The  new virtual office visit is upon us, and the COVID-19 shutdown serves as the perfect catalyst.  Various government agencies and third party payers are working out the rules and logistics.  The IT industry is rapidly evolving to accommodate.  Multi-state provider credentialing is here.  For myself as an orthopedist there is one major laggard, and that is the ability to obtain and view x-rays.  In order to opine regarding a bone or a joint issue I need to see both a  picture (photograph uploaded or steaming video) as well as an x-ray. We need a user-friendly, secure  radiology format that can be shared with providers or examiners.  We need to eliminate the ridiculous experience of playing a CD and navigating proprietary radiology software from whence the CD came from…after receiving the CD in the mail.  CD radiology viewing is the most inefficient aspect of the encounter whether for an in person visit or a virtual one.  This process has not evolved in more than 10 years. If anyone out there has the answer then please share?   A solution must be imminent to facilitate the shift to virtual visits.

​This current epidemic I predict will produce some lasting ‘social distancing’ cultural changes, more than the contagions  that  preceded  in recent times. It will be interesting to  see just which changes ‘stick’ and which ones fade away.  Will we return to crowded stadiums?  I think so. But maybe crowd avoidance will be a lasting recommendation for folks with co-morbidities, or over age 65?  Public transportation as in planes, subways, taxis are obvious  ‘high touch’ environments; will there be wipes at every terminal stop? Will we all travel with a ready package of wipes?  Will we wipe door handles as a routine prior to grasping them?  Will we wipe down our own steering wheels and countertops with ongoing regularity. Or maybe wear some type of protective gloves when in public environments.  I see a new glove industry in the making. We may soon be disposing of more rubber gloves than we do plastic bottles. I have not seen any commentary discussing  our shoes picking up and transporting virus? Next to our hands I would think shoes are the ultimate fomite?  Removing shoes  in our houses should be the standard, but how about restaurants and other public gatherings? What is practical?  How about always having a cough drop on hand, just in case of a throat tickle?  Will there be a new stigma for public coughing?  Maybe athletes should stop spitting as a rule, and to set a healthy example? Who knows, but I predict there will be many cultural changes from this international epidemic.  New standards from abroad will emerge and we may adopt some of those.   An interesting year lies ahead once we emerge from this immediate threat.

​Gerald Rosenberg, MD

The COVID-19 crisis will produce many spin-off side effects, as we all recognize.  One of those will be the expansion of telemedicine.  Beyond bridging distances and ease of appointments, add to the list 'safety and protection from disease transmission.'  Telemedicine platforms and user-friendly apps are steadily improving  the virtual experience.  For orthopaedic injury evaluation exams there is an inherent caution regarding palpating a claimant, and accuracy is skewed.  Here, detailed observation as opposed to hands-on touch can yield 90 percent of the essential data.  Standardized scoring for various joints and functions will become widely utilized.  Standardized data collection will improve 'outcome' knowledge.  Our polititions have stated "this (covid-19) is a war!"  I agree.  And like all war times a boom in knowledge is a side-effect.  Expanding the applications for telemedicine will be one of many. Reducing physical contact exposures with telemedicine capability is a natural fit. And remember to wash your hands!

Gerald Rosenberg, MD