Doctor Patient Relations

How to Make Telemedicine Work for Your Practice

By David I. Geffen, OD, FAAO

Sept. 14, 2016

Prospective patients are hearing about telemedicine, and the convenience of “eyecare” from home is compelling to many. Telemedicine, in which communication and care are delivered from afar via online technology and mobile apps, also offers potential benefits to eyecare practices that jump on board early, in a way that protects patients’ private information. If delivered judiciously, telemedicine can offer important benefits to practice owners. My practice is discussing how, and whether, to use a new HIPAA-compliant app designed specifically for ECPs that facilitates telemedicine.

Most states allow billing for telemedicine “visits” as if they were happening in the office. However, you need to document the appointment as if it is in your office. And the patient needs to use a HIPPA-compliant service to do this and fill out the required paperwork on the site to verify their personal information. The billing codes would be the same as if the patient was seen in the office, coded most likely as an intermediate or brief visit.


Advantages to Patients

No hassle driving into office and waiting for an appointment.
No cost for parking, gas nor time away from business.
Scheduled time online at the convenience of both patient and doctor.

Advantages to Practices

Lighten the schedule with follow-up appointments and minor emergencies done long-distance and quickly.

Can bill the same as if in the office.

Most Common Telemedicine Patient Need
Sub-conjunctival hemorrhage

If you decide to try telemedicine to communicate with and care for patients, you must use a HIPPA-compliant site and app, like the one we’re considering using, CoolDoctors, which is HIPAA-compliant and designed specifically for eyecare providers. Sending and receiving communications and photos from patients via e-mail or text message is not secure. The messages can be breached by hackers, or an IT mishap, and then fall into the wrong hands, or even be made public. The sites and apps you use for telemedicine must not only be HIPPA-compliant, but in compliance with all state and federal laws. The doctor is ultimately liable for all interactions with patients.

The simplest way to begin to communicate and offer care via telemedicine is to sign up for a patient communication app and go through a platform that has proven to be secure. There are many hurdles to setting up a HIPAA-compliant online platform and app on your own, and unless you’re a computer wiz, it will be difficult and probably costly.

Face-to-Face, In-Person Isn’t Always Necessary

Telemedicine may be the next paradigm shift in healthcare, as well as for optometry specifically. Our schedules are getting burdened by many quick office visits for minor follow-ups. Many of these appointments could easily be handled by a video conference call.

For example, a patient calls and says they woke up with a bloody eye. Most of us have already–many times–diagnosed a sub-conjunctival hemorrhage. If they are a friend (not a patient), we often just tell them to text a picture or Facetime with us.

If not a friend, we have the patient drive to the office, hassle with parking and wait to see us while we squeeze them into our over-booked schedule. If the patient could set up a time to see us by video conference, it would take five minutes to see them and diagnose their problem. If the site is HIPPA-compliant and legal in your state, you can bill the visit as if they were in your office. You can set aside a specific time in your schedule to do these calls, and this allows the doctor to see many more patients than they would jumping from exam room to exam room, and with much less hassle.

Use HIPAA-Compliant Site to Receive Patient Photos

The only way to receive patient photos or video is by using a HIPPA-compliant site. There are new apps available, which provide the vehicle to use a HIPPA-compliant site, as well as providing the ability to do several online tests to check the patient’s vision and other problems. For example, CoolDoctors can check the visual acuity of the patient and take photos of the eyes. Future upgrades will test color vision and some binocular functions. CoolDoctors is an ECP-only app for telemedicine unlike almost every other telemedicine site and app, which are for general medicine.

There are a couple of ways to utilize CoolDoctors. One is to use it to do follow-up appointments or a consult with your own patients. The other is to use the site and app to attract patients who are looking online for help with an eye problem. Patients who are searching online for eye problems may come across the CoolDoctors site, and when they search they will look for a doctor in their area, or someone who is online to consult with. They can find you by the listing featuring your profile.
This is a huge paradigm shift in how we see and deal with patients, and many doctors have great fear of this type of technology. It is apparent to me that this is the way health care is going and optometry needs to get to the forefront in developing this technology. The difference here is the doctor is still in control of the situation and can go as far as they feel comfortable in its utilization.

Interact Live with Patients

The best way to use a telemedicine site or app is in real time, so you can directly Interact with your patient. If you are busy in the clinic, the patient can send photos or video and you can view these at a later time and respond to the patient by mail or do it live. You can utilize staff to do screenings and get the information to the doctor. If in doubt, then have the patient come into the office for confirmation.

Dr. Geffen’s shared OD-MD practice is exploring using CoolDoctors, a new app designed specifically for ECPs, that facilitates HIPAA-compliant communications and photo-sharing between doctors and patients. Dr. Geffen says it’s a secure way to allow for the long-distance communications between doctors and patients that is known as telemedicine.

Just Use for Follow-Up Care and Emergency Messaging?

My partners and I have discussed the ability to perform some of our follow-up exams by utilizing the CoolDoctors app. Many of our follow-up visits are to check vision and make sure the patient is doing well. Obviously, if we need a magnified view of the cornea, or to look at the lens and retina, we need to see the patient. However, there are many visits that are just monitoring visits which can be accomplished by telemedicine.

We have a 24-hour call service and always have one of the doctors on call. Telemedicine will enable us to take these calls through an app and be able to triage the patient at home. I believe we all should be available for emergencies.

Educate Your Staff About Telemedicine Dos & Don’ts

Our staff need to be educated about what telemedicine can and cannot do. We need to be aware that there are legal obligations as to what our staff tells patients. Staff needs to be able to sort through those patients who need to get in as soon as possible–and in person.

It is always difficult for our staff to determine who needs to get in ASAP instead of a regular visit. If there is doubt, the staff can set up a quick online visit with the doctor to evaluate the best visit. Staff can go through some of the online testing to help determine the nature of the problem. The doctor obviously needs to monitor and educate the staff for scripting, and to make sure the staff understands the testing.

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David I. Geffen, OD, FAAO, is a partner in Gordon Schanzlin New vision-TLC in La Jolla, Calif. Contact:


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