What Telehealth Offers and How It Works

Tim: Welcome everyone. My name is Tim Begley. I'm here with Iyad Salloum. He is a physiotherapist who is offering tele-health. So I'm excited to find out more about telehealth and exactly what it is. So Iyad, please tell us what is telehealth? 

Iyad: Yeah, thanks Tim. So basically when you go see your doctor, your physiotherapist, your chiropractor, any practitioner, really, your assessment, you know, for a new injury involves, you know, a little conversation about what happened and the patterning of it and how it's affecting your life. And then, you know, they proceed to assess you and provide you with some kind of treatment ideas and treatment plan. 

Tim: Normally it's, you go in person. As a person. 

Iyad: Yes. Yes. You'd hope so at least. And then I'll, you know what, this is, what tele-health allows us to do is deliver that same kind of a service just to be a different medium. So we're using either a video conferencing platform, kind of like you and I are doing here, or just over the phone and it really just, maybe cuts out some aspects of the in person contact, but maintains that the meat and potatoes of this whole interaction, which is, you know, what can you do about your injuries and what can you do about your own function and recovery?

Tim: Right. So instead of someone actually, you know, going, attending a clinic. They would from their computer, from their home, they would hop on exactly like what, this is, which is a conversation, right? Whether it's a video or phone call but they'd have a conversation and then, so then you'd be, I guess you'd be asking them, would it be the exact same questions as if they showed up in person.

Iyad: I think it would be more or less the same. There might be a little more focused on the patterns of this, because it's one of our main diagnostic tools that we have. And to assess you properly is, you know, that the subjective history, the history of the complaint and the patterns of it. So yeah, I think it's, although it's different, it's more or less the same. 

Tim: Right. Right obviously it's not exactly the same, but similar questions. That's awesome. I know a lot of people are very excited about this right now, and you know, but there's a lot of practitioners who are starting to offer it from like a client perspective, from a patient perspective. Do you think that people will be successful even though they're just tuning in from their home from their computer. They're not actually coming. You can't actually, you know, see them. Do you think people will still be successful? 

Iyad: Yeah. There's no reason we think that it shouldn't be. We have actually a lot of data on this too. So we've studied this. Is it as effective as, as other forms of treatment, like in person treatment or other kinds of ways that it's delivered in classes. Yes actually is shown to be very successful at improving people's quality of life, reducing their pain and improving their function. So I have no doubt that people could be successful using telehealth.

Tim: Yeah. So people will be successful. And there's also, it's not just your opinion. There's actual research studies onto this now too, aren't there? Because it's been around for a little while. 

Iyad: Tons. Yes. There's actually two big reviews. They've done a review on just the surgical  patients who have had an operation and it's, they've clustered all these surgeries together and they found that these guys do really well actually with tele rehabilitation where the rehabilitations delivered via video conferencing or phones, like a phone call.  And then there's another one that they just looked across all the populations and they found that a), it was not inferior, so it means it wasn't worse. You want to always deliver something that's not a second grade treatment. Right. You want to always deliver something that's just as good, if not better than, than the standard of care. And then the other thing is that it has actually shown some success in improving people's functions and reducing it.

Tim: Right. And you know, one thing I've found with respect to exercise is if you're prescribing exercises to people, is that, you know, you can show somebody how to do an exercise in person but he's still gonna forget. And you know, whether you're showing them in person or you're sending them a routine, it's really about having good tools to help them remember it, help them stay on track. Do you have tools that you would use to communicate exercises with people? 

Iyad: Yeah. Luckily a lot of the interfaces and the platforms that we use to interact with our clients have a, you know, a different things like screen sharing or different things like where we, the software that I'm going to be using, has embedded exercise prescription attached to it with videos and descriptions. So those are going to be things that are going to be supplemented, you know, throughout the interactions and then given to the client so that they can go and apply these things, you know, in between sessions, let's say. Right. And I think this is really the most important thing when it comes to a building patient self-efficacy and you know,  letting them take charge of their own treatment instead of you know, being handed off to someone, fixing for them. And I think that's why that's probably why we see really good success with this platform.

Tim: Totally. Yeah. And self-efficacy, I'll, maybe I'll speak to that a little bit while you, if you want to pull up and share your screen and show us what the tool looks like, that'd be great that you use. But I think ultimately it comes down to who's the one in control. And for a lot of people, if they turn up to a clinic, they might think that it's up to the practitioner to help them get better. 

And one of the great things about it being remote is I think that people really, feel as though it's up to them to figure this out and to learn how to, you know, be in charge of their own health care and make sure that they recover. So this is what the tool looks like. So I see you have lots of different exercises you can send to people. And then is that a video?

Iyad: I can customize the sets and reps based on what we assessed in the session, basically. So I can get this guy, you know, four sets of 10 per leg.  So this is my quarantine exercise program here that I've designed for some of my clients who want to stay active indoors and maintaining their social distance from other people. So in the absence of gyms, you know, these are definitely good options for you to, to stay healthy and stay fit, which are actually good things for your health overall anyways. 

Tim: Awesome. That is great.  If you want to drop that screen share now and then, you know, a question that comes up really frequently cause you know, I think a lot of people are going to see this. They're going to be like, you know what? I would really benefit from that. You know? Iyad is a very sharp practitioner and he's going to be able to help you find great, especially, you know, if it's like exercise rehabilitation, a great routine. People are going to wonder, you know, is extended health gonna pay for this? Is WorkSafeBC. ICBC. Like are people going to have to pay out of pocket? Can they pay out of pocket? Or is their insurance coverage? Maybe you could speak a bit about how that would look. 

Iyad: Yeah. So initially, you know, cause it's still relatively new to, as a third party payer system, especially extended health providers. You know, like ICBC and WorkSafe. We've seen some changes in the last week. So WorkSafe and ICBC have decided to approve coverage up to the end of the month and they're going to constantly review this. Obviously as things change, I imagine that that line of the end of the month might change very soon with you know, the more we have changes in the province here with the cases of Covid-19. Some other extended health providers, it's been on a case by case basis. So we've actually been able to get coverage for some of our clients but they would have to call in and talk to their providers directly because each plan is different. 

Tim: And I know there's a lot of different insurance companies, a lot of different extended health so probably the best thing for someone to do  is to call their insurance company too, but they could also reach out via the links to the clinic for you or to the practitioner they work with to make sure that tele-health is being offered as well right?

Iyad: Yeah, yeah, exactly. And, the other thing I would really recommend is  to kind of, look at the facts and ask them directly about this. Make sure you have your plan number when you call in, just so that you know, you're actually asking if your plan specifically covers this. From what we've seen some providers have approved this in the meantime. It can be a temporary thing, but I imagine in the future this is going to be a little more complex. 

Tim: Awesome. Yeah. And you know, the other thing especially as it relates to people either deciding they're going to pay out of pocket or, and an insurance company is, you know, is this for everyone? Is this gonna work for every challenge, every ailment? Everyone who would normally come in person? Do you see this working for everyone? 

Iyad: So that's actually a really good question. And the way I would answer this is, you know, when you go see, you're a practitioner in person, let's say a physiotherapist or even your family doctor, a lot of the times, the first session tends to be a triaging session where we try to figure out if this service is appropriate for you. 

Tim: Right. And so by, by triage, you mean you're deciding whether or not to treat them or whether to send them elsewhere? Like, Oh maybe it's more of an emergency than they realize. And you need to call nine one one. Right now. It's less of an emergency and there's something that a different practitioner or a different direction for them to go.

Iyad: Absolutely. So for example, somebody comes in with complaints of numbness and tingling, but we think it might be related to their diabetes we're probably not the best practitioner in that case to help manage that in the meantime. So we can refer them on to their primary care physician to kind of quarterback that. And then vice versa. Let's say if somebody goes in with a case of mechanical low back pain or neck pain or one of those, or just trying to get active, again, trying to get conditioned and want to do, somebody who wants to do this safely. Their family doctor's probably going to end up referring them to a service like ours to help them with that process.

So yeah, I think the first session is probably prudent on that. We need to make sure that the service is appropriate for you. So I imagine if physiotherapy in person is going to be appropriate for you, then so will tele-health. Obviously the biggest difference, there are a few differences in terms of what you're able to get and what you don't get. But generally, I would say for most musculoskeletal conditions, they should be okay for you. 

Tim: Right yeah. And I think you know, I think that that makes good sense, especially in the beginning to point people in the right direction. And, you know, like I've had IMS treatments before, which is a fairly aggressive in person treatment. So obviously, you know, seeing the practitioner, getting that kind of treatment, it's going to be entirely something you wouldn't do remotely. But I think that particularly for pointing people in the right direction, setting themselves up with things they can do on their own at home, regardless of what equipment they have or don't have, is going to be tremendously valuable to people.

Iyad: Absolutely. We see in, in all our history of being an evidence based profession. What's one thing that consistently stands the test of time is good education about your condition, a good knowledge about what's safe and what's not. And also self management tools. And you know, let's call them the cure. How do you fix yourself in this case, right? Those are the things that are gonna help you long term. I'm not saying that nothing else works. I'm just saying that you will still get better if you know what to do properly. Right. It's just going to look differently than if you were to, let's say, go to the clinic, get some manual therapy, some IMS on top of your exercises.

Tim: Awesome. Yeah, I think this has been a great, you know, short overview of what tele-health is about. Thank you so much Iyad for joining me here. 

Iyad: Yeah, thanks Tim, keep pushing the good content out there. 

Tim: You bet.