Intervention: Telemedicine Protocol
As part of the COVID-19 national emergency, the Office for Civil Rights (OCR) at the Department of Health and Human Services loosened the regulatory requirements under the Health Insurance and Portability and Accountability Act (HIPAA) to allow provider use of any non-public facing remote communication product to provide telehealth services.24 The earliest visits were conducted via Apple FaceTime, (Apple Inc., Cupertino, California, U.S.A.), keeping in line with the OCR’s notification of enforcement discretion during COVID-19. Following department implementation of an institution-licensed platform, BlueJeans (BlueJeans, Verizon Enterprise Solutions LLC, Mountainview, California, U.S.A.), video-based visits were preferentially conducted through BlueJeans, whenever possible. Faculty received training in BlueJeans via virtual telehealth training sessions and recorded demos from the Penn Medicine Center for Connected Care, the University of Pennsylvania’s telehealth center.
In the case where BlueJeans was unable to be utilized, video telemedicine visits were conducted by Doximity video dialer (beta, Doximity Inc., San Francisco, California, U.S.A.) accessible most easily on provider and patient smartphones or, as a last resort, Apple FaceTime (Apple Inc.). BlueJeans and Doximity both adhere to HIPAA recommendations with regard to security of protected health information. In all cases, patients were contacted by an administrative assistant from the office to assess capability for a video-based telemedicine visit, scheduled appropriately, and provided with instructions for accessing the visit. Just prior to the visit, a medical assistant called the patient via telephone to ask a series of intake questions and obtained verbal consent to conduct the video visit. The physician was then notified, and the visit was started. At the end of each video visit, the clinician stated that a research assistant would call to ask about the experience.