Just like you need a stethoscope for a proper physical exam, the right telemedicine technology for physicians simplifies the virtual patient visit. Unlike the stethoscope which is mostly a decorative piece worn around the neck, the telemedicine tech needs to be spot-on in order to make your work easier.
In this post, I’ll talk about the technology I use to do my telemedicine work as a digital nomad physician. I have it optimized to make my work as easy as possible. And some redundancy is helpful if you rely on telemedicine for your sole income.
For 2022 I recorded the following podcast:
Telemedicine is done either by text, email, telephone, or video. By far the toughest ones to suffer through are the video visits. These are both hardware and bandwidth-intensive.
Avoid doing them if possible. Some data even shows that video can decrease your empathy and lowers you listening abilities.
Video visits are often done to circumvent certain laws in certain States. But they rarely serve a clinical purpose.
Video visits don’t allow a good enough resolution for evaluating lesions or other physical findings. Taking a picture will be of much higher resolution and much easier for most.
In 2022 it’s not hard to get a fast enough connection for proper audio or video communication.
For video, you’ll need at least 10 Mbps down and 5 up. That’s a lot. You’ll need far less than that for audio (phone) visits.
I do many of my telemedicine visits from an Airbnb or hotel room. Sometimes the connection gets jammed and you only have 3 Mbps to play with.
Always check your internet speed using an online connection tool. It also will show you the connection latency and your IP address.
For a telephone visit you really just need a good laptop and a good cell connection. But I often use Google Voice or another virtual phone number provider. This is the backbone of my telemedicine tech.
The biggest issue is the kind of microphone you use or the speakerphone feature. Both of these can create a lot of static which the patient may not even be aware of. But it will wear them down and frustrate them.
Some microphones will pick up every bit of noise from the cords rubbing against your shirt or transmit the hiss of your breath. As soon as you turn your head in one direction your voice drops off, when you turn back then the sound is too loud for the patient.
Avoid using the speakerphone feature on your phone or laptop.
I use wireless Bluetooth headphones like Galaxy Buds or anything similar.
Caller ID Blocking
Then there is the issue of caller ID blocking. Not to mention having to dial each and every patient by hand which can be quite tedious.
Call centers overcome this by having software that automatically connects the caller to the patient, picks up their voice and even transcribes what they say.
More and more telemedicine platforms are using a 3rd party number to connect you. This means that you don’t have to worry about blocking your caller ID.
But it means that wherever you are in the world as a digital nomad physician you need a phone which can receive phone calls.
Using Google Voice I am able to receive a call on my cell phone as well as on my laptop.
Text-Based Telemedicine Visits
Your telemedicine gadgetry for asynchronous visits (text-based) needs to be very basic. Dictation is your best friend.
Text-based interactions will likely become more popular in the future.
In text-based telemedicine, you can share videos or images. Everything is supposedly HIPAA compliant and it’s the least technology-intensive of the various telemedicine visits methods.
There are a few companies that are doing an email type of visit. Basically, the patient has all the data collected from them, it’s packaged up and then emailed to the clinician. She then clicks on a few links and sends the email back, either approving or denying the clinical management option.
In order to make this work easier I use my phone’s dictation ability to type out my responses when interacting with an app.
When using my laptop, I use a Chromebook which allows me to dictate my responses quite quickly and accurately.
Sustainability of Telemedicine Tech
I have been doing telemedicine since 2015 and I have gone through a lot of different gadgets. Sadly mostly aren’t repairable.
I focused on spending big bucks on products which I believe the manufacturer would continue to support.
In the end I think it’s easier and less costly to buy cheaper items which you can dispose of quickly and replace easily.
Android based devices fit the bill. From Chromebooks to Android phones. These can be backed up and so when you lose one or it dies the replacement will restore to exactly where the last one left off.
I prefer a laptop because I do a lot of my work from a coffee shop. I can’t do my video visits from there but my text-based visits are really enjoyable to do from a cafe or a library.
A MacBook laptop is fine but it’s a tough laptop to replace when you are overseas. That’s why a Chromebook is my go-to telemedicine technology for physicians these days.
I do recommend a 2nd laptop – a backup laptop. Yes, I travel with 2 laptops. But they are so thin and light, it’s hardly noticeable. And I’ve earned good money over the years from my laptops.
I avoid working with telehealth companies that want me to use their proprietary laptops. It’s fine but avoid it if possible.
A Chromebook is like having an Android phone on a laptop. It uses the same apps you use on your Android phone on the laptop – it’s brilliant.
I can receive phone calls on my Chromebook laptop by using Google Voice. There are even laptops with SIM cards which I haven’t found helpful.
If your tech fails you can always use your laptop’s speaker or your phone’s speaker as a backup. But there will always be an echo – I avoid it when possible.
I carry wired headphones as a backup. Many Android phones these days don’t have an audio port so I carry a USB-C port to audio jack converter.
My Galaxy Buds are Bluetooth headphones. They connect reliably to my cell phone or laptop. My patients hear me clearly from this and I can use it in a loud background.
Caller ID Blocking
I am not as sensitive about my patients having my cell phone number as others around me. Clinicians go through great lengths to block their caller ID but 99.99% of patients are incredibly respectful and wouldn’t dial back their provider’s number.
Perhaps it’s a bigger deal for psychiatrists and that would make sense. For the rest of us I would advise either of these 2 options:
- Dial *67 before calling a patient with your cell phone
- Get a Google Voice Number
Using the *67 feature to disable caller ID isn’t as convenient as you might think. When you call elderly individuals they usually will have their phones reject your call in order to prevent calls from unwanted telemarketers.
Quite a few individuals will also have people they don’t want to talk to or bill collectors. For that reason, they won’t pick up your call when it says “Unknown Caller”.
Most medical groups will require you to block your outgoing number for malpractice reasons. There are free apps you can use which will mask your number and have a different outgoing number – one example is doximity.
Google Voice Phone Number
You can sign up for a free Google Voice Number which will allow you to make free calls and it comes with an app for your phone which acts very similar to your native dialer app.
The above is the option I choose. I can disable all incoming calls so that the patient cannot contact me back. It’s also the number I use to have patients send me pictures of whatever is relevant to their medical condition. There are ways to make this process HIPAA compliant such as accessing it from a HIPAA-compliant device, etc.
Another huge advantage is that you won’t use up your minutes since GV is a VoIP. This means that only data is used to make the calls.
The cell phone or mobile phone is the next most important telemedicine technology for physicians. Even without a SIM card, you can still use most Android phones connected to Wifi to make calls. This is a huge bonus.
For me, the most important thing is that the phone is reliable and easily replaceable if I lose it or if it dies on me.
In the states, I use Google Fi and tried using it overseas but had a tough time getting calls. I now just purchase a pre-paid sim and use my Google Voice number overseas to receive and make calls. Easy.
When my laptop dies which it has at random times I can always use my phone to complete a visit. Most EMRs are web-based so I can document on my Android phone’s browser or use the dedicated app
One key technology for doing telemedicine is having the ability to use your phone’s mobile data to connect to your laptop.
Some phones make this really easy – some, not so much. Some cell providers make it really easy and others will throttle you. You’ll have to do your research to figure that out.