Video doctor visits gain ground during coronavirus pandemic
By American Heart Association News
Dr. 10年前，戴维·惠勒(David Wheeler)在怀俄明州的神经病学诊所开始通过远程医疗为病人看病，为生活在偏远地区的病人提供常规就诊. He'd see three to four patients by video or telephone chat each day, which only made up about a fifth of his regular practice.
Then the new coronavirus began to spread across the nation. Now, even though Wyoming has a relatively low number of positive COVID-19 cases, he said, every patient is being rescheduled to a virtual visit. His staff works from home.
“我们试图不重复其他人的错误”，等待太长线上电子游戏飞禽走兽来限制社区曝光, Wheeler said. "We are doing all encounters virtually now. I expect to be doing this for several weeks or months."
This is telemedicine's moment.
Already on the rise prior to the current public health crisis, it is fast becoming a critical tool in preventing exposures, 以及释放卫生保健工作者和用品，以减轻受灾严重地区卫生系统的压力.
At Boston Medical Center, 波士顿大学医学院的教学附属机构，也是新英格兰最繁忙的创伤和急救服务中心，在新型冠状病毒爆发之前，远程医疗很少被使用.
"We had no clinical capability for this," said Dr. Rebecca Grochow Mishuris, 他是BMC的内科医生和副首席医疗信息官. "We are now fully up and running with telemedicine. We did it in 48 hours."
米休里斯说，BMC现在每天安排约1500次电话问诊. They've also started video chat visits.
联邦政府在3月中旬放宽了HIPAA规定，允许医疗保险报销使用诸如 Skype, FaceTime and Zoom. And in 42 states and Washington, D.C.在美国，私营保险公司被要求至少提供部分远程医疗服务. Wheeler said private insurers in his state are beginning to follow suit.
"We now have a reasonable expectation that we can get paid," said Wheeler. “这有助于我们保持大门开放，因为我们也不得不停止提供选择性手术，这导致我们亏损."
People having symptoms of a heart attack, stroke or other health emergency should still call 911. 但对于那些想知道何时使用电话或视频访问而不是亲自访问的人, experts say people should call their physicians, who are making decisions case-by-case.
“我们不能通过电话或视频来做所有的事情，但我们可以做很多事情，”米休里斯说. "A patient can show you a rash, you can see if they are breathing too quickly, if there is a facial droop. 很多医学只是听取病人的病史，了解他们目前的状态，以及他们认为自己是如何到达那里的.
"In the current situation, we might say come in in three months but call me if x, y or z happens," she added.
通过音频或视频就诊的医生将指导患者如何呈现症状, Mishuris said – even if they can't see them. For example, “他们可能会让你在镜子前张开嘴，伸出舌头，告诉我们你看到了什么. 但如果我们在这次访问中听到什么让我们觉得你需要进来, we'll tell you and we'll explain the risks to you."
Likewise, Kaiser Permanente, which had been greatly increasing its use of telemedicine for several years, has moved to using telehealth visits as a default.
"Our doors are still open to patients who need to be seen," said Dr. Edward Lee, 他是北加州凯撒永久医疗机构和永久医疗联盟的远程医疗负责人. "But we're trying to shift every initial visit to telehealth."
他说，那里的医生首先通过视频看到病人，以进行初步评估. Then, using clinical judgment, 他们决定哪些需要通过远程医疗治疗，哪些需要亲自就诊.
“你必须权衡病人外出接触病毒的风险，以及他们所呼吁的情况," Lee said.
他说，不懂技术的患者不应该担心尝试远程医疗. “好处是，这不是一项复杂的技术，而且几乎普遍可用. All you need is a smartphone. Most people have that."
李说，对于那些不知道的人，还有其他方法可以远程与医生沟通. Regular phone calls made from landlines can be scheduled. Kaiser Permanente还“每年与患者进行数百万次安全电子邮件通信”. We can answer questions to many common health concerns in this way."
编者注:由于围绕冠状病毒的线上娱乐电子游戏网站迅速演变, 本文中提供的事实和建议自出版以来可能已经发生了变化. Visit Heart.org for the latest coverage, 并向疾病控制和预防中心以及当地卫生官员咨询最新的指导意见.
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