Just like you need a stethoscope in order to be a proper urgent care provider, you will need the right telemedicine gadgetry. Unlike the stethoscope which is mostly a decorative piece worn around the neck, the tech needs to be spot-on in order to make your work easier.
In this post I’ll talk about the technology I use to do my telemedicine work. I have it optimized to make my work as easy as possible. However, it’s become even more important to have dependable technology. Some redundancy is helpful if you rely on telemedicine for your sole income.
Telemedicine is done either by text, email, telephone, video. By far the toughest ones to suffer through are the video visits. These are both hardware and bandwidth intensive.
Video visits are often done to circumvent certain laws in certain States which won’t allow a visit to be legit unless it’s done by video. Patient preference is another one, though most who are used to telemedicine soon opt to avoid video due to how intrusive and ineffective it is.
Video visits don’t allow a good enough resolution for evaluating lesions or other physical findings. Taking a picture will be of much higher resolution and much easier for most.
It’s tough to navigate HIPAA laws when using traditional text messaging apps. You and the patient can always choose to use standalone apps (ohMD) especially if the image is of the face or private parts.
Not only is a good connection necessary but you need a good video camera and microphone. I recommend at least 10 Mbps download speed and 5 Mbps upload speed. You can get away with less but then it’ll be hit or miss.
This is really easy since most of us have done it since residency. However, it actually has gotten harder to do a good job with telephone visits since technology has been getting in the way. I’ll explain below.
The biggest issue is the kind of microphone you use or the speakerphone feature. Both of these can create a lot of static which the patient may not even be aware of but will certainly wear them down and in a subtle way frustrate them.
Some microphones will pick up every bit of noise from the cords rubbing against your shirt or transmit the hiss of your breath. As soon as you turn your head in one direction your voice drops off, when you turn back then the sound is too loud for the patient.
Then there is the issue of caller ID blocking. Not to mention having to dial each and every patient by hand which can be quite tedious. Call centers overcome this by having software which automatically connects the caller to the patient, picks up their voice and even transcribes what they say. Unfortunately, nothing like this is available as far as I know for telemedicine platforms.
Text Based Telemedicine Visits
Neither you nor the patient really wants a text-based interaction. But guess who does? Data-hungry companies. Data is everything. Data is the future.
Clean data is what you and I input through text. Dirty data is what we filter out and then transcribe into a note. Companies want the raw data, the clean data. This is often worth more than the visits themselves.
In text-based telemedicine you can share videos or images. Everything is supposedly HIPAA compliant and it’s the least technology intensive of the various telemedicine visits methods.
There are a few companies which are doing an email type of visit. Basically, the patient has all the data collected from them, it’s packaged up and then emailed to the clinician. She then clicks on a few links and sends the email back, either approving or denying the clinical management option.
It’s so easy to treat technology the way the big companies want us to treat them – as disposable fad products. They are incredibly resource intensive, terrible for the environment, horrible for societies tasked with manufacturing them and pose an endless list of health concerns for the user.
With the above in mind, it’s important to buy something that’s versatile, ideally upgradeable, or at least not likely to be obsolete in the next few years.
Telemedicine Gadgetry: Computer
I prefer a laptop because I do a lot of my work from a coffee shop. I can’t do my video visits from there but my text-based visits are really enjoyable to do from a cafe or a library.
A laptop can be easily hooked up to an external keyboard, an external mouse, and an external monitor. I haven’t had a need for external accessories with my little MacBook. I bought a last-year-model on Amazon for less than $1k.
You won’t need the computing speed of a Macbook pro. So a Macbook Air or Retina (my model) should suffice.
I do recommend a 2nd laptop. You could go with a PC if you want to stay versatile. The HP or Dell models are decent though it seems that the IBM Thinkpads are likely to last longer. The advantage of getting a 2nd laptop identical to your first is that you only need to buy 1 set of accessories which may be device specific.
American Well uses Mac OS’s FaceTime software to do video visits. I must say that this has been incredibly reliable except for when my internet speed drops off. However, they have video software for PC users as well.
So far, I don’t know of any company that requires you to have a specific operating system.
Overall, I am content with my MacBook Retina (2016) for doing the majority of my telemedicine visits. It is light, durable, dependable, and easy on my fingers and eyes. It hasn’t been very friendly on my neck because the screen doesn’t tilt back all too much. Due to its small size I also tend to assume the sniffing position often to see the screen better.
I do a fair bit of voice dictation on my MacBook. If I have a screen open then I just dictate unless I am listening to music in the background. This can be a huge time saver and give your wrists a break.
I have to use Kaiser’s HP EliteBook because the emulated VPN is very slow on my MacBook. The screen is huge and tilts back all the way – the bigger screen makes a massive difference in my opinion. For that reason, I would advise going with at least a 13″ screen, depending on how much telemedicine you do.
Your laptop should have a single audio/mic port since that’s what a lot of the wired headsets use. And it also should have bluetooth. Plenty of laptops out there don’t ship with bluetooth, sometimes for security reasons. You obviously will want a camera and built-in microphone.
I have a set of wired $150 in-ear headphones with 3 buttons. 2 buttons allow me to control the volume and 1 allows me to activate my phone’s “smart” features. These are made in Colorado and supposedly repairable (though I found out that when they broke down the company just replaced them).
When you have to call 25 patients in 5 hours, it’s nice to not have to unlock your phone every time and dial each patient’s number. Instead, I press the smart button and say “dial five-zero-three…” This way I can call up the patient and my hands never leave the keyboard.
When I do video visits I actually take the headphones and plug it into the laptop. Patients prefer when their clinician has headphones on because then they know that nobody in the background can hear them. And of course, your voice will be clearer to the patient’s ears.
I have a $500 bluetooth over-the-ear headset as well. Incredibly expensive and incredibly comfortable. I bought it because it’s made in Germany and because I think it will last me for decades.
Avoid using the speakerphone feature on your devices. The sound quality isn’t good and the delay is annoying. The more professional you sound the more likely it is that your patient will take you seriously.
I regret buying the wired headphones for several reasons. Looking at the new technology coming out, ports are a thing of the past. One of my work phones doesn’t even have an audio plug-in. So, even though bluetooth technology means battery technology which means even more crap that will end up on landfills one day, I would advise you to stay away from the wired headphones and go for bluetooth.
Caller ID Blocking
I am not as sensitive about my patients having my cell phone number as others around me. Clinicians go through great lengths to block their caller ID but 99.99% of patients are incredibly respectful and wouldn’t dial back their provider’s number.
Perhaps it’s a bigger deal for psychiatrists and that would make sense. For the rest of us I would advise either of these 2 options:
- Dial *67 before calling a patient with your cell phone
- Get a Google Voice Number
Using the *67 feature to disable caller ID isn’t as convenient as you might think. When you call elderly individuals they usually will have their phones reject your call in order to prevent calls from unwanted telemarketers.
Quite a few individuals will also have people they don’t want to talk to or bill collectors. For that reason they won’t pick up your call when it says “Unknown Caller”.
Most medical groups will require you to block your outgoing number for malpractice reasons. There are free apps you can use which will mask your number and have a different outgoing number – one example is doximity.
Google Voice Phone Number
You can sign up for a free Google Voice Number which will allow you to make free calls and it comes with an app for your phone which acts very similar to your native dialer app.
The above is the option I choose. I can disable all incoming calls so that the patient cannot contact me back. It’s also the number I use to have patients send me pictures of whatever is relevant to their medical condition. There are ways to make this process HIPAA compliant such as accessing it from a HIPAA compliant device, etc.
Another huge advantage is that you won’t use up your minutes since GV is a VoIP. This means that only data is used to make the calls.
Most smartphones these days will do everything you need them to in order to carry out a telemedicine visit with a patient. Even an old iPhone 5 will be more than adequate.
In the States I had Ting as my cell provider and have been incredibly happy with them.
You need a front facing camera and bluetooth connectivity. If you have an iPhone then you have the added advantage of placing calls hands-free. I realize that Android is also supposed to have this feature but it has never worked for me.
The current form of hotspot technology is that you select an option on your cell phone which allows you to share the cellular data with your laptop or desktop.
I recommend having this option for times when your home internet connection goes down, you lose electricity at home, or your laptop and router refuse to connect over the right frequency.