Editor's note: This story is part of Southwest Michigan Second Wave's On the Ground Kalamazoo series and our ongoing COVID-19 coverage. If you have a story of how the community is responding to the pandemic please let us know here.

Going to see your doctor has taken on new meaning while the medical community wrestles with the coronavirus outbreak.
 
Many Kalamazoo area doctors and dentists are only doing in-office patient visits on an emergency or “as needed” basis. And most, who would typically require an office visit before they would try to diagnose an ailment or write a prescription, are expanding the use of technology to “see” their patients.
 
That is the case with various physician offices in the area as well as Bronson Healthcare, which has expanded the use of its Bronson MyChart patient portal to schedule online visits as well as in-person visits.
 
Dr. Aaron Lane-Davies, chief of quality at Bronson Medical Group, says the use of technology has been steadily growing over the last four to five years to allow the healthcare group to communicate better with its patients.
 
“We’ve been gradually expanding that capability,” Lane-Davies says. “One of the evolutions that has been jump-started in the last four to five weeks is to have video visits with a primary care provider or specialist. It has really accelerated.”
 
The Bronson MyChart App allows patients to email their health care provider about health concerns or request an appointment for a video visit. Bronson also has fee-based video visits to address the immediate care and behavioral health care needs of its patients, inpatient, or any other adults in the community via its BronsonConnect Video Visit App. The service provides counseling by appointment to those age 9 years or older and psychiatry by appointment to those 18 or older.
Information about the MyChart App is available here.

Information about BronsonConnect is available here.

Using a smartphone, electronic tablet, or laptop, patients can schedule an appointment and get an electronic reminder of that appointment “just as if they were going into the office,” Lane-Davies says. They enter a virtual waiting room and can answer any questionnaires before their appointment starts. Through a new partnership with video conferencing firm Zoom Video Communications, “patients are essentially having that conversation in a secured, protected fashion,” Lane-Davies says.
 
“Prior to the coronavirus,” he says, “our teams were doing a few of these visits every day and we were hoping to expand that over the next few months with the goal that by the end of the year, every provider in the Bronson system would have the ability to have a video visit with their patients.”

But all that was accelerated.
 
The number of video conferencing visits for the hospital and its practitioners has grown from six or seven per day before the coronavirus (COVID-19) outbreak to 600 to 700 per day over the last month.
 
Dr. Stephen Dallas upgraded the phone system at his medical office just in time to beat the coronavirus.
 
“Back in January we changed our phone system and as part of that upgrade in the telephone technology, we purchased a telemedicine product through JIVE Communications,” says Dallas, whose Kalamazoo-based, independent medical practice is called Opus Internal Medicine. As people were ordered to stay at home, it has allowed his office to do telephone and video-conference “visits” with them in a way that insurance companies will recognize.
 
It was necessary for insurance companies to approve such systems – secured and in compliance with HIPAA regulations – in order for them to agree to make reimbursements for virtual visits, he says.

Referring to the use of Skype, Facetime and other unspecialized apps for medical conferencing, Dallas says, “The difference is security and HIPAA (Health Insurance Portability and Accountability Act) compliance.” Insurance companies agreed to the systems after Medicare approved their use, he says.

Of the coronavirus and the expanded use of technology for patient visits, Dallas says that while the potential of telemedicine has long been recognized,  “All of these changes were made because of the pandemic – and they are temporary. We do not know what Medicare will do whenever the pandemic issues are resolved. Before this happened a lot of telemedicine visits were paid for out of pocket.”

As the coronavirus pandemic spread across the nation like a rolling bank of storm clouds, people were ordered to shelter at home and most have avoided emergency room visits for fear they will be exposed to someone with the virus, Dallas says. To prevent the spread of the virus, physicians have limited their in-office visits to emergencies, special cases, and situations that require in-person care.
 
However, “if they are having acute respiratory difficulty or are in some other serious need, we send them immediately to be evaluated,” he says.
 
Of telemedicine, Lane-Davies says, “There are a number of advantages for patients – certainly for people with limited mobility (and) people who have busy work or personal schedules. It eliminates the need for them to take time to travel to the doctor’s office and wait to sit and fill out paperwork.”
 
There’s a comfort in remaining at home, and he says, “The other advantage in the era of the coronavirus – with the governor’s executive order to stay at home --  it allows people to access care without the risk of coming into contact with people who might have COVID-19 in the community.”

Dallas says that when an employee of a small business with, say, 10 workers has a medical problem and they need to take time off to come to a doctor’s office, that can be very difficult for the employer and other employees to manage. If the ailing worker is an hourly employee, “that’s an additional imposition for the employee,” Dallas says.

In the meantime, he says a lot of large corporations, including Stryker Corp. and Pfizer Inc., offer telemedicine services to their employees so they don’t have to leave work or home. They typically provide the service through a private, third-party company or through a contract with a physician's office – as opposed to through their employees’ regular insurance provider.
 
Video conferencing is typically being used by surgeons in place of having patients come back into their offices to talk about how their recovery is going, Lane-Davies says. Via laptop, surgeons can see the patient’s wound, hear about his or her level of comfort, and review other things.  Primary care providers and specialists are using it to consult with patients about everything from adjusting the levels of their medications to interpreting sleep study results.
 
Laurel Barber, chief operating officer at Bronson Medical Group, says Gov. Gretchen Whitmer’s executive order for people to stay at home has resulted in the postponement of routine and elective visits to the hospital so the health care group’s providers are using video visits to continue to manage many health conditions and stay connected with their patients.
 
“The feedback from our patients has been very positive and they appreciate the ability to stay connected with their care team during this time,” Barber stated in a press release. “For patients who need hands-on care, our providers continue to safely perform many procedures and surgeries that should not be deferred.”
 
Dallas echoes those sentiments and says he continues to see patients in his office for urgent care, such as lacerations or acute injuries. He and his two nurse practitioners are also seeing some longtime patients who simply prefer to come into the office. And he is making house calls for a short list of longtime patients who are homebound or limited by mobility or visual problems, or who are unable to work technical devices because of dexterity problems. He says he also has patients who don’t have the necessary technology or any experience working with it.
 
“There are a number of people who do not want to use the technology,” Dallas says. “They don’t know how. Technological literacy is a barrier. They may not have the tech – or no computer or smartphone. … You’d be amazed at how many people still don’t have smartphones.”