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28 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING patient via phone call or video chat. This option, Dr. Habash said, keeps staff employed, keeps necessary patients minimally exposed, and keeps providers safe. It's also helpful for post-COVID-19 return to work backlog. You can have dedicated teams for these vis- its, she added. Dr. Habash discussed coding for telemedicine visits, as this continues to be updat- ed. She discussed video visits, phone calls, virtual check-ins, reviewing photos, e-visits, and doctor-to-doctor consults for both the consulting doctor and the referring doctor. The included chart provides a sum- mary of these services, which codes to use, and reimburse- ment for each. Editors' note: Dr. Habash has no financial interests related to her presentation. by Ellen Stodola Editorial Co-Director A n instructional course on Sunday featured in- formation from Ranya Habash, MD, Miami, Florida, about implementing telemedicine in practice. During her presentation, Dr. Habash highlighted some best practices for implementing telemedicine programs: • Engage office staff for admin- istration of telehealth and continuity of care. • Establish phone call routing, emergency calls, and route requests for telemedicine. • Be proactive; go through existing schedules to identify patients for telehealth. • Create telemedicine con- sent forms (there are many resources online for this). • Use video platforms, like Zoom, Skype, FaceTime, Dox- imity, and Microsoft Teams. • Engage patients with apps. • Use templates for telemedi- cine encounters. • Send email announcements to patients such as: "Great news! Your doctor is now offering telemedicine visits to keep you cared for during this crisis." Sometimes it's hard to visu- alize what's going on and what your office is going to look like in this sense, Dr. Habash said. She put together a chart (steps outlined below) for Bascom Palmer Eye Institute, where she's practicing, for how they are handling telemedicine workflow. Step 1: Providers designate patients who they think might benefit from telehealth by put- ting a yellow dot by their name in the schedule. Step 2: The scheduling people then call those patients and offer them telemedicine and send the enrollment in- structions. Step 3: Patient access people will confirm the ap- pointment about 24–48 hours beforehand, just like confirm- ing any regular visit. This step is crucial because you want to make sure the patient has the apps downloaded and they're ready to go. Step 4: Supervisors review physicians' schedules about 24 hours before the appointment and assign technicians and scribes to assist in the visits. Step 5: A technician assists the patient in getting on the video call and begins the work- up for the physician. Dr. Habash shared some of the "best-use" cases for tele- medicine in ophthalmology, which include new patient tri- age, patient follow-ups, acute/ ER triage, hybrid tele-visits, drive-thru IOP checks, virtual counseling, second opinion consults, resident/ER tele-staff- ing, remote exams, and patient monitoring. Dr. Habash discussed in depth some of the "best-use" cases. She first noted tele-tri- age and assisting transfers, emphasizing that this helps in being able to determine if the patient has an immediate need to go to the ER. Next, she discussed resident/ER staffing before moving on to highlight the possibility of some patients being triaged just by looking at pictures. Later in her presentation, she discussed the option for "hybrid tele-visits." These might be used when a patient has a medical necessity to come to the office for expe- dited, focused testing, like an IOP check for glaucoma or OCT for AMD monitoring. The physician would not be present for the testing but would later review the complete test re- sults and correspond with the Implementing tele-ophthalmology An overview of options for types of telemedicine services during the COVID-19 public health emergency with codes and reimbursement noted Source: Ranya Habash, MD

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