ROJoson Telemedical Consultation

Date site created: March 17, 2020

ROJoson Telemedical Consultation

Trigger: Community quarantine in the midst of COVID-19 epidemic (President of the Philippines Rodrigo Duterte imposed community quarantine in Luzon effective March 17, 2020 - prior to this - Metro Manila community quarantine in March 15, 2020 - MEANING I have to stay home and patients have to stay home - I have to work from home to treat my patients - the only way is through TELEMEDICAL CONSULTATION)

Have been doing telemedical consultation when I started private practice in 1981 through telephones, through emails, and through facebook (starting June 16, 2011). Will now formalize it - ROJoson Telemedical Consultation starting March 17, 2020.

Backstory:

Seriously thought about ROJoson Telemedical Consultation in March 10, 2020 even before President Duterte imposed community quarantine in Metro Manila because I anticipated its need for my patients and for me. I expressed this in my FB post: https://www.facebook.com/rjoson2001/posts/10156685786550800

20mar14 - ROJoson Telemedical Consult or ROJoson Telemedical Consultation

Started thinking about this on 20mar10 in the midst of threat of COVID-19 in Metro Manila and will seriously pursue it starting today (have discussed over lunch today with my daughter who will help me set this up for me). This is in the light of threat of COVID-19 - there were 4 cancellations of booked appointments in my clinic in 20mar12 and 7 cancellations again today 20mar14.

Will publish the details of ROJoson Telemedical Consult or ROJoson Telemedical Consultation in a few days.

Face-to-face medical consultation in my clinic will still continue to meet the needs of my patients who want and are amenable to this arrangement.

Note: results of face-to-face consultation and medical evaluation are more accurate than telemedical consultation as I can directly see and feel the patient's body. Palpation of a patient's body particularly a mass is not possible with telemedical consultation. Palpation is an very important tool in the clinical diagnosis.

Best efforts will be done in ROJoson Telemedical Consult or ROJoson Telemedical Consultation.

In the face-to-face consultation, I would like to re-emphasize the importance of calling 85224713 for a booked appointment in my clinic (tuesdays, thursdays and saturdays), specially in the midst of COVID-19.

I have given instructions to my secretary NO BOOKING - NO CONSULTATION as we will not hold clinic (will stay home) if there are NO bookings for consultations.

I have also given instructions to my secretary - those with BOOKINGS but did not show up and did not cancel their bookings at least 2 days before will be billed accordingly. SO, please cancel your reservations at least 2 days before if you have to cancel previous bookings.

All the above measures are being taken in the midst of threat of COVID-19. My secretary and I will continue to serve the needs of our patients in the midst of threat of COVID-19. This will be done in the safest way possible for everybody, for all of us (including my secretary).

Welcome FEEDBACK.

Dr. Rey

Initial thoughts on March 14, 2020 (posted in FB):

Will establish an online system of booking - will consider regular schedule (Wed and Fri - 0900H to 1100H -30 min-, over-30 min-blocks)-and urgent schedule (by special arrangement) - with booking fee and consultation fee (to be determined yet).

Will consider use of video chat (through Messenger and Viber) - approximating ROJoson's face-to-face interactions with patients in the clinic - greeting; personal data; concern; symptom data; previous and past medical treatment; sign data (inspection and guided patient self-palpation); medical recording; primary clinical diagnosis; explanation; recommendations; informed consent and decision-making on treatment plan. A scanned medical record will be given to the patient. Will consider making a record of the video chat.

Online payment of consultation services (to be determined yet).

if there is a need for a face-to-face clinic consultation, this will be recommended. (Usual indications - need to do palpation of masses; preparation for operation; need for more in-depth evaluation)

Looking at this link:https://femaglobal.com/fema-telemedicine-consult/ for reference. https://femaglobal.com/fema-telemedicine-consult/?fbclid=IwAR2gV0_bpIZKXro7C6C4Gkv9ofamyVz5eupcNP3kh7nhOcqjahxKENTXkOE

Sample Tele-consultation Fees (from a Singapore company) to study and used as a reference:

General Practice Tele-Consultation Fees

• • Tele-Consultation Only up to 10 min – SGD$55.20

    • Prescription of each medication is chargeable

      • prescription of 1 medication on one script is SGD$18

      • prescription of subsequent medication(s) on same script SGD$10

  • Tele-Consultation Only to 15 min – SGD$65.80

  • Tele-Consultation Only up to 30 min -SGD$128.50

All consultation in excess of the booked appointment duration will be billed in 5 min blocks of $38.50

Related event that reinforced my plan to have ROJoson Telemedical Consultation

https://www.facebook.com/rjoson2001/posts/10156687789750800

20mar15 -

Already canceled a previously scheduled non-urgent operation on March 21. Thanks to the patient for the understanding (Michelle). We agreed to reschedule once the COVID-19 crisis has died down.

I was asked by the nurse when I cancelled the schedule on the reasons: I just said COVID-19. She accepted COVID-19 right away without asking further questions.

Yes, general answer for the reasons of cancellation is COVID-19.

Specific reasons:

1. To promote safety of everyone involved in the interaction (operation) - patient, hospital staff and myself - as nobody knows who are infected now - to promote "social distancing" and to abide by government advisory to stay home as much as possible.

2. To decrease the workload of the hospital staff so that they can have adequate rest and there will be enough standby manpower to assist the frontliner hospital staff when there is a surge of COVID-19 in the hospital.

Slice of enjoyment (accomplishment pleasure) - slice of my contribution in the fight against COVID-19 - particularly on "flattening the curve."

For the ROJoson Telemedical Consultation Project, I will use the reason of "To promote safety of everyone involved in the interaction (consultation) - patient, my secretary and myself - as nobody knows who are infected now - to promote "social distancing" and to abide by government advisory to stay home as much as possible.

Brainstormed with my daughter, Therese, on March 14, 2020:

Things to do:

1. Create a ROJoson Telemedicine FB account (will create a Google account - ROJoson Telemedical Consultation - created - 20mar17 - will use this solely for telemedical consultation - will not use Facebook - will try Hang-out or other Google apps for chats and video chats - tried it already with my daughter just 30 minutes ago - will use it instead of FB chat and other apps - can simultaneously use video and chat - patient has to use an email account though - will teach them to use email - email better for archiving medical records purpose rather than FB).

2. Inform people of TELEMEDICINE (will use "Telemedical Consultation" - will put a business name to it - ROJoson Telemedical Consultation - extension of my ROJoson Medical Clinic)

   1. What is it? (Telemedical Consultation is not a face-to-face medical consultation where the physician directly sees and touches a patient to evaluate his /her medical concern, then to make a clinical diagnosis and then recommendations for treatment. In Telemedical Consultation, interactions between the physician and patient for purposes of medical evaluation and medical recommendations are made through information technology such as telephone, email, Facebook, Hang-outs, and other online apps with no face-to-face interaction.)

   2. What are the benefits? (Answers will be the same as in No.3) - Addition: Patient Empowerment Program - Learn the right way to approach a medical consultation; learn how to palpate oneself

   3. How is it relevant? (Telemedical consultation is most relevant at this time (March 2020) because of the social distancing and community quarantine being imposed by the Philippine government in the fight against COVID-19. Telemedical consultation avoids face-to-face interaction between physician and patient thereby avoiding transmission of COVID-19 in case one party is infected. With community quarantine, where people are strictly confined to their houses, patients and physicians will have difficulty meeting each other face-to-face in the clinic, telemedical consultation can in general achieve the objectives of a face-to-face medical consultation, specifically, medical evaluation of the patients' concern and physicians' medical recommendations on management and treatment. Note though results of face-to-face medical consultation are more accurate than telemedical consultation as the physician can directly see and feel the patient's body. Palpation of a patient's body particularly a mass is not possible with telemedical consultation. Palpation is an very important tool in the clinical diagnosis. Note also that telemedical consultation that approximates the processes and procedures of a face-to-face medical consultation usually takes longer - usually double the time or longer, thus, more tedious.)

   4. Scope of RO Joson Telemedicine (ROJoson Telemedical Consultation approximates the standard ROJoson's face-to-face medical consultation with patients in ROJoson Medical Clinic - Greeting; getting to know the patient (personal data); elicitation of concern or reason for consultation; gathering of data to be used in arriving to a primary clinical diagnosis [symptom data; data on previous and past medical treatment; sign data - inspection (looking at the patient's body and pointed area/s of concern with still and video pictures) and physician-guided patient-self-palpation of areas of concern]; ROJoson doing medical recording in a stationary which contains primary clinical diagnosis; explanations; recommendations; discussion with shared decision-making and informed consent on treatment plan. A scanned medical record will be given to the patient. Patient shall acknowledge understanding and receipt of the medical record.)

   5. Procedure (See scope)

      1. Duration of session [choice of consultation blocks - initial or long consultation (30 minutes; 45 minutes; 60 minutes); follow-up consultation (20 minutes)] consultation)

      2. Cost

         1. Initial or long consultation: 30-min session, P3000; 45-min session, P4000; 60-min session, P5000

         2. Follow-up consultation: 15-min session: P2000

      3. Payment (all online)

• • • 1. Pay in full before starting the session

      2. Payment methods:

         1. PayPal

         2. Charged (to deposit in bank account)

Please send a screenshot of the payment for validation. Once payment is confirmed received, we will start the consultation.

1. Documents will be sent after the session (email)

2. Who can avail?

   1. Those with internet connection, ipad, laptop, android cellphones

   2. Those with Google account (Gmail and Hang-outs)

   3. HMOs cannot be accommodated

3. How do people book appointments?

• 1. Notify ROJoson of wish to have ROJoson Telemedical Consultation through cellphone (09188040304) or FB Messenger

  2. Process?

     1. Doc pwede consulta?

        1. Send availabilities

        2. Reminder on telemedicine

        3. Have them pay

     2. Send them a form (clinic form)

• • • 1. Full Name

      2. Address

      3. Cellphone #

      4. Occupation

      5. Date of Consultation

      6. Concern of Patient

      7. Any previous medical history?

4. Feedback forms

Tried ROJoson Telemedical Consultation using Facebook Messenger in March 16, 2020 using Facebook messenger.

Patient (a healthcare provider) contacted me through FB Messenger with this initial message:

for consultation patient: AR 28/F case: s/p pilonidal cyst and sinus excision (dec 16 2019) course: continually irrigated and packed twice a day (am,pm) with sterile gauze packing stopped 3days ago due to small caliber of openings/ postop holes ( left gluteal and medial) (gauze can no longer be inserted) currently: no discharge, no bleeding nontender but with induration induration noted to slightly decrease when packing was stopped concern: with prolonged sitting (2-3hrs or more): (+) sensation of vague pressure in the postop site but no pain, slight increase in induration but relieved with rest/lying prone/standing

She also sent me still and video pictures in FB messenger.

I studied the still and video pictures. I asked questions. Then, I made a formal medical report which contains my findings, primary clinical diagnosis, and recommendations. See below.

Questions and answers (Interactions) ensued. See samples below.

This telemedical consultation lasted for about 30 minutes.

ROJoson Telemedical Consultation - Basic Concept

approximating ROJoson's face-to-face interactions with patients in the clinic - greeting; personal data; concern; symptom data; previous and past medical treatment; sign data (inspection and guided patient self-palpation); medical recording; primary clinical diagnosis; explanation; recommendations; informed consent and decision-making on treatment plan. A scanned medical record will be given to the patient. Will consider making a record of the video chat.

ROJ@20mar17;20mar22