• Telemedicine is the use of two-way communication technology to provide health care.
• More people than ever are using telemedicine during the COVID-19 public health emergency.
• Following simple tips to prepare for telemedicine appointments can help ensure a useful and effective session with your doctor.
• Being open with your doctor about your symptoms is necessary to receive high-quality health care.

Telemedicine, or telehealth, is the use of two-way communication technology to provide health care services. While its use has been limited in the past, the U.S. Department of Health and Human Services (HHS) is encouraging providers to offer telehealth services more widely as a safer way to deliver health care during the COVID-19 pandemic. While telemedicine cannot be used for every aspect of health care, it can be an effective, convenient, and valuable way to access your health care provider.

Making Telemedicine Work for You

On May 29, the Pulmonary Hypertension Association hosted a virtual town hall to discuss how people with pulmonary hypertension (PH) or pulmonary arterial hypertension (PAH) can best prepare for a telemedicine appointment. Speakers included cardiologist John Ryan and Jennalyn Mayeux, DNP, a nurse practitioner and advanced practice registered nurse at the University of Utah Pulmonary Division. “Your telemedicine visit is yours,” said Dr. Mayeux. “It's your time with your care provider. It's your time to ask questions and have your concerns addressed. It’s the time to help keep you healthy.”

Some people with PH or PAH may need to visit a laboratory for tests, such as bloodwork, a lung function test, a six-minute walk test, or an echocardiogram, prior to a telemedicine appointment. Others may be asked to come to an in-person appointment after an assessment of their needs via telehealth.

Tips for Telemedicine Appointments

With a little preparation, you can ensure your telemedicine appointment is effective and useful. Here are some tips to help make your telehealth meeting successful:

	Have the meeting in a quiet place with privacy and good lighting.
	Make sure the device you are using — whether a cellphone, tablet, or computer — is fully charged and has a stable connection via Wi-Fi, internet cable, or your cellular service.
	If your internet connection tends to be slow, consider asking others in your household to suspend streaming, downloading, or online gaming activities during your appointment.
	Write down your questions for the doctor in advance.
	Keep a pen and paper handy to take notes, or ask a family member to attend the appointment with you and take notes for you.
	If possible, take your vital signs to share with the health care provider. If you have the ability, measure and write down your:
	Weight Temperature Oxygen levels on the pulse oximeter Blood pressure Blood glucose level, if you have diabetes or prediabetes
	Be ready to describe your recent PAH symptoms and any changes you have experienced.
	Note any changes to medication, oxygen therapy, or other treatments you have been using for PAH or other conditions.

If you live with extended family or roommates, it may be difficult to find a private or quiet space in your home. It may work to conduct the appointment in a parked car or garage, if you have access to one. Before the meeting, check to make sure you have a stable internet connection in this location.

Come Prepared and Be Honest

A health care appointment can only be effective when you are honest and open about the symptoms and side effects you are experiencing. This is just as important during a telemedicine appointment as an in-office visit.

Dr. Ryan drove this point home during the town hall hosted by the Pulmonary Hypertension Association. “Keep in mind that we can actually get a lot from your story,” he said. “When you come, come prepared as per usual, and then be honest if you're doing well. Tell us you're doing well if you're doing well, [and] obviously tell us if you're not doing well.”

Being open with your health care provider is the only way to get the care you need to stay your healthiest and feel your best. Many people are uncomfortable talking about their health problems, even with doctors. They may feel embarrassed or as though they are complaining or being bothersome. Since telemedicine is providing a new way to connect with health care providers, it can be an opportunity to change this habit and begin sharing full details about your condition with those whose job it is to take care of your health.

Addressing Concerns About Telehealth

Some people may have concerns about using telemedicine for the first time, especially if they are generally uncomfortable using technology.

Technical Difficulties

Keep in mind that technical difficulties are normal, even for those who are experts. Be patient and do not panic if the video freezes or the sound cuts out for a moment. You may need to repeat yourself or ask your health care providers to repeat themselves at times. If technical issues arise, your health care provider will work with you to resolve them.

If you will be using a video meeting platform (such as Zoom, Skype, FaceTime, or Google Hangouts) with which you are not familiar, consider practicing with a friend or family member in advance of the appointment. This will help you build familiarity and confidence with the technology.

Privacy and Security

Prior to the COVID-19 public health emergency, the Health Insurance Portability and Accountability Act (HIPAA) tightly controlled the ways technology could be used to share health information. On March 17, 2020, the HHS waived penalties for potential HIPAA violations against health care providers using “everyday communications technologies” as long as they are serving patients “in good faith” during the COVID-19 emergency.

The privacy and security of your health information depends largely on which technology platform you’re using for telemedicine. Direct phone calls and texted photos are easier to secure than other forms of technology. If you have been using your health care organization’s portal to share information with your doctor, this platform is just as secure as ever. If you have concerns about sharing particularly sensitive information with your doctor over a video communication platform, consider asking whether you could have a traditional phone call instead, or follow up a video appointment with a phone call to share any especially private information.

Telemedicine and Cost

In some cases, copays or other costs associated with telehealth appointments are the same as those for in-person visits. Some commercial health insurance companies are waiving copays for telehealth appointments. America’s Health Insurance Plans (AHIP), an organization representing insurance providers that cover hundreds of millions of Americans, has provided an alphabetized list of its members that have taken actions to address COVID-19. The list includes several providers that are waiving telehealth copays or expanding access to telehealth. Call your health insurance supplier to find out how they are covering telemedicine appointments.

During the public health crisis, the federal government has temporarily lifted restrictions to allow people using Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to more easily access expanded telemedicine services. Similarly, federally qualified health centers and rural health clinics have been cleared to provide telehealth.

For those on Medicare, in most cases telemedicine will cost the same amount as if they received the services in person. Note that the Medicare Part B deductible applies.

Telehealth: The Future of PAH Treatment?

Telemedicine is proving indispensable as a way to access health care while avoiding the risk of infection during the coronavirus pandemic. As people with PAH and their health care providers become familiar and comfortable with telehealth technology, it may prove useful in the future, even after the pandemic has come to an end.

“What we're hoping to see in the future is that telehealth medicine becomes a bridge to several patients,” said Dr. Moyeux. “Whether it's distance, or inability to get out of the house, or sheer convenience, [we’re hoping] to continue having payers cover these types of visits.”

Hopefully, expanded access to telehealth will become a trend that improves health care for people living with pulmonary hypertension and pulmonary arterial hypertension.

Have you used telemedicine appointments to access health care for PH, PAH, or other conditions? Share your experiences in the comments below or post on myPHteam.