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TELEMEDICINE

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because continuity of care matters. Different from urgent care busi-
ness models which solely focus on acute concerns, current UT
Health Physicians patients who utilize On-Demand care will find
that On-Demand clinicians can ensure communication of the visit
to their own UT Health Physicians primary care physician. On-De-
mand team members can connect primary care patients to their spe-
cific medical home even before the appointment begins. A team lead
and a clinical supervisor help facilitate communication between the
On-Demand provider and the patient’s primary care physician so
that there is seamless care for patients. Importantly, if a chief com-
plaint is determined to be inappropriate for an On-Demand visit,
our team helps facilitate the scheduling of an in-person appointment
at their medical home. Patients even receive follow-up calls one or
Although telemedicine is not a new care delivery option, COVID-
two days after their On-Demand visit to ensure the patients acute
19 has sped-up its implementation and utilization. Facilitated by ad-
issues are improving and to further help maintain continuity of care
vances in technology and a receptive patient population,
with the patient’s primary care physician.
telemedicine is currently meeting the needs of the community while
Overall, the response from patients has been extremely positive.
catering to the wants of patients. It will be interesting to see how
Patients repeatedly tell us that the service is high-quality, accessible,
clinical medicine and telemedicine will continue to change and adapt
and convenient. They appreciate the ability to receive medical care
into the future.
rapidly, on their schedule, and often from home. Over the past few
months, patients aged 20 to 50 years old have utilized the service
Joyce Yuen, DO, is a Lead Physician with UT Health Primary
the most. However, we have had patients as old as 90 years old suc-
Care On-Demand Urgent Care.
cessfully complete a visit. Patients have been logging into On-De-
mand Urgent Care for upper respiratory symptoms, COVID
Ramon Cancino, MD, MS, FAAFP, is Director, UT Health
concerns, urinary tract infections as well as other minor illnesses.
Physicians Primary Care and is a member of the Bexar County
Medical Society.
There are limitations and challenges
to telemedicine. References:
The physical exam is limited. While some patients have ther- 1. Lurie N, Carr BG. The Role of Telehealth in the Medical Re-
mometers, pulse oximeters, and blood pressure monitors at home sponse to Disasters. JAMA Intern Med. 2018;178(6):745-746.
to take their own vitals, others do not, potentially making the doi:10.1001/jamainternmed.2018.1314
telemedicine visit less effective. We anticipate that there will soon 2. Duffy S, Lee TH. In-Person Health Care as Option B. N Engl J
Med. 2018;378(2):104-106. doi:10.1056/NEJMp1710735
be a proliferation of cost-effective telemedicine vitals collection
3. Centers for Medicare and Medicaid Services. Medicare telemed-
equipment, such as interactive digital stethoscopes, which will help
icine health care provider fact sheet. Accessed September 26,
clinicians conduct more in-depth physical exams via virtual care. 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-
The future of reimbursement is still open-ended. It is uncertain telemedicine-health-care-provider-fact-sheet
whether telemedicine visits will continue to be reimbursed at similar 4. Bennett N, Lemoine GJ. What a difference a word makes: Un-
rates as compared to in-person visits. If current policies expire, then derstanding threats to performance in a VUCA world. Bus
Horiz. 2014;57(3):311-317. doi:10.1016/j.bushor.2014.01.001
it will be difficult to continue providing patient’s care through
5. Acute Hospitalizations Decrease During the COVID-19 Pan-
telemedicine.
demic | Cigna. Accessed September 27, 2020.
Disparities may still exist. Telemedicine using video visits certainly https://www.cigna.com/about-us/newsroom/studies-and-re-
increases access to those with video visit-capable technologies, such ports/deferring-care-during-covid-19
as smartphones with data plan and home computer with camera, 6. Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung S-
microphone and internet connection, at their disposable, but we H, Ambrosy AP, Sidney S, Go AS. The Covid-19 Pandemic and
the Incidence of Acute Myocardial Infarction. N Engl J Med.
worry that those who do not have access to these technologies may
2020;383(7):691-693. doi:10.1056/NEJMc2015630
not benefit. Reimbursement limitations for “audio-only” (tele-
7. Cabana MD, Jee SH. Does continuity of care improve patient
phone) visits may further widen gaps in access to care. outcomes? J Fam Pract. 2004;53(12):974-980.

20 San Antonio Medicine • November 2020