Telehealth: Primary or adjunct healthcare service

I am experiencing a health issue right now wherein I think telehealth would be the perfect way to determine the next step.

On Sunday afternoon, I was stung on the hand by a wasp. As a gardener, I have had many such stings, but my reaction seems to be getting strong. On Monday morning, I went to my doctor’s office to receive a flu shot. I knew that having a cold was an obstacle to receiving a shot and asked if an allergic reaction to a wasp sting might be. The nurse examined my hand and decided it should not be a problem. She recommended that I take an oral antihistamine and call if there were any further issues.

I doubled up on my usual antihistamine for chronic rhinitis, used a corticosteroid cream to manage itching, and iced the hand. On Tuesday morning, I awakened with my hand ballooned up with swelling in three fingers. I managed to remove a ring and called the doctor’s office. Since I was having no shortness of breath or other indication of shock, I certainly did not want to sit in the emergency room and be triaged to the bottom of the list. I left a message asking if a stronger antihistamine or some other treatment might be indicated. I thought about taking a photo and sending it to the office, but really did not have a way to do that; the EHR they use does not allow me to send a photo.

I found myself thinking this would be a perfect opportunity for a Telehealth service. I had left a message for the nurse. When she called me back, we could have easily setup a video session so she could see the condition of my hand. That would allow her to make a quick decision about whether I should go to the ER, whether she should make an appointment for me to see the doctor, whether the doctor would do a telehealth session with me, or whether we should wait another day to decide.

In April, 2015, the Office of the National Coordinator (ONC) commissioned a ‘design session’ focused on consumer-centric aspects of e-health and telehealth. The white paper they produced, Designing The Consumer-Centered Telehealth & eVisit Experience, is available on the healthit.gov website. My peek into this was reported by FierceHealthIT, my go-to newsletter for healthcare IT news.

The non-telehealth outcome was that I sat in the doctor’s office from 2:10pm until 3:30pm before I saw him (it had been a 2:15pm appointment). I then traveled to the pharmacy to pick up the prednisone he prescribed and the hand is almost back to normal after three doses of medication. My afternoon was shot, but my hand is much better. [By the way, the doctor and I shared a laugh over the ICD10 diagnosis. Allergic reaction to bee, wasp or hornet venom allowed him an additional character to code whether it was 1) accidental (unintentional), 2) intentional, self harm, 3) assault, or 4) undetermined. Assault by wasp is a new one to me!]

I think telehealth interventions may become indispensable to behavioral health providers. Do you have guidelines that you use for telehealth and e-health sessions or transactions. How do you incorporate information about such exchanges in your patient records? Please share your experiences and comments below.

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