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.