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Due to the Coronavirus pandemic, there has been a rapid increase in virtual visits between patients and their providers to ensure they continue to get the care needed during these difficult times. Returning guest Sarah Vogler, MD joins Butts & Guts to discuss how virtual visits work, the benefits of these appointments, and how Cleveland Clinic is using them to stay connected with patients.

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What to Know About Virtual Visit Appointments

Podcast Transcript

Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi again, everyone, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, the Chairman of Colorectal Surgery at the Cleveland Clinic in beautiful Cleveland, Ohio. And today I'm very pleased to have a returning guest, Dr. Sarah Vogler, who's the Section Chief for Pelvic Floor Disorders in the Department of Colorectal Surgery here in Cleveland Clinic Digestive Disease & Surgery Institute. Sarah, thanks for joining us on Butts & Guts.

Sarah Vogler: Thanks for having me.

Scott Steele: We all understand that Coronavirus has disrupted our daily listeners' lives, and these are very uncertain and obviously very scary times for a lot of people. And so I know I speak on behalf of both Sarah and I to say, we want to thank all of our listeners out there who are working in not only the healthcare environment, but also in multiple different jobs within our communities to try to help out those in need.

And as the COVID-19 health crisis continues to evolve, just a subtle reminder to remember that the Cleveland Clinic facilities, the emergency departments, are open. We are committed to keeping our patients safe and having our hospitals be amongst the safest hospitals in healthcare, so patients can get the treatment they need when they need it.

And what we're going to talk about a little bit about today is another different opportunity to reach out to your healthcare provider, and that's in addition to in-person appointments. There are other options for connecting with your healthcare provider. And I would say COVID-19 has accelerated this, but this is something that we're going to call virtual visits, including here at the Cleveland Clinic, where we do anywhere between 5,000 virtual visits a month to upwards of 200,000 virtual visits in a month.

And now, Sarah, you recently published an article in the British Journal of Surgery discussing the emergence of these virtual visits for surgical patients, as well as kind of the aspect of this, as well as the practical importance in it. So thank you again so much for joining us, and that's where we're going to discuss a little bit about today. So I recognize that you've been on Butts & Guts before, and with that longer introduction, I would like you just to set the background for our listeners, first by telling us a little bit about you again, and then also give us a little bit about a background in terms of what is a virtual visit, and how does it work?

Sarah Vogler: So I've been at the Cleveland Clinic almost a year now, and I'm part of the Department of Colorectal Surgery, Section Chief for Pelvic Floor. So I work a lot with patients who have pelvic floor disorders, such as prolapse incontinence, constipation, and it's been great to be part of such a dynamic department, wonderful colleagues. It's been an interesting year because of COVID, so it's changed the way everybody practices medicine. And virtual visits has been one of the key drivers to being able to take care of patients during this pandemic. Virtual visits are essentially a video chat visit between a patient and their caregivers. So this maybe a fancy FaceTime phone call with your provider. There are different platforms that are being used, but it allows you to continue to have interaction with caregivers and provide medical advice and care without having to be physically at the clinic or in the hospital.

Scott Steele: So along those same lines, is it really practical to have a health care visit with your doctor? Don't doctors need to always be able to put their hands on you and listen to your lungs and your heart and to do a belly exam and, in our case, aren't there are other aspects of a kind of more sensitive examination? How do we get to that virtually?

Sarah Vogler: So this has been a big shift, I think, for everyone, patients and caregivers, because we're very used to having that interaction. But there is a lot that can be covered on a virtual visit, even if it is just an introduction type visit, and then it's going to follow with some sort of in-person visit. But you can glean a lot in talking to patients and hearing what their main concerns are, what their problems are, kind of prioritizing what needs to be focused on and worked on if you were to come for an in-person visit. There's also been some creativity around how you can do an exam on a patient virtually. You start to learn, after doing a few of these, how much you do just rely on looking at a patient and hearing what they're saying, how that plays into your exam. So when you're watching them on a video, you can essentially do a full head, neck, and neuro exam in some ways just during that discussion.

And then you can obviously ask the patient to sit, stand, walk around. They can show you what's hurting. For the most part, you can do an abdominal exam, obviously without touching them, but they can show you incision, scars, points of tenderness, what causes the tenderness, if they twist or turn, how they have tenderness. So you can still elicit a lot from a physical exam. I think there's still some hesitancy as to how good is that exam and, obviously, it doesn't reach the standards of being face to face. And there's certain things you still just can't do, but it can allow you to start mapping out a care pathway for that patient so that when they do come in person, you can be very efficient with their time.

Scott Steele: Yeah, I think that's critically important aspect and well said, the fact that in certain cases there are things you can and can't do, and we're cognizant of those. But in many cases, there's a lot more knowledge that's been gained through virtually and then just using that as a starter for the next visit. So, truth or myth, I'm not very tech savvy. I got a little bit of an older phone or older computer, and I can't do a virtual visit.

Sarah Vogler: Well, probably more of a myth than a truth. During the pandemic, we've allowed multiple different platforms to be used, including even telephone visits. And there's certain parts of these rules that have changed that will probably flip back to a "more normal" sense of having caregivers interact with patients. But for right now, it's almost any way is possible to communicate back and forth with your caregiver. So even if you do have old telephone, it's not a smartphone or you're not savvy enough with your computer, this is still an option for you because you can just communicate by phone.

Scott Steele: Along those lines, I have a 92 year old at home and has maybe an older smartphone, but a lot of times these patients just like to bring families in first, and they have families with smartphones. What is the Cleveland Clinic, and what is our department, for example, doing that kind of help facilitate these and to kind of introduce and get the computer and the phone set up for a virtual visit?

Sarah Vogler: So one thing that you were touching on there is almost everybody has somebody around who's tech savvy. So sometimes you can use nephews, nieces, siblings to help you if you need it. And the Cleveland Clinic has launched a new platform for our electronic medical record using Epic, which is a Zoom based platform. Again, this is a virtual visit, but it walks patients through how to connect to their doctor. So the minimum that a patient needs is to have access to their MyChart account, which is kind of their personal medical record that's electronic. They will log into the MyChart account and then they receive step-by-step instructions as to how to set themselves up for a virtual visit. And for the most part, this is very easy. I know that's easier said than done in some ways, but we have an entire tech team that's available to help patients if they start this process and have difficulty. We're also training a lot of other support staff and nurses, so there's a lot of different touch points before that actual virtual visit takes place to allow patients to ask questions.

Scott Steele: Sarah, can you talk about some of the initial data, and this is being tracked, not only here at the Cleveland Clinic, but worldwide, in terms of what patients think about a virtual visit? Are there other benefits to a virtual visit?

Sarah Vogler: Yeah, I think virtual visits are going to be here to stay both from patient's standpoint, from their family members' standpoint, and from caregivers' standpoints because they're very convenient. There's no traffic. There's no crowds. There's no COVID. There's no exposure to anything else that may be happening in a healthcare type of environment. So, for instance, you can have a consultation with a new patient about a new diagnosis, and they can actually bring in their son or their daughter or somebody else who may want to be part of that discussion who, in other circumstances, may be in a different state or a different time zone and wouldn't be able to be physically present in person. So it allows a lot more convenience than having these in-person visits. It doesn't replace the in-person visit, but it can answer a lot of questions without having an in-person visit that's followed up by multiple different phone calls and different... the telephone game of the patient trying to tell three people what needs to happen next.

Scott Steele: Yeah, I think I've been surprised about how much the patients themselves have said, "I really like that. I didn't have to get in my car and drive and park and pay and do this, that, and all the other thing." And it's been a very eye-opening experience for many of us on the provider side.

Sarah, some of the other concerns that have come up maybe you can address these, is that I've heard patients say, "I don't really want to do a virtual visit because I don't want the security issues... If people are going to be able to see what I'm doing and everything." What is the security behind virtual visits?

Sarah Vogler: So the virtual visit platforms have been developed for health care are completely HIPAA compliant and secure, so there shouldn't be any concern that the video is going to be available out there on the internet. That is being followed very carefully, that it's not a recorded visit. So the recording still takes place based on what the provider writes down in the medical record. There is not a video that's being recorded. Any type of photographs or whatever the patient shows you, none of that is being actively recorded. And it is all under a secure network that's being monitored continuously and upgraded. I think that's of the utmost importance that people feel secure in having these visits. And they should be just as assured that it's safe to come to the hospital, it's also very safe to have a virtual visit.

Scott Steele: Okay. So, I'm a patient out there, and I was skeptical of these virtual visits and listen to this podcast has kind of got me to the point where I can say, "Fine, I'll give it a try." So walk our listeners through what takes place in reality. What am I going to experience? What do I got to do? What is this like? So you give them a little sneak preview into what a virtual visit encompasses.

Sarah Vogler: Sure. So this is much easier than trying to figure out where to park and where to go. Basically what's going to happen is that you would be given, for example, an appointment with Dr. Steele at two o'clock this afternoon. Once that happens, you'll receive a message through your MyChart, if you're part of MyChart, that welcomes you into MyChart. You log into the account, and you can complete a pre check-in process. This takes about five minutes. It basically asks you to update who you are, where you live, what medications you take. And once that pre check-in process is complete, you're ready and set for that visit.

So at that point, you just wait until about 15 minutes before the visit. Log into your MyChart account, click on the little icon that says appointment with Dr. Steele. And then that will bring you to another area that you click on and basically says, join the visit. So they're ready and waiting. And then once you join the visit, you can start having the conversation and going through the motions. You can also invite different people. So if your nurse wants to be on the visit, your physician assistant, some of their family members, there can be multiple people on that visit.

Scott Steele: Yeah, very, very interesting stuff. And so is there any other kind of final take home messages for our patients or any of our listeners out there with regards to future technology or future of virtual visits, and kind of how you see this going forward?

Sarah Vogler: Yeah, I think it's here to stay. And I think with this option, patients really need to be mindful that they don't neglect different health problems. So I know it's easy to be scared and not want to go to the hospital or think this is just an easy, simple problem. I'm just going to deal with it later. Virtual visits are going to allow you to see your provider when you need to see your provider. So don't neglect anything at this point. Go ahead and call, have a virtual visit. If nothing else, that virtual visit will help you to understand where you need to go, what tests need to happen, so that when you do have an in-person visit, it's as streamlined and as efficient as possible. It'll also keep you from having to take extra time off work. I mean, you can do these visits in the time that they're scheduled. There's no extra time needed on either end of the visit.

Scott Steele: And, to kind of finish up here, it should say, are there any limitations to a virtual visit that make more sense for a patient to come in for an in-person appointment?

Sarah Vogler: There's certain things, obviously, you can't do via virtual visit. So I can't physically touch the patient. I can't do any types of scopes or tests, but in general, you can normally start with a virtual visit so that when you do come in for that in-person visit, you can kind of march through those things pretty quickly. So I'll typically have a virtual visit and then have the patient, when they do come in, be scheduled to have labs and imaging tests, and perhaps a consultation with another, say a gynecologist and myself, so that they can knock out four different parts of me figuring out what the underlying problem is at the same time, rather than coming back and forth for four different visits.

Scott Steele: So that's absolutely fantastic stuff. And I encourage everyone out there that if you want more additional information, kind of on healthcare, as Sarah says, this is not a time to ignore your health, your problems. As a matter of fact, we're trying to look at all opportunities to open up access and to facilitate you getting your medical care out there. If you're going to come into one of our Cleveland Clinic facilities for an appointment, or you want to do this virtual visit, and you want to first and foremost understand what are we as a healthcare institution doing to keep you safe, I recommend listening to our series of Butts & Guts podcasts regarding the Coronavirus pandemic. And I just want to reiterate the importance that you should go to doctor's offices and hospitals, or set up this virtual visit for standard appointments, preventative screening and, of course, any critical care issues in there.

For more information on connecting with the Cleveland Clinic for virtual visits, second opinions, and online healthcare management, please visit Clevelandclinic.org/access. That's Clevelandclinic.org/A-C-C-E-S-S. And to speak with a specialist in the Digestive Disease & Surgery Institute, please call (216) 444-7000. That's (216) 444-7000.

Finally, in times like these, it is absolutely important to keep up with your medical care, and rest assured here at the Cleveland Clinic, we're taking all necessary precautions to sterilize our facilities and protect our patients. Sarah, thanks again for joining us on Butts & Guts.

Sarah Vogler: Thanks!

Scott Steele: That wraps things up here at Cleveland Clinic until next time. Thanks for listening to Butts & Guts.

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Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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