🔒A new wrinkle to telemedicine: virtual-care clinics

As medical assistant Stephanie Orozco puts an otoscope in a patient’s ear in New Haven, Dr. Jasdeep Sidana, seated at his computer in another location, can see live images inside the ear canal.

He can see any signs of infection, make a diagnosis and prescribe medication — without ever being physically in the same room with the patient.

All patient-doctor interactions take place virtually at a new business Sidana launched earlier this year, a medical office called DOCSNow at 926 Chapel St., in New Haven.

“This concept as a standalone is absolutely unique, and it’s the first in the state of Connecticut,” Sidana said. “If I am a physician sitting in East Haven, I can see patients in any location.”

Patients at the New Haven clinic sit in an examination room with a technician, who uses Food and Drug Administration-approved technology from virtual care company TytoCare to capture medical data and imagery.

Patients can talk to the doctor via video while seeing the same live images the technology captures on a large television screen in the examination room.

Patients still check in at a front desk and go to an examination room, where their vitals are taken.

The only difference between this and what customers routinely experience at a doctor’s office is that the provider is virtually seeing patients with the help of technology.

Medical assistants at the clinic also use special hardware that allows the doctor to listen to a patient’s lungs and heart, or view the inside of their throats, for example, all in real time. The physician can then recommend treatments and write prescriptions.

Sidana’s DOCS Medical Group has locations around the state — including in Bridgeport, East Haven, Hamden, North Haven, Southington and Waterbury — providing both in-person and virtual care.

DOCSNow in New Haven is the first brick-and-mortar, virtual-only model the business is piloting.

Sidana asserts that a high percentage of patient visits can “absolutely be done as well” virtually as in person.

But he also acknowledges the limitations: you can’t give someone stitches or an injection virtually. He plans to hire nursing staff to provide in-person services like these.

The clinic can also refer patients to its sister locations, where on-site doctors can perform such procedures.

The virtual-only DOCSNow clinic is also not for emergencies. If a 70-year-old arrives with shortness of breath and low oxygen, DOCSNow staff would call 911 and tend to the patient until emergency personnel arrive.

“This is not to replace in-person care 100 percent,” Sidana said. “It is to give patients an option and an alternative.”

Leveraging technology

Sidana said he sees potential for expanding the virtual-only care model, and is looking at more potential locations in other urban areas that could attract more foot traffic.

Another DOCSNow location could open as soon as late 2023, he said, though he declined to specify where.

He also sees potential expansion using this technology in schools and businesses.

“We are able to leverage technology so we can examine an individual while they are at their job and can call in medication and prescriptions,” Sidana said. “I look at this as something that should be available in malls and at rest stops.”

Marinet Soto, site manager in New Haven, said the TytoCare devices and technology are “the new wave of medicine.”

“This (New Haven clinic) is the first virtual-only location,” Soto said. “The patients like it — it is downtown and in the center. We are starting to get patients who are regulars.”

Dr. David Emmel, a physician and ophthalmologist who chairs the legislative committee for the Connecticut State Medical Society, said he isn’t aware of any other virtual-only clinics.

The society supports telemedicine, and Emmel noted that it was used a lot during the COVID-19 pandemic.

However, Emmel said an ongoing patient and physician relationship is critical to the well-being and successful diagnosis of patients, and he expressed some reservations about the virtual-only clinic model.

“What if there is an acute problem and a trained physician isn’t there to do tests on location?” Emmel said. “If a physician isn’t there, such as physically palpating a patient, symptoms can be missed. A virtual exam is not the same thing. It makes me nervous.”

Telemedicine has been used for years, with physicians meeting patients virtually via video chats and telephone, computer or electronic device.

In 2021, approximately 37% of adults had used telemedicine within the past 12 months, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Dr. Pamela Hoffman, medical director of telehealth services at Yale New Haven Health Services and Yale Medicine, said Yale has been using technology for virtual visits since well before the COVID-19 pandemic.

Through Yale’s Video Care OnDemand telehealth service, patients can use their smartphone, tablet or personal computer to see a Yale New Haven Health clinician for a variety of minor, non-emergency medical conditions, from sinus infections and pink eye, to skin conditions, rashes, colds and the flu.

Through the service, Yale clinicians can diagnose symptoms and prescribe medication. Patient visit details can then be shared with primary care providers.

The idea is to be able to reach out to your provider whenever you are in need, said Hoffman, who predicts virtual healthcare technology will continue to advance.

“The technology will go even further,” Hoffman said. “So, much more can be done, and we will harness technology to provide treatment and care wherever.”

Debating rules, regulations

Lawmakers are still sorting out rules and regulations surrounding telehealth. Patients can visit several websites to access virtual care, such as through New York-based Teladoc Health.

State lawmakers this session debated a bill that would allow out-of-state healthcare providers to provide telehealth services in the state on a permanent basis.

It passed through the Public Health Committee and received significant attention and reaction from the healthcare industry, but the legislature didn’t take action on it by the end of the session.

State Rep. Cristin McCarthy Vahey (D-Fairfield), co-chair of the Public Health Committee, said it will be taken up again in the next legislative session.

“One thing we all agree on is ensuring that people have access to telehealth,” McCarthy Vahey said. “It is an issue of equity and prevention. There was more to the conversation than we could get to in this session.”

Layne Gakos, executive director of the Connecticut State Medical Society, submitted public hearing testimony indicating that the society is generally supportive of telehealth, but objected to allowing out-of-state providers to offer telehealth services in the state on a permanent basis.

The proposal, according to Gakos, would “open the flood gates of unlicensed, unregulated healthcare providers providing telehealth to Connecticut’s patients.”

Melissa Meyers, CEO of Generations Family Health Center Inc., submitted testimony in favor of the bill, as the center has locations throughout eastern Connecticut and employs providers based in Massachusetts and Rhode Island.

“Since the pandemic began, telehealth has become a key component to the delivery of accessible health care in our region, and is often the only care accessible to local residents who do not have transportation,” she said. “Many of our medical and behavioral healthcare providers conduct the telehealth visits from their homes, when they are working outside of the office, and those homes are out‐of‐state.”

As lawmakers debate the rules governing telehealth, healthcare providers will need to keep up with regulations to avoid running afoul of them.

In December, Sidana and his practice reached a $4.2 million civil settlement agreement with the state and federal governments to resolve allegations of improper medical billing.

The government asserted that Sidana and his businesses submitted claims for services that were not medically necessary, were not properly supervised by a physician, and were allegedly performed by Sidana when he was out of the country.