What Is Telemedicine?
Telemedicine is simply the practice of receiving medical care at a physical distance from your healthcare provider through the help of technology. A practitioner or other healthcare professional uses various telecommunications to deliver care to patients not physically present in a medical office or hospital.
The term “telehealth” is used even more broadly, to include technology used to collect and send patient data, such as email and remote patient monitoring.
Telehealth access has grown dramatically over the past decade, as the available technologies have improved. This has been especially important for people in rural and remote areas, who might have otherwise lacked easy access to a specialist.
However, the COVID-19 pandemic has expanded telemedicine options even further. Some regulations have been loosened regarding telehealth, such as allowing certain communication platforms that hadn’t previously been authorized. Healthcare providers are also receiving much better and more reliable reimbursement for these visits.
Switching to Telemedicine
Many rheumatology and primary care practices who previously did not offer telemedicine now are including this as an option. In some cases, practices are encouraging telemedicine over in-person visits, at least for higher-risk patients.
You may also be able to set up a telemedicine appointment with a new medical provider, even if you’ve never seen them for an in-person visit. You can find a healthcare provider who treats RA in the same way that you normally would—from a referral from your healthcare provider or by checking with your insurance company.
Call the office directly to see what telemedicine options are available. Telehealth options are now widely available to see primary care physicians and rheumatologists.
Telemedicine also may be option even if you don’t have insurance. There are private-pay telehealth providers (such as Teledoc) that may be able to meet your needs. You can also try calling a local healthcare provider and see if they accept patients without insurance for telemedicine appointments.
What Should I Do Ahead of Time?
You can call your health clinic to find out what platform will be used for your telemedicine encounter. If you don’t already have it, you will need to set it up on the device you plan to use, such as a computer, a tablet, or a smartphone.
For a video chat, you will need a stable, high-speed internet connection. If you are using your phone, logging on to wi-fi usually works best.
If you haven’t used a specific platform before, it’s helpful to do a practice run with a family member or friend. If you’ve never had a telemedicine visit, some clinics will have a support person call you ahead of time.
Fortunately, most of the platforms are relatively easy to use, even if you aren’t very tech-savvy. If you need help, ask a friend or family member so you can have your technology ready at your scheduled appointment time.
If possible, plan to have your telemedicine appointment in a quiet room with good lighting, to better interact with your healthcare provider. Make sure your device is fully charged ahead of time.
How Will the Appointment Work?
You’ll need to make contact at your appointment time using the platform specified by your healthcare provider’s office. It’s fine to have a family member with you for the visit, the same way you might at an in-person visit.
A backup phone and medical office phone number, for any audio issuesA list of questions/concerns to share with your healthcare providerPen and paper, to take notes about follow-up questions or next stepsSupplies you might need for the exam, if available (thermometer, scale, blood pressure cuff)A list of your current medications and supplements (or a physical container with all of them)
Some things will be similar to the way you’d have an appointment in person, but some parts will have to be adapted or skipped. The exact nature of the encounter may vary based on whether you are a new patient and on the exact nature of the problem (e.g., regularly scheduled follow-up or unscheduled disease flare).
You’ll start by checking in with your healthcare provider about your current medical issues, describing in detail your most recent symptoms. For example, you’d explain if you’ve been having more trouble with morning joint stiffness, increased joint swelling, or worsened fatigue. If a first-time appointment, you’d provide your clinician with a full medical history.
Your healthcare provider will probably want to make some sort of assessment of your disease’s activity level. For this, you might need to answer a questionnaire, such as the RAPID3. You can also use our downloadable Doctor Discussion Guide below, which can help you prepare by teaching you relevant terminology, suggesting questions to ask your practitioner, and more.
This can give your healthcare provider a good sense of how active your disease currently is. If desired, you can even take the survey ahead of time through an online questionnaire, so you’ll have that information already available to discuss.
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The exam portion will obviously be different. Depending on the circumstances, your healthcare provider might have you take your own vital signs, like your weight and your temperature. If you have your own equipment to take your blood pressure at home, you might do that as well. However, these might not be necessary.
Normally, your clinician would touch and feel your joints to see if they are swollen or warm. That isn’t possible during a telemedicine visit.
Your clinician may ask to see your joints up close with the camera. You might be asked to take a picture of your joint and send it virtually. Your healthcare provider might ask you to perform certain actions, such as closing your fist (which can also give a sense of your disease activity).
Working together, you and your practitioner will plan your treatment, including any follow-up steps. Depending on the situation, this might mean deciding to do a future in-person visit, an in-person treatment (such as an infusion), or follow-up blood tests. Or you might make a treatment plan with the idea of following up via telemedicine.
When Does Telemedicine Work for RA?
Telemedicine can often be especially helpful for a follow-up visit if you’ve previously seen a healthcare provider for an in-person visit. It’s especially easy to do if your disease is relatively stable and you just need to check-in with a practitioner. It can work pretty well if you are having an exacerbation of certain rheumatoid arthritis symptoms, like more swollen joints, as shown in the model below.
Telemedicine also works well as in initial screening visit if you aren’t sure if you need to be seen in person. You may be able to address the problem then and there. However, sometimes a virtual visit will make clear that you really need to be seen in-person. Your healthcare provider will let you know it that seems to be necessary.
Telemedicine won’t work for every situation, however. If you have very serious symptoms related to your rheumatoid arthritis, such as heart or lung issues, you may need to see someone in person (either urgently or at a scheduled in-person appointment).
You also may need to see someone in-person if you haven’t yet received a diagnosis of rheumatoid arthritis and the diagnosis isn’t clear. Or you might need to see a medical professional in-person if your disease isn’t adequately responding to treatment. And if you need to get blood work, you won’t be able to do that remotely either.
Telemedicine also doesn’t work for certain types of treatment related to RA, such as infusions that are normally done at the healthcare provider’s office. For example, Remicade (infliximab), Orencia (abatacept), and Actemra (tocilizumab) are three treatments commonly given via infusion in an office.
These aren’t typically given at home, though this might be possible under very unusual circumstances. So you’ll have to make a plan with your healthcare provider about how you want to handle your treatment.
How Well Does Telemedicine Work for RA?
Although research on telemedicine in this specific group of people is limited, more general studies in medicine have shown that telemedicine can be surprisingly effective a lot of the time.
A telemedicine study of 122 RA patients in Alaska also concluded that patients receiving telemedicine did not show any differences in disease activity or quality of care compared to people receiving in-person visits.
One review compiled data from twenty studies of telemedicine in rheumatology patients (of which people with RA were the most common). On the whole, it concluded that telemedicine appears to be effective for diagnosing and managing rheumatic diseases such as RA. However, it also concluded that more evidence is needed to determine the ideal uses of telemedicine, including its specific uses in RA.
Should I Choose Telemedicine?
Depending on your specific situation and your local health conditions, you may have an option about whether to get a virtual telemedicine appointment with your physician or an-in person one.
At present, many people are choosing telemedicine because of concerns about contracting COVID-19. People with RA have a health condition that may put them at risk of having a more severe case of COVID-19. Additionally, many people with RA are over the age of 65, which is another risk factor.
Some people with RA also take immunosuppressive medications that might make them more likely to become infected or have a worse outcome, but this isn’t completely clear.
However, telemedicine offers some benefits even without these concerns. Many people find it convenient, especially for follow-up appointments for which not a lot has changed. People who live a long way from their healthcare provider may especially benefit from the reduced time needed to make a telemedicine visit.
Currently, medical offices are performing intense infection control measures, such as aggressive disinfection, patient pre-screening, social distancing, and appointment spacing. You can always contact your local office about their practices. In any case, it may be a perfectly reasonable choice to plan for an in-person appointment, even if telemedicine is an option for you.
It doesn’t have to be either/or. You might choose to mostly see your healthcare provider over telemedicine but come into the office if a particular issue comes up. If you have never seen your practitioner in-person, at some point you will probably want to do at least one comprehensive in-person visit. Work with your healthcare provider to see what makes sense for you.
Will My Insurance Cover Telemedicine?
Prior to the COVID-19 pandemic, many insurance companies were not providing payment for telemedicine visits or were only doing so in limited circumstances. Since then, most insurance providers have loosened these criteria and are reimbursing for telemedicine visits.
However, some companies have still not been covering all types of telemedicine visits, such as those done exclusively over the phone.
Telemedicine is also a potential option for people with Medicare or Medicaid. Since the pandemic, these services have also widely expanded in terms of telemedicine options. However, it’s not clear if all these changes will be permanent.
It never hurts to check with your insurance provider ahead of time to discuss your coverage. You can also call your healthcare provider’s office to get their perspective.
A Word From Verywell
Telemedicine visits aren’t always ideal, but they provide people with RA another option for managing their health. If you haven’t done it before, don’t let the technology intimidate you. There are people who can work with you to get telemedicine up and running. On the other hand, don’t feel like telemedicine is your only option. You can always call your healthcare provider’s office to get advice about what will make sense in your situation.
