Virtual house calls: Telemedicine brings the doctor to you
About a month into the COVID-19 quarantine, Kelley and Thomas McCord and their one-year-old son, Thomas, had their first telemedicine visit with John E. Herzenberg, M.D., FRCSC, FAAOS, director of pediatric orthopedics at Sinai Hospital of Baltimore. 
Thomas was born with clubfoot (a birth defect in which a newborn's foot is twisted out of shape), and the McCords had been bringing him to see Dr. Herzenberg at his office on a regular basis.
Amid the COVID-19 pandemic, however, telemedicine quickly became a new option for McCord and many patients seeking care for reasons related and unrelated to the virus. Kelley McCord says that while it was "a relief to see and hear Dr. Herzenberg" for Thomas' routine check-up during the telemedicine visit, it "was tough feeling the reassurance I needed without having the doctor be able to touch and manipulate his foot."
"[Pediatric] physical examinations [via telemedicine visits] can be challenging because I do certain things where I have to have the parents do it, like move the foot up and down and change the camera angle," Herzenberg says. "It helps if there's more than one parent."
As healthcare delivery continues to evolve in response to COVID-19, providers at LifeBridge Health and around the world have been embracing a convenient, potentially safer option in telemedicine.
A saving grace of sorts at the height of the pandemic when providers were scrambling for safer alternatives to traditional care, telemedicine visits were used in a rather limited capacity pre-COVID-19. Some health insurance companies would cover only certain types of visits, and not all technologies were approved for telemedicine purposes.
However, in the early days of COVID-19, when many people didn't feel safe going to the hospital or doctor's office, or just wanted the convenience of seeing a doctor from anywhere as they do now, the use of telemedicine increased, and it appears it will play a vital role in healthcare delivery going forward.
The shift to telemedicine has been an adjustment for both patients and doctors. Some doctors, at the beginning of the pandemic, shifted their practices completely to telemedicine. Older practitioners found that telehealth could allow them to practice longer and more frequently since technology enables them to provide care right from the comfort of their own home in some cases.
Prior to COVID-19, Dr. Herzenberg had never done a telemedicine visit with a patient. About two months into the quarantine, he was seeing about half of his patients via telemedicine and the other half in his office.
"Sinai figured out that this is something of the future, so we had [telehealth] infrastructure set up about a year ago," Herzenberg says. "Of course, none of us took advantage of it. Until now."
When the pandemic broke out in early March, Dr. Herzenberg and his colleagues-like many other providers around the world-had to quickly make the jump to telemedicine in order to continue seeing patients. The technology was there, of course. They just had to turn it on and learn how to use it. "Now, the patient gets an email, gives consent for treatment, completes all the usual forms, and it all gets done," Herzenberg says.
If during a telemedicine visit it is determined that an X-ray is needed, the doctor can write up a prescription for the patient to get one at a nearby freestanding radiology clinic. Another telemedicine visit can be arranged to go over the results of the X-ray. Dr. Herzenberg, for instance, uses Zoom videoconferencing technology to share his screen with his patients so they can review the X-ray together.
Telemedicine visits don't always replace traditional office visits. Several months into the pandemic, new protocols and safety measures have allowed doctors to re-open their practices and see more patients in person. Under tightened procedures and protocols, the Sinai orthopedics team have begun seeing more and more patients in person and scheduling surgeries.
Still, telemedicine remains a good option. About half of Dr. Herzenberg's patients come from out of state, which for such patients makes telemedicine visits even more convenient and in some cases necessary. Telemedicine may also be efficient and convenient for things like routine visits and post-surgery follow-up appointments.
Telemedicine also offers a window into a patient's life at home. Sometimes there are other children, dogs and cats in the frame. "It adds some color to the whole thing," Dr. Herzenberg laughs, recalling a recent telemedicine visit with a family who had a new addition - a chicken.
LifeBridge Health offers telemedicine services across various areas of care. To learn more, visit lifebridgehealth.org/telemedicine. Additional information about telemedicine and pediatric orthopedic services is available at lifebridgehealth.org/RIAO.
**This article was originally reported and written by Kelly Swan in late spring 2020. LifeBridge Health editors added updates for publication in August 2020.