• Telemedicine is the use of two-way communication technology to provide health care.
• More people than ever are using telemedicine during the COVID-19 pandemic.
• Following simple tips to prepare for telemedicine appointments can help ensure an effective session with your doctor.
• Being open with your doctor about your symptoms is necessary to receive high-quality health care.
• If you’re receiving infusions of biologic medications for rheumatoid arthritis, your doctor may require virtual visits to protect you from infection.

Telemedicine, or telehealth, is the use of two-way communication technology to provide health care services. While its use has been limited in the past, the U.S. Department of Health and Human Services (HHS) began encouraging providers to offer telehealth services more widely in March as a safer way to deliver health care during the COVID-19 pandemic. While telemedicine cannot be used for every aspect of rheumatoid arthritis care, it can be an effective, convenient, and valuable way to access your health care provider.

Telemedicine for Rheumatoid Arthritis

The treatment of rheumatoid arthritis — a chronic inflammatory disease — requires frequent visits to a rheumatologist. Routine checkups are important in preventing disease progression and complications. For that reason, telemedicine has become a key part of RA care during the COVID-19 pandemic.

When Telemedicine Works Best for RA

Virtual RA appointments are most beneficial for certain aspects of rheumatoid arthritis care.

• Routine follow-ups — Doctors can observe joints and range of motion, look for swelling, or watch while people check their own joints.
• Refilling or adjusting medications — Based on the virtual exam, your rheumatologist can change, remove, or tweak medications to control symptoms and side effects.
• Discussing new symptoms or pain — If you’re having pain that wakes you up at night, makes it hard to walk or move, or prevents you from putting weight on a joint, a virtual visit can be the first step toward diagnosing a flare or a new condition.
• Physical therapy — If you’re feeling increased pain from disability or inactivity during quarantine, your doctor may prescribe movement therapy or exercise classes to keep joints moving. These sessions can be modified to meet your abilities.

How myRAteam Members Experience Telemedicine

Of the myRAteam members who’ve had telemedicine visits, most report positive experiences. Some say their doctors spend more time with them and actively engage in their care. Others are grateful for the ability to visit with a rheumatologist from the comfort and safety of their own homes.

“I had my first virtual visit last month. It went very well. I was able to discuss my concerns and could see and converse with my doctor,” shared one member. Another appreciated not leaving home: “I didn’t have to drive to my doctor or get dressed in any particular way.”

Getting medication refills via telemedicine is another big plus. “My doctor’s office is great and will refill my meds with no visit of any kind, as long as the risk of an in-person appointment is high for me,” explained one myRAteam member.

Virtual visits also reduce fear and worry for some myRAteam members. “My stress level went down 100 percent knowing I can stay in where it's safe!” posted one member.

But telemedicine is a big change, and not right for every situation. As one member explained, “I’ve had several appointments now online. Some worked well, others haven't.”

What To Expect From a Virtual RA Visit

Although doctors can’t perform a hands-on examination, they can assess your condition using several virtual techniques. These include:

• Inspecting and counting swollen joints (you’ll need to move close to the camera)
• Detecting pain and tenderness as you self-palpate joints
• Assessing range of motion and mobility by watching you perform certain small-joint movements — such as making a fist or gripping an object
• Asking questions about your mental well-being, sleep quality, and pain levels
• Discussing any lab results and medication side effects

They may also assess disease activity by having you fill out a questionnaire called RAPID3 prior to the exam. This, among other measurement tools, helps doctors assess inflammation and disease progression without taking bloodwork.

How frequently you’ll need to be seen virtually depends on disease severity and whether additional tests or treatments are required. Some people may need to physically visit a laboratory or hospital for blood work and imaging studies, prior to a telemedicine appointment. Others may be asked to come to an in-person appointment after a virtual assessment of their condition.

What Can’t Be Done by Telemedicine

Aside from hands-on physical exams, rheumatologists can’t give injections or infusions via online visits. Guidelines from the American College of Rheumatology, revised in May, note that the risk versus benefit of infusions is unique to each person. Talk to your doctor about the best options for you.

“My doctor doesn't recommend that people on biologics and infusions make office visits. So, I'll be doing a virtual visit,” said one member of myRAteam.

Tips for Telemedicine Appointments

While remote visits are safe and effective, there are some limitations. With a little preparation, you can ensure your telemedicine appointment is effective and useful. Here are some tips to help make your telehealth meeting successful:

• Have the meeting in a quiet place with privacy and good lighting.
• Make sure the device you are using — whether a cell phone, tablet, or computer — is fully charged and has a stable connection via Wi-Fi, internet cable, or your cellular service.
• If your internet connection tends to be slow, consider asking others in your household to suspend streaming, downloading, or online gaming activities during your appointment.
• Do a test run before your appointment. Check your audio, video, and internet connection. Log in to the designated platform at least 15 minutes before your appointment time.
• Write down your questions for the doctor in advance.
• Keep a pen and paper handy to take notes or ask a family member to attend the appointment with you and take notes for you.
• If possible, take your vital signs in advance to share with the health care provider. If you have the ability, measure and write down your weight, temperature, and blood pressure.
• Be ready to describe your RA symptoms, as well as any changes you’ve experienced since your last visit.
• Note any changes to RA medications or other treatments.
• Gather the labels or containers of all your medications, vitamins, and supplements. Be ready to show them, in case your doctor has questions about symptoms and side effects.

If you live with extended family or roommates, it may be difficult to find a private or quiet space in your home. Consider conducting the appointment in a parked car or garage, if you have access to one. Before the meeting, check to make sure you have a stable internet connection in this location.

Come Prepared and Be Honest

A health care appointment can only be effective when you are honest and open about the symptoms and side effects you are experiencing. This is just as important during a telemedicine appointment as an in-office visit.

Being open with your health care provider is the only way to get the care you need to stay your healthiest and feel your best. Many people are uncomfortable talking about their health problems, even with doctors. They may feel embarrassed or as though they are complaining or being bothersome. Since telemedicine is providing a new way to connect with health care providers, it can be an opportunity to change this habit and begin sharing full details about your condition with those whose job it is to take care of your health.

Here's a checklist of questions about pain symptoms a doctor may ask you during your telemedicine visit.

Addressing Concerns About Telehealth

Some people may have concerns about using telemedicine for the first time, especially if they’re generally uncomfortable using technology.

Technical Difficulties

Keep in mind that technical difficulties are normal, even for those who are experts. Be patient and do not panic if the video freezes or the sound cuts out for a moment. You may need to repeat yourself or ask your health care providers to repeat themselves at times. If technical issues arise, your health care provider will work with you to resolve them.

If you’ll be using a video meeting platform (such as Zoom, Skype, FaceTime, or Google Hangouts) with which you are not familiar, consider practicing with a friend or family member in advance of the appointment. This will help you build familiarity and confidence with the technology.

The doctor’s office will generally email you a link to register for the virtual visit or an app you can download. The app will connect you to a patient portal where you will be able to speak “face-to-face” with your doctor at your appointment time.

Before your meeting, look up your doctor’s phone number. Keep it handy in case audio, video, or internet connection fails on either side. Confirm with the doctor’s office that this is the correct number to call back in case of technical difficulties. If they need to see you in person to examine swollen joints or range of motion, ask about rescheduling the appointment.

Privacy and Security

Prior to the COVID-19 public health emergency, the Health Insurance Portability and Accountability Act (HIPAA) tightly controlled the ways technology could be used to share health information. On March 17, 2020, the HHS waived penalties for potential HIPAA violations against health care providers using “everyday communications technologies” as long as they are serving people “in good faith” during the COVID-19 emergency.

The privacy and security of your health information depends largely on which technology platform you’re using for telemedicine. Direct phone calls and texted photos are easier to secure than other forms of technology. If you have been using your health care organization’s portal to share information with your doctor, this platform is just as secure as ever. If you have concerns about sharing particularly sensitive information with your doctor over a video communication platform, consider asking whether you could have a traditional phone call instead, or follow up a video appointment with a phone call to share any especially private information.

Telemedicine and Cost

In some cases, copays or other costs associated with telehealth appointments are the same as those for in-person visits. Some commercial health insurance companies are waiving copays for telehealth appointments. America’s Health Insurance Plans (AHIP), an organization representing insurance providers that cover hundreds of millions of Americans, has provided an alphabetized list of its members that have taken actions to address COVID-19 safety. The list includes several providers that are waiving telehealth copays or expanding access to telehealth. Call your health insurance supplier to find out how they are covering telemedicine appointments.

During the public health crisis, the federal government has temporarily lifted restrictions to allow people using Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to more easily access expanded telemedicine services. Similarly, federally qualified health centers and rural health clinics have been cleared to provide telehealth.

For those on Medicare, in most cases telemedicine will cost the same amount as if they received the services in person. Note that the Medicare Part B deductible applies.

Telehealth: The Future of Rheumatoid Arthritis Treatment?

Telemedicine is proving indispensable as a way to access health care while avoiding the risk of infection during the coronavirus pandemic. As people with RA and their health care providers become familiar and comfortable with telehealth technology, it may prove useful in the future, even after the pandemic has come to an end.

“I’ve had good experiences with the virtual visits. I think this will be the future for our doctor visits,” shared a member of myRAteam.

Hopefully, expanded access to telehealth will become a trend that improves health care for people living with RA.

Have you used telemedicine appointments to access health care for RA or other inflammatory arthritic conditions? Share your experiences in the comments below or post on myRAteam.