Oh Telemedicine!

Telemedicine?

The short version of the telemedicine thread: This is basically free consulting about various aspects of RantWoman's healthcare experience. RantWoman sharing the experience from her perspective is NOT authorization for people bound by other rules to deviate from those rules. Readers who have questions and who do not already know how to reach RantWoman directly are invited to leave comments. Please specify whether you want the comment published or just want a private response to a question. RantWoman also means to include a Creative Commons license. RantWoman is acutely aware, this post could probably use an editor, but that may not happen.. It's the pandemic. You're welcome.

RantWoman has tons of technology. RantWoman does not have to worry about data plans and connectivity. In fact, in RantWoman's opinion, if providers and insurers are going to rely on telemedicine, particularly for some market segments, then either insurers or providers should be carrying the cost of the telecommunications!  And as RantWoman has previously noted, telemedicine sounds great until the devices one needs are locked up in closed computer labs and libraries.

But RantWoman digresses. Even before the events recorded here, RantWoman already had used the UWeCare online charting  tool. RantWoman has also been interacting with questions of HIPAA compliance for a number of other apps and RantWoman has a HIGH tolerance for a certain amount of fussing around to figure things out. Good thing because figuring out new apps and communicating tips to other people figuring out new apps has been a key way RantWoman has been trying to stay out of trouble while many normal activities are shut down.

This telemedicine experience involved lots of RantWoman photographing changes in patches on her legs. Peculiarly, although RantWoman is legally blind and really should not rely only on her own eyes, RantWoman makes very little use of AIRA and BeMyEyes, two services that provide sighted assistance to blind people. For one thing, in this context, RantWoman has no information about HIPAA compliance; RantWoman expects at least one of these services comes with some kind of big fat warning that the providers of these services do not promise HIPAA compliance.

It also occurs to RantWoman to wonder if video is needed or useful, could a provider instruct someone about how to use their cellphone camera to generate needed video. But in RantWoman's case, RantWoman for awhile was sending photos showing that red patches on her legs were indeed decreasing in size as antibiotics took hold.. It occurs to RantWoman to wonder, was that level of daily overkill from the provider's perspective?

With all that as an intro, some parts of a recent telemedicine experience were wonderful and smooth and full of courtesy. It matters SO MUCH to have the provider call RantWoman instead of RantWoman having to spend phone minutes in hold hell. Okay, phone minutes are not a problem for RantWoman but they definitely are for some of her neighbors.And there were still moments that drove RantWoman CRAZY. RantWoman going CRAZY may or may not be a great barometer of whether other people can manage or whether they would also be driven crazy. In any case, narrative on the way to the telemedicine info.

#StayHomeSaveLives

First, AT LAST, RantWoman thinks she GETS IT: "Stay home. Save Lives." RantWoman is still on the edge: RantWoman really needs to walk and move around. RantWoman really does NOT want to bring home anything lethal. RantWoman's cough all the time, no worse that average cough just alarms people. RantWoman can TRY to hang in there with "Stay Home Save Lives." But RantWoman still needs to up her daily level of exercise even if RantWoman is just spending 20-30 minutes / day walking back and forth on her breezeway.

Thank you to The Stranger. Don't accidentally kill someone this weekend. RantWoman usually does not read very much of the Stranger, but Twitter served up an article by Charles Mudede about depression over his brother's recent deal as preparation for all things #CoronaVirus .

RantWoman has another rant brewing about the sense of who's in and who's out in some messaging, but for now let's just focus on RantWoman's experience with telemedicine and non-Covid health care while doing a pretty crappy job of self-isolating for two weeks. To repeat a couple details: RantMom learned she tested positive for the Corona virus on March 11. RantWoman last saw RantMom on March 1. RantMom still shows no symptoms. RantWoman was advised to call her clinic about testing: RantWoman's clinic says, good news , bad news, RantWoman does not have enough chronic conditions to qualify for testing. So please go home and self-isolate for two weeks.

Self-isolate? Cover face with bandana or mask when outside apartment. Signs at RantWoman eye level and therefor not readable to wheelchair users say please avoid more than 2 people in the elevator. Please consider #SocialDistancing realities for people who cannot see or hear each other.

RantWoman's strategy: DO NOT go to public areas at times when there are a lot of people. Get out and walk. Do as needed but wear bandana or mask. Hah! Easier said than done. Laundry did finally happen, blissfully with only other person in the room at the same time and definitely practicing #SocialDistancing. But even this was a trial. Was a trial, implying that, now that the 14 days have passed, RantWoman is, um less diligent. In fact the bandana has gone AWOL and the mask RantWoman scored for coughing in a waiting room lurks in a pocket in RantWoman's purse. RantWoman is also relieved actually to learn about services now available to people in her situation. RantWoman will write of that separately but is permitting herself to wonder about if she had spoken up more clearly about her situation during the initial self-isolation conversation..

Over this time, RantWoman had no #Covid19 symptoms worrisome enough to seek advice. RantWoman has headaches all the time. RantWoman coughs all the time. But there was nothing or almost nothing new and the new was more a matter of interpretation than solid information.

RantWoman repeats: she thinks her situation of living alone in a multifamily community is not specific to any particular category of housing provider. In terms of people with disabilities in the picture about all kidns of things, RantWoman knows a blind woman who manages a rental building and thanks to accessible content on the CDC website could probably offer plenty of rental property managers some perspective for example about what surfaces need to be wiped down regularly...

Two health moments

RantWoman had two sort of interesting health moments from this self-isolation exercise. One falls into the category of "edit an experience and was that #CoronaVirus? The other is telemedicine for a condition RantWoman gets every once in awhile and that has historically responded well to antibiotics.

First the "WAS IT CORONA?" moment: One night RantWoman was hiding out at the computer lab typing away. The heat gets turned off at certain hours; RantWoman does not work very hard at knowing what bashes at the thermostat magic will deliver heat during off hours. RantWoman just tends to put on a hat and a jacket and keep working. But one night RantWoman found herself really cold and also awake until a weird hour. RantWoman went home, had a headache slightly different from usual, on the left side of her head, fell into bed, slept for 10 hours and then another 6 the next night. RantWoman has not gotten her act together to get a thermometer and never had a sense of burning up but the ability to sleep 10 hours stands out. Also a slight variation in RantWoman's headaches, but not even enough to take a painkiller, something RantWoman just does not do very much anyway. Okay, RantWoman also admits: this narrative could be total #Covid19 wishful thinking: "Oh, good, a very light case. RantWoman is all done and out of danger." Little Sister has been meditating about a similar point: Little Sister had pneumonia in January or early February. Antibiotics took care of it. In Little Sister's case, taking care of something as difficult as Covid19 with one pneumonia episode would be much less difficult than often happens for her, but ...

Cellulitis

The other event, the one that generated a trail of telemedicine interventions: RantWoman sometimes gets cellulitis in her legs, swelling, redness, the first night skin was warm to the touch. The next day RantWoman woke up with a whole bright red area on one leg and some redness on the other, but the second day the skin was not warm to the touch. RantWoman here notes that it mattered a lot to be able to see the redness even though RantWoman could tell the foot was also swollen.

RantWoman has had this before. Sometimes it is an issue with a blood pressure medication. This time maybe there was an infection connected with some cracked skin on RantWoman's heels. And RantWoman has an ongoing drama in her life that sometimes whacks her sleep patterns and immune system.And RantWoman frets because RantDad had similar swelling issues. Although RantWoman is way less sedentary than RantDad was, RantWoman is also aware of her level of exercise decaying somewhat over the last several years. In other words, not #CoronaVirus but something, more exercise, RantWoman needs to pay attention to on a regular basis.

In any event RantWoman woke up one morning with legs that were swollen and warm to the touch. RantWoman whined about the alarming leg issues by phone to two friends along with total lack of desire for in-person health care visits right now.. Both friends said, "RantWoman call your clinic. You need antibiotics or you can wind up in the hospital" RantWoman did call her clinic on Friday during business hours. The clinic did call back, but RantWoman picked up the message after business hours. RantWoman also had no path to a provider after hours from the outgoing call menu. But RantWoman did upload some photographs to her online chart, in spite of the warning that it might be two business days before anyone responded.

Usability digressions.

--RantWoman would love for Ecare to have a verbose mode and a compact mode or some parts of the app especially on Smartphones. RantWoman gets that all the words are probably necessary at least the first time through, but they are a nuisance to have to scroll through.

--It took RantWoman a couple tries to figure out how to decide where to direct the message.

--RantWoman also does not find it intuitive to have to scroll back up if she wants to upload more than one picture. But RantWoman Figured It Out. Note, RantWoman was mostly able to navigate visually; it occurs to RantWoman to wonder if having to rely on a screen reader would actually help a person figure out the interface more quickly.

Tough! Forget the two-day timeline. Saturday morning RantWoman called her clinic. RantWoman remembers it took a couple tries about something to do with the outgoing message, but RantWoman finally punched the option for UW consulting nurse. RantWoman reached a friendly human pretty quickly. The provider was able to look at the pictures, check RantWoman's record for past experience, and ping a doctor to write a prescription, all without RantWoman having to travel across town to the clinic. RantWoman kind of hoped someone she knows could go by the pharmacy and deliver it; RantWoman also figured out that actually if her goal is to walk more, she can perfectly well walk to the pharmacy herself.

True, On the way, there are narrow sidewalks with weird bus stops where it might be hard to do #SocialDistancing. And there are many deteriorating sidewalk issues. And there are traffic and traffic signal issues. And RantWoman should just STFU and enjoy the sunshine and exercise.

RantWoman's Saturday calls generated recommendations to follow up with her clinic on Monday AND a referral for some imaging to see if RantWoman had a blood clot. RantWoman has never had a blood clot. RantWoman's symptoms were nothing like the very warm point description Little Sister has used when there was need to rule out a blood clot. But the referral happened and RantWoman decided to wonder whether the imaging might help her figure out some circulatory issues in her left leg. The imaging center contacted RantWoman on Tuesday after the Saturday calls to the doctor. RantWoman explained about the self-isolating. The scheduler said she would talk to the doctor, but also basically said "Come on down. Our schedules are wide open." RantWoman decided to wait until her self-isolation was officially over and scheduled the appointment for Wednesday.

RantWoman rode the bus. That is its own story. The appointment was at the UW
Surgery center. RantWoman was using her cane but RantWoman considers herself VERY lucky to do basic wayfinding without having to rely on apps such as AIRA or BeMyEyes. RantWoman wanted to find an entrance from outside the building without having to walk through a lot of closed
space. RantWoman also definitely entered a different way than anticipated if the default assumption is that people arrive by car instead of foot, bike, bus.  RantWoman also just wanted to be outside as long as possible. RantWoman found a route from the bus stop but encountered someone who said "staff only." RantWoman said she had an appointment and was screened into the building.

But RantWoman's cough all the time cough also scored her a mask a
light weight mask with a wire over my nose. The mask will work better
than the bandana RantWoman has been using. And the imaging told RantWoman what she
already thought. Maybe, though, the important thing is just the experience
and people's concerns about not contaminating space for ordinary
services. RantWoman in bean counter mode might gripe some about the imaging visit, but it's the #pandemic.

RantWoman's takeaways:

--Even for RantWoman the road to telemedicine is pretty bumpy but definitely saved RantWoman time and got her needed treatment more quickly than without telemedicine.

--RantWoman needs to take better care of herself. Make sure to get support stockings on early in the day. Pay attention to skin issues. Keep trying to walk ()and sleep) more.