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Cure SMA: Evaluation of SMA in the Era of Telehealth - Episode 7

Workflow for Remote Visits During COVID-19


The workflow for a remote visit during COVID-19 is outlined.

Diana Castro, MD: During this time, what’s your workflow for remote visits? How does it work in your practice?

Garey H. Noritz, MD: I work in a primary care team that includes a dietitian, a social worker, and so on, and we do a group visit over Zoom. As the doctor, I will usually go on first, but if I’m tied up talking to one patient, one of my team might start with another patient. Generally, I do my part of the visit. I talk to the family member, I look at the baby, I listen to what their concerns are, and then I go through in my head the checklist of things I would normally do at that age visit in terms of developmental screening and surveillance. 

Generally, those formal screening visits are at 9, 18, and 30 months. The babies with very severe SMA [spinal muscular atrophy] are going to be evident much earlier because of how weak they are. But we might pick up on the less severe patients during those developmental screens. More important, to some extent, is the surveillance: going through the visit to see how they’re doing, if they can sit by themselves, and how they are holding up. If you don’t have a weight to look at, you can still look at a child and say, “They look pretty well nourished; that’s good,” or “I’m a little concerned; they look a little bit bony.” So we’ll do that part of things.

The other team members can alert me on the newborn screen, as if the dietitian picked up on something. At the same time we have the video visit, I have another screen with a chat with all my folks. They’ll say something like, “Can you go back to this 1? The mom has questions about bowel movement.” It’s interesting. It’s almost like being an air traffic controller, doing this but also paying attention elsewhere.

Diana Castro, MD: Do the families get called by somebody from your office to tell them about the system and what they can do to assist in the physical examination? Do they get prepared? For example, new parents who don’t know what to look for.

Garey H. Noritz, MD: It’s different in different systems and in different offices. To some extent, for our folks, the first time they use our computer system, they log on through the patient portal and the medical record. They get a notification that it’s time for the visit. They log on to the visit, and when I see that they’ve logged on to the visit, I log on and we start. But the first time, somebody from registration needs to talk to them and say, “You’re going to need to download this onto your phone. You’re going to need to be in a place where it’s quiet. You’re going to need to be with the baby. Don’t just come and tell us about the baby. We want to see the baby.” They can assist in resetting passwords and all those things, because it is secure, which is nice. So they get a little a tutorial, especially the first time. But once they’ve done it, they do it very easily without a lot of problems.

Diana Castro, MD: You guys work with Epic, so you have the capacity of getting videos and things the family could send even before the visit, right? Is that a possibility?

Garey H. Noritz, MD: They can. Yes.

Diana Castro, MD: Dr Noritz, thank you so much. It was a very interesting conversation. Thank you for watching this HCPLive® Cure Connections® program. If you’re enjoying the content, please subscribe to our e-newsletter to receive upcoming programs and other great content in your inbox. Thank you so much.

Garey H. Noritz, MD: Thank you.

Transcript Edited for Clarity