Rothman Orthopaedics ramps up telemedicine but physical exam still challenging for spine, says Dr. Gregory Schroeder

Practice Management

Philadelphia-based Rothman Orthopaedic Institute transitioned to telemedicine to connect with patients and review imaging after CMS expanded the range of services that can be provided through the technology.

The practice officially launched its telemedicine initiative on March 25 and received more than 300 appointment requests within the first few hours.

The practice is conducting telemedicine visits via the Healow app on mobile devices or a desktop with a microphone and camera. 

Rothman Orthopaedics' spine surgeon Gregory Schroeder, MD, spoke to Becker's Spine Review about the technology's applications for spine and how it will progress after the COVID-19 pandemic:

Note: Responses are lightly edited for style and clarity.

"Telemedicine in spine surgery is seeing a dramatic increase in usage in the COVID-19 era. At the Rothman Orthopaedic Institute, we have rapidly ramped up our telemedicine visits. Importantly, my patients have been extremely satisfied with their telehealth visits. Many of the rules have been relaxed so that some previously non-HIPPA compliant platforms such as FaceTime can be utilized now. However, it is not clear for how long this will be permitted. While there are many different platforms that are HIPPA compliant, some of these such platforms require patients to download an app on their phone. These applications have proven challenging to use in my practice and I prefer applications such as that do not require an app for the patient. 

"Regardless of what application you find to be the best for you and your patients, the most challenging part of a telemedicine visit is the physical exam. It is helpful to understand what can and cannot easily be tested on telemedicine visits. For instance, when evaluating a patient for myelopathy, rapidly alternating movements and tandem gait are easy to perform, whereas reflexes and a Hoffman's sign are not possible. Similarly testing motor strength for levels zero, one, two and three is easy, but it is challenging to judge strength between level three, four and five. Last year at the Cervical Spine Research Society, we presented a pilot study validating a telehealth neurologic exam, but it requires the use of therabands. If telehealth becomes increasingly common, further studies are needed to determine the best way to perform a good virtual physical exam."

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