Jay Berger started by asking Patience Breckenridge how she was feeling. Breckenridge had had a rough night. The seizures continued, as they typically do.

After hearing about a few more episodes Breckenridge had, Berger suggested she get a gate for the top of the stairs, in case Breckenridge were to fall. She then asked Breckenridge if she had set up Alexa, the virtual assistant developed by Amazon, which she had.

They then discussed different exercises they had gone over in the past. Berger asked the patient about her arm mobility — asking her to lift her arm — and stability, prompting her to stand up without holding on to anything.

After about a 30-minute session, they said their goodbyes and logged off their computers.

Berger, a physical therapist, certified dementia specialist and owner of Rehab Smarter, conducted the entire session online.

Rehab Smarter is a local telehealth business that provides comprehensive rehabilitation services to patients over the internet.

“This has been a saving grace for me,” Breckenridge said. “It’s not because I don’t want to go to the doctor’s office. It’s because I can’t get to them. If I could, I would be there.”

The Brunswick resident turned to telehealth services due to her decreased mobility. She is, for the most part, homebound due to having multiple seizures a day.

While she has online sessions with doctors, they still recommend that she come into the office at times to run certain tests and other functions that physicians are not yet capable of completing online.

She works with Berger through online sessions about twice a week. Working with her is “completely the same” as if she were sitting with Berger face to-face.

“Just because you’re stuck at home doesn’t mean that you can’t get the help that you need,” she said. “People just need to find the help that they need, and sometimes it’s on the internet.”

Berger started Rehab Smarter about 18 months ago. She conducts sessions with her patients through an online portal where she can email with them directly, upload videos and add notes for their benefit.

Everything is Health Insurance Portability and Accountability Act, or HIPAA, compliant.

She typically doesn’t do a face-to-face assessment with the patient, but she has gone in-home to see the setup and suggested any modifications to help the patient with mobility. She may also do an initial assessment and meet with the caregiver, if there is one, and ask what the patient’s goals are.

“Most of what clinicians do is educate and teach the client how to take care of themselves,” she said.

She demonstrates different exercises with her patients online and, with her expertise, can detect muscle strength and functionality by just observing them perform simple tasks.

“You can test cognition over the internet, you can test sensation,” she said. “You can’t listen to the heart without special equipment, but that exists.”

Her average client has COPD, heart failure, diabetes, kidney disease, arthritis, high blood pressure and other conditions, all at once. They turn to telehealth because it’s difficult for them to get out of the home and go to a doctor’s office, although they sometimes do so.

“It’s not really home care,” she said. “It’s not really outpatient. It’s a platform for clients that either have maxed out their benefits through traditional means or have prevention and wellness issues that will not be covered. It’s another opportunity for people.”

Telehealth can be beneficial to the healthcare provider as well.

When Berger provides home care through a company she works for, she can see up to six clients a day and then has hours of paperwork to complete, for insurance purposes. Through virtual care, she can see up to 12 patients with minimal paperwork.

Her telehealth service is not covered under insurance, which cuts out a lot of the paperwork. A session can range from $80 to $200.

With telehealth, a patient is not limited to one doctor. If Berger finds that a patient needs care in an area in which she’s not an expert, she can consult with a doctor across the country to get the patient the care they need.

“So you can now get care by anybody who’s appropriate, wherever you are, at least to a point that you could not have gotten before,” she said.

But even with the internet playing such a vital role in the future of medicine, there are still many limitations to telehealth.

“You can’t touch a patient,” Berger said. “If you have an abdominal problem and your physician is palpitating your stomach to feel for tension and different things, you can’t do that (over the internet). Blood tests and physical surgeries also can’t be done, at this point in time at least.”

Frederick Memorial Hospital is also making headway in telehealth services. The Chronic Care Management Program gives patients tablets, blood pressure monitors, a pulse oximeter and a scale to detect their vitals in the comfort of their own home. They consult with a nurse on the team once a week by phone. By the end of the summer, they plan to have video conferencing, according to Lisa Hogan, a nurse at FMH and the team lead for both the Chronic Care Management and telemonitoring programs.

The program took off in 2017 and started with 30 monitors for in-home patients. Today it has 203 in the community. Up to 200 more monitors will be added in 2020. There is already a waiting list to be a part of the program.

This past winter, the hospital also launched a separate Virtual Visit Program through Monocacy Health Partners, the hospital’s own physician group.

The program is for employees and primary care patients of MHP, according to Alex Nason, director of IT innovation at FMH.

Through a series of questions, primary care providers can assess ailments such as upper respiratory infections, flu, cold, rash and pink eye.

Although physicians can make diagnoses and write prescriptions after conducting a telehealth session, about 20 percent of the time the provider decides that they would like to see the patient in person.

Through these efforts, FMH saw an 84 percent reduction in readmission rates and a 56 percent reduction in emergency room visits in 2018, according to Hogan.

“Telehealth as technology has become easier to use, less expensive and more accepted. And the clinical validation is there as more and more parts of health care are embracing it,” Nason said. “I think as the technology advances, the research continues to accrue validation and the economics of healthcare continue to evolve, we’re seeing more and more movement, acceptance and options of telehealth because the stars are starting to align.”


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