t an issue anymore.”
Milton Chen, co-founder of VSee, has used their telemedicine platform to connect American physicians to Syrian refugees in need of care. They’ve helped American specialists oversee complicated surgeries in Iraq, life-saving procedures that the local surgeons there would otherwise not feel comfortable doing.
“The medical field has been on the verge of a telemedicine explosion for the last couple years,” said Mike Merjanian, who works as an ER physician.
Kaiser has nurse hotlines as a preliminary screening to help determine whether a patient needs to make an in-person appointment with the doctor. Telehealth is also being used in remote areas and for homebound patients when travel is difficult and in fields like psychiatry that don’t require physical exams.
But in Orange County, these technologies often weren’t being used by the average doctor.
Until the coronavirus happened.
Dr. Vinh H. Nguyen, the medical director for MemorialCare’s Huntington Beach Health Center and MemorialCare Medical Foundation’s medical director of information systems, can pinpoint the exact day he started seeing patients over Zoom video conferencing: March 25, 2020.
Physicians at AltaMed in Huntington Beach, Mission Hospital in Mission Viejo, Hoag Orthopedic Institute in Newport Beach and the Laguna Beach Community Clinic also say that they were not regularly using telehealth — and when the Orange County health officer ordered a stop to all nonessential gatherings in mid-March, the pandemic forced their clinics to adapt almost overnight.
“Honestly, it’s been really amazing,” said Dr. Christine McLemore of AltaMed’s Huntington Beach Community Clinic. “A lot of us have wanted to do this, and there were a lot of barriers to it before.”
For a long time, there were two main roadblocks. First, insurance didn’t cover telehealth visits, so medical providers couldn’t bill for it.
And even when insurance companies started to pay for it, there were different reimbursement rates for different medical specialties, and often the system was hard to navigate, explained Jennifer Stoll, who leads government relations and public affairs at OCHIN, a healthcare nonprofit that acquired the California Telehealth Resource Center in 2017.
Second, there were restrictions against using videoconferencing that wasn’t HIPAA-compliant in order to protect patient privacy.
In early March, the federal government loosened the regulations for telehealth, allowing insurance like Medicaid and Medicare to pay the same rate for a telehealth visit as an in-person visit. They also relaxed HIPAA restrictions, so doctors can now see their patients over more accessible platforms like the free version of Zoom and FaceTime.
Recently, McLemore estimated AltaMed does about 50% of its visits through phone and video, which means an estimated 30,000 patients were able to receive care without putting themselves or the staff at AltaMed at risk of coronavirus exposure.
And while the loosening of regulations is temporary, the hustle to develop an infrastructure to support telemedicine will have permanent effects.
OCHIN, whose mission is to level the technology playing field for low-income, vulnerable and underserved patients, has been providing technical assistance to its member clinics, many of which would otherwise be unable to afford telehealth services.
Stoll emphasizes that telehealth would be a game-changer for patients who can’t afford to take a day off work and travel for hours to get to a clinic — and others that currently may not even have access to smart phones.
“It took a crisis to redeliver healthcare, and this is an opportunity for innovation and disruption,” she said.
The Laguna Beach Health Clinic is one of the many community clinics that OCHIN has helped by getting their telehealth services up and running quickly during the COVID-19 crisis.
Started 50 years ago by volunteer physicians and activists, the Laguna Beach Health Clinic was originally a free clinic funded by the city and a “pickle jar” passed around the waiting room to collect donations, explained Dr. Jorge Rubal, who now leads their staff in serving low-income, uninsured and homeless populations in Laguna and its surrounding cities.