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Clare Brennan

Telehealth in Times of Crisis: Best Practices for Patients and Clinicians During the COVID-19 Pandemic and Beyond

By Jay Flanagan, MS, CGC, NSGC Reproductive Health Expert

 When I was in graduate school, we often said there were “no genetic emergencies.”  In many cases, that may still be true, but genetics has become an integral part of healthcare, especially at the point of care. For example, in prenatal cases, new diagnoses of cancer, or when a patient receives an abnormal test result, there is urgency for counsel.

As more clinics and hospitals are restricting access to clinicians and cancelling non-essential appointments in an effort to stop the spread of COVID-19, the use of telehealth services is increasing dramatically to ensure this counsel and other medical services can be provided.  Genetic counselors are not strangers to telehealth services; many have been providing telehealth services as an option to their patients for years. However, it has become more of an acute need right now as we are all facing the challenges of COVID-19.

Telehealth services are still in their infancy at many institutions. Some have only started offering telehealth in recent years and in some cases COVID-19 has accelerated the use of this offering.  Patients and clinicians are often navigating the experience together and learning best practices as they work through implementation. Studies have shown that telephone genetic counseling is as good as in person genetic counseling for promoting knowledge, decision making and in helping patients managing the anxiety they may have coming into the appointment.

Some of the major benefits of telehealth include:

  1. A more comfortable environment for some patients, perhaps leading to more transparent conversations.
  2. Increased access to services that may not be available in certain regions.
  3. Potentially reduced patient costs (no need to travel or take time away from work).
  4. Patient satisfaction. Studies show more than 90% of patients have had a positive interaction with telehealth services.

What is a telehealth visit or appointment?

There are many different options for telehealth services and the names for these services will vary.  In general, there are four primary types of telehealth services:

  1. E-visits
    1. A patient describes a problem via an online portal and a provider will email back a solution or recommendation.
    2. They are typically used for medical issues of low concern (i.e. red eye, nasal infections, etc.).
  2. Virtual visits at host sites
    1. These visits typically refer to a patient going to a healthcare office that is close in proximity to them and visiting with a provider who is physically located in another region.
    2. They can include a physical exam and depending on the issue, can even lead to procedures including remote surgeries.
  3. Telephone
    1. These visits involve a conversation over a phone, computer or other device without video. In these cases, a patient will call their provider or vice versa and discuss their health issue. The provider will then outline a plan of action the patient can take to resolve the issue.
  4. Video visit
    1. These visits are typically done through a secure video platform, hosted by the provider or their clinic.
    2. Patients can be anywhere on their smart device or computer and interact with the provider via video.

What method is best for genetic counseling?

Each service has its benefits and limitations. For genetic counseling, the most beneficial method is often the video visit. In this case, the patient could be anywhere on their smart device and can see and hear their genetic counselor.  The significant benefit of the video visit over a phone call is that the genetic counselor is able to pick up on any non-verbal cues the patient is giving. Research estimates that about 90% of communication is non-verbal.  While some of the non-verbal cues will be lost over a video chat, this technology still provides a better opportunity for connection than a typical phone consult. 

If video visits aren’t available, virtual e-visits at host sites are another good option for genetic counselors. However, it is important to note that patients typically don’t like this option as much because they still have to travel to a nearby host site, and the site must have staff available to set up the visit.

E-visits, which are based on email, have limited value in an initial genetic counseling discussion but may be an option for follow-up appointments, particularly when patients have a quick question that can be answered in a single reply. 

When might a telehealth visit be appropriate?

There are many cases where a telehealth visit may be an option. Some examples include:

  • Prenatal: You are 11 weeks pregnant and would consider genetic screening options, but are not able to travel to a clinic. A visit with a genetic counselor via a telehealth service could help you to determine what options make the most sense for you.
  • Oncology: You were recently diagnosed with breast cancer and your doctor suggested that genetic testing may be an option for you. You have questions about costs, what the implications of testing may mean for you, or you just want to learn more. A telehealth visit would be a great way to begin the conversation and, in many cases, a genetic test kit could be sent to your home so you would not even have to attend a clinic to have your blood drawn.
  • Direct to consumer testing: You recently received your results from a direct to consumer test. You have a lot of questions, but have not had time to visit a professional to go through the implications of what that result means for you. With the current limitations on travel because of COVID-19, you find you have some extra time and would like to speak with a genetic counselor before your life gets hectic again.

In each of these instances, patients should talk to their providers to determine the best method of telehealth service for their situation. Patients should stay in close communication with their providers to ensure they’re getting the services they need at the right time and in the way that is most appropriate for their needs.

I am grateful to live in a time when telehealth options are available. My own health has benefited from telehealth technology, and I have used these options to help increase my access to the care I needed while limiting the time I had to be away from my work or family. During this time of uncertainty, telehealth tools have an even greater impact in ensuring our communities and patients still have access to critical, and often urgent genetic services.

Find a genetic counselor to meet with you virtually or in-person at Billing practices vary from institution to institution.  For genetic counselors seeking support for telehealth billing, click here.   

 Jay Flanagan, MS, CGC, is the National Society of Genetic Counselors Reproductive Health Expert with a focus on infertility genetics. He’s a preconception/prenatal genetic counselor at Sanford Health in Sioux Falls, South Dakota.

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