This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.
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Patients spend a large amount of their visit at the doctor’s office not being seen by the doctor, but rather sitting in a waiting room or even trying to find a parking spot outside the office to begin with. Or maybe they planned an appointment weeks or even months in advance, but the doctor has to reschedule.
Luckily there’s a new form of medical technology out there that’s looking to revolutionize the industry as we know it. With occupational telemedicine, prospective patients can see a doctor without having to drive to the doctor’s office. Through video chat, they’re able to get diagnoses for many kinds of injuries or illnesses without having to be physically seen. This saves money and time for all parties involved, which is a win-win.
Telemedicine (noun) – the concept of delivering care at a remote distance.
Triage (noun) – the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment.
Ancillary (noun) – providing necessary support to the primary activities or operation of an organization, institution, industry, or system.
HIPAA (noun) – the Health Insurance Portability and Accountability Act of 1996. The Act consists of five Titles that regulate and protect different areas of health care.
Claire Williams: Hello, and welcome to the California Workers’ Comp Report podcast. Today is Tuesday, September 27th, and I am here with Dr. John Alchemy. Hi, John.
Dr. John Alchemy: Hello there.
Claire Williams: Today we’re discussing occupational telemedicine, and we’re gonna go ahead and start off with answering the question: What is occupational telemedicine?
Dr. John Alchemy: So, telemedicine in general is this concept of delivering care at a remote distance. And telemedicine has actually been around for a long time with health plans, but what we’re gonna talk today about is a new use of telemedicine, and that’s delivering injury care to occupational medicine patients. So, if a situation where an injured worker needs to connect with a doctor, they do so on electronic devices connected to the internet, in a HIPAA-secure and private environment, and an interview and/or physical exam takes place, medical decisions are made, and a treatment plan is created along with everything else, just like in the office.
Claire Williams: Sounds great. So, specifically, how will you see it benefiting employers in California?
Dr. John Alchemy: Well, telemedicine in general for workers’ compensation will not only benefit employers and employees, it’s gonna actually benefit all stakeholders in the work comp system. And in order to do this disruptive technology, and we use that in a positive way, a change in the way that care is gonna be delivered, it really has to meet three criteria. The first one, is it needs to be better than the existing system. The second, it needs to be faster, and then third, it needs to be cheaper. So when those three things are present, we have the market conditions set for disruption to come in. And the last thing is that these three elements, better, faster, cheaper, they need to be at least ten times more powerful and effective than the current system. And that’s exactly what we’re going to talk about today. How is delivering telemedicine in occupational medicine going to change the landscape of the industry, improve the quality and speed of reporting and access to care?
Claire Williams: Great, so yeah, let’s go ahead and paint the scenario.
Dr. John Alchemy: Let’s talk in present day, what happens? So, injured worker comes into the employer’s office, they say “I’ve been hurt.” They then have to contact the insurance company, the insurance company will tell them to go to some location to be seen, and technically they both need to get in a car because the employer cannot send the employee out in a car if they are uncertain of the significance of the magnitude of the injury that may have occurred, for safety reasons. So now we have two people leaving the workplace, they’re gonna go and check in at either an urgent care, an ER, or a general occupational medicine clinic. They’re gonna sit in the waiting room, they’re going to need to fill out all their paperwork, and now at some time, hours later, they will be in front of the doctor, and then the exam will take place and then the discharge will occur. So that’s the current system.
Claire Williams: Okay, and then, how does the same day play out when we’ve got occupational telemedicine onboard?
Dr. John Alchemy: Right. So the way that the system can work, and does work now in certain environments, is that the employer will access the telemedicine doctor for workers’ compensation through an electronic device connected to the internet, a secure connection is made, and then the patient is now right in front of the doctor, able to tell the story just minutes after the injury occurred, instead of hours or days, as the current system. The doctor can fill out a form, simultaneously ask all the questions, get that doctor’s first report done, they can do a fairly detailed exam telemed, create that physical, the findings, and now generate the RFA, and also create the work status, answer any questions that the employer may have. So basically what we’re doing is we’re flipping the system on its head, and instead of the employer and the employee investing all of their time to see the doctor, the doctor is now being made near-immediately, or can be made near-immediately, for both the employer and the employee. So let’s take this scenario: You click in with me, we do a telemed visit, and I make a determination: “You know what, you really need to go into the emergency room. We’re not comfortable handling this by telemed, and this wouldn’t be handled well in a regular office setting.” So what we’ve done now is we’ve not only done our triage, we’ve done our doctor’s first, but we’ve efficiently now placed that employee at the correct care level before they even leave the employer’s property. We think about this: Same scenario, the employer and employee have been sitting in an office for two hours, they go back to see the doctor, and now the doctor informs them: “You know what, we can’t take care of this here, you have to go to the ER anyway.” And that is not an uncommon scenario.
Claire Williams: Great. It is definitely sounding better, faster, and cheaper. Are there any foreseen drawbacks to performing occupational medicine this way?
Dr. John Alchemy: Well, it’s basically the drawback of any telemedicine visit, and that’s going to be certain limitations and procedures that obviously can’t be performed, for example: “I was working overhead and got something in my eye, I rinsed it and it’s still there.” That is something that’s gonna have to go into the clinic. “I fell on my wrist, it’s really sore, I can’t move my wrist very well,” that’s gonna have to go in and get an X-ray.
Claire Williams: Right.
Dr. John Alchemy: “I cut myself,” you know, bleeding, gotta go in and get some stitches. So you know, definitely the brick and mortar is not going to go away, but I will tell you in my experience, about 80% of the things that I see in the outpatient clinic can be handled by telemedicine triage in this way, and again, effectively place that injured worker in the proper care setting for what they need.
Claire Williams: Wow. And so, what are some of those injuries that are very compatible with telemedicine?
Dr. John Alchemy: A common one, a common one we see is “I lifted a box a week ago, I thought my back would get better and it didn’t.” Or “I’ve been at my desk typing for three months in an awkward position, my wrists now hurt.” Similarly, “With my shoulder, I do repetitive things on a production line, I’m getting pain at the top of my shoulder, what should I be doing?” The repetitive stuff is very common. Skin conditions can effectively be triaged as well, exposures, burns, of that nature, all of that in the constellation of those types of injuries, and again, in my assessment, about 80% can be seen and treated without an immediate requirement of going to the ER or the urgent care. Now let’s also think about scaling this. Now you can have after-hours access to a provider, get your doctor’s first written 24/7, around the clock. Imagine if you’re at a big box store and you’re running that night shift, okay, and it’s going from 11 p.m. to 6 a.m. You cannot afford to be pulling someone off of that team, as their manager, to go sit in the ER or after hours, and be at the mercy of this schedule of the hospital basically, because it’s unpredictable. So you can kind of start to see in your mind, hey, it’s not only an effective way to be used on routine injuries, but also after-hours and really shortening those goalposts of getting that injured worker in front of the eyes of a provider to make some medical determinations.
Claire Williams: So, what are next steps for people in California workers’ comp that are interested in telemedicine?
Dr. John Alchemy: Well, I would recommend to anyone listening to the podcast, to check out a group that I’m working with, called Kura MD, out of Sacramento. Basically what this group is doing is they’re putting together a network of acceptive providers for insurance companies, and employers, that is doing exactly what we just talked about. It’s lowering the barriers of delay, and getting access to injured workers where they’re hurt, and when they’re hurt. And this is going to be a complete disruption to the system. I mean, imagine doing away with all the sitting, all the waiting, all the calls, wondering when, if you’re going to be seen, and all the questions that get raised from the employer. “Can they go back to work? I’ve got questions, I keep leaving messages with the clinic, and they don’t call me back.”
Claire Williams: Mhm.
Dr. John Alchemy: So that is really what I see coming up ahead, short-term. Longer-term, what I see coming up is also other deliverables in the current system being performed online or remotely, such as delivery of medications, splints or Thera Bands or other durable medical equipment delivered to your doorstep, or also going online now with a physical therapist, doing physical therapy at home, getting your supervising there, making sure you’re doing your exercises and stretches and being able to have that relationship with the ancillary team that makes any work comp recovery possible. So we can all use our imagination, but the good news is that the basic core of connecting that injured worker with the medical provider is now available, and it’s saving tons of time. And a lot of that waste, driving, 80% of the visit, which is waiting, driving and moving around, parking your car, is now gone. And again, we’ve turned the system on its head with telemed, and it’s here to serve the patient and the employee, and the doctor becomes the one that can now be available anywhere, at any time.
Claire Williams: Wow, so that all sounds so great. And we’re definitely gonna go more in-depth into how telemedicine works as fair as impairment rating next time. Any closing thoughts for our listeners today?
Dr. John Alchemy: Well, I would just ask of everyone listening to start to open their minds and thoughts over telemedicine in the workplace. It’s an exciting time, there’s a lot of potential, and it is a difficult transition for a lot of people who have been in the field for a long time to adjust to. But I tell you, that as the workforce continues to get older and more familiar with electronic communications, this will become the standard, no doubt. And it’s an exciting time to actually be in occupational medicine and telemedicine is now bringing in all this benefit.
Claire Williams: Definitely. Well, thanks so much, and we will continue the conversation next time.
Dr. John Alchemy: Absolutely, we’ll see you then.
Narrator: Thank you for joining us for this episode of the California Work Comp Report. We look forward to next week in continuing our discussion of work comp claims in California. Questions or comments? Got a great workers’ compensation story to share? Find us on Twitter at @ratefast or at rate-fast.com.