In early May, the UAB NF Clinic resumed in-person visits as the COVID-19 vaccine became widely available and cases decreased significantly in most parts of the U.S. However, due to the later resurgence of COVID-19 cases related to the Delta variant, UAB clinics were again encouraged to utilize telemedicine as much as possible to reduce viral transmission and protect patients. Before the pandemic, our NF Clinic had plans to integrate telemedicine into patient care. The explosion of the pandemic in early 2020 served to accelerate our adoption of telemedicine as a practical tool that allowed us to continue serving patients. As telemedicine continues to play an integral role in patient care in the UAB NF Clinic, I’d like to discuss the limitations and benefits of the technology as well as the potential role of telemedicine in the future of patient care.
Medical Licensure Restrictions Impact Telemedicine
During the initial phase of the pandemic last year, medical licensing restrictions on providing care to patients in other states through telemedicine were relaxed temporarily, allowing us to serve patients in some states outside of Alabama. These restrictions have subsequently been restored and, as a result, we can no longer see patients outside of Alabama using telemedicine.
Some patients have asked whether our inability to utilize telemedicine for patients outside of Alabama is related to concerns about insurance reimbursement for out-of-state patients. This is not the limitation, however. Rather it is related to medical licensing restrictions, which require a valid medical license to see patients in whatever state the patient is located in at the time of service.
UAB is exploring options to assist physicians in obtaining medical licenses in other states to enable more of them to see out-of-state patients using telemedicine. Because this has not yet happened for any physician in the NF Clinic, we are currently unable to utilize telemedicine for patients outside of Alabama.
Telemedicine Benefits and Limitations
During our high usage of telemedicine in the NF Clinic since the beginning of the pandemic, several benefits and a few limitations of the technology have become apparent. First, telemedicine works well in certain clinical circumstances when patients would otherwise travel a long distance for an in-person visit. For example, telemedicine works well to address specific patient concerns, arrange diagnostic testing, and discuss the results of imaging, genetic tests, and other diagnostic tests. For most of these types of visits that do not require a physical examination, there is no need for patients to spend time and financial resources traveling to the Clinic when the appointment can be handled more efficiently with telemedicine. Another benefit of using telemedicine for these types of visits is that the technology provides the capability to share my computer screen when explaining test results, which can’t be done as easily during an in-person visit. Finally, we can take a thorough history through telemedicine and can then make a judgement as to whether diagnostic testing is appropriate, or whether it is necessary to arrange an in-person visit. I suspect that some people put off seeing the doctor to investigate a problem until it gets too serious to ignore; having the simpler option of a telemedicine visit might allow the clinician to make a judgement as to how urgent it is to fully evaluate the problem.
Of course, the primary limitation of telemedicine is that it does not allow a complete physical examination to be performed. Telemedicine does not, for example, allow us to fully examine neurofibromas – not just to see them but to judge their size and consistency. There are also obvious limitations on doing a neurological exam by telemedicine.
It is important to recognize that some people have limited access to computers, the Internet, and smart phones, and also may experience connectivity issues, and these are barriers to utilizing telemedicine. This creates a potential health disparity by precluding some individuals from utilizing the technology to gain access to care. There are areas of Alabama that have particularly poor internet connectivity, something I hope will be addressed in the near future as the power of telemedicine and the importance of having the ability to connect to the internet is increasingly recognized.
Future Role of Telemedicine
Due to changes in the delivery of medical care during the pandemic, telemedicine has assumed an increasingly important role in patient care that will continue to evolve and expand well into the future. For both providers and patients, the use of telemedicine is a trade-off that provides advantages such as improved access and efficiency in certain clinical circumstances with the fundamental limitation of limiting the ability to do a complete physical examination. I am hopeful that the experience with COVID will bring recognition to the potential of telemedicine and perhaps, over time, lead to changes in medical licensing restrictions. This could be especially helpful to persons with NF, since NF clinics are concentrated in large cities with academic medical centers, and therefore many people in rural areas or smaller towns do not have the same access to care. For many patients with NF, telemedicine offers a long-term benefit of accessibility to specialized care that helps to overcome this potential obstacle.
