This is part of a blog series from genetic counselors at the Basser Center. This was written by Jacquelyn Powers, MS, LCGC.
This March, like so many other organizations, the Basser Center’s genetic counseling team at Penn Medicine transitioned from in-office appointments to telehealth in an effort to slow the spread of COVID-19. “Telehealth” refers to the use of technology to support long-distance healthcare. For example, instead of an office visit, the patient is seen via video chat or telephone. Simply stated, a telehealth visit includes the clinician and the patient interacting via a digital platform. Though considered a “non-essential” healthcare service, genetic counseling and testing are recognized to be integral components of healthcare. This particularly applies to cancer care, where genetic testing can aid in the treatment, early detection, and prevention of hereditary cancers.
The Basser Center’s genetic counseling program, like many genetic specialists across the country, has adopted telehealth out of necessity. However, telehealth genetic counseling is not a new service delivery model; it has been in existence for some time and has predominantly serviced rural communities or locations with scarce genetic counseling resources. In terms of patient satisfaction and knowledge, studies have shown that telehealth is comparable to in-person genetic counseling. Patients have reported enjoying the convenience and reduced barriers to access.
Though there was a stressful adjustment period in the early weeks transitioning to telehealth, in my experience, genetic counselor and patient interactions through telehealth have become logistically much each easier since the beginning. Clinicians and patients worked together to adapt during this unprecedented pandemic, learning the technology and platforms required to make telehealth successful. Currently, the majority of patients participate by video but there are certainly patients who prefer telephone, or who elected video initially but are ultimately counseled by telephone due to technology challenges (user-based and server-based).
If the appointment is done by video, patients are instructed to download an app either on their laptop, desktop, or smartphone. They are then provided a unique URL link which they are to click on at the time their appointment. Through this platform, patients receive text and/or email remainders regarding their appointment date and time, and it allows genetic counselors to send text reminders and other information, such as notifications if we’re running late. Separately, prior to their appointments, patients are provided with an electronic questionnaire to complete regarding health and family histories. Genetic counselors can access this information via a HIPAA-compliant virtual private network (VPN). The latter is an unchanged practice that has been part of our workflow for several years.
Additional records may be uploaded into patient portals, by email or fax, either requested from the patient or their physician/genetic counselor if outside the Penn Medicine Network; again, all these are practices already in place. The nuts and bolts of what we do as genetic counselors—review of medical and family history, risk assessment, discussion of information with patients, and facilitation of genetic testing—can be done via telehealth. If genetic testing is ordered, the laboratories typically mail test kits to patients’ homes for saliva specimen collection (or phlebotomy through arrangement). Genetic test results are disclosed by telephone and if recommended, patients can schedule a virtual follow-up consultation with one of our Basser physicians for further review of results and medical care recommendations.
To be discussed in a future blog post are the distinct differences and challenges compared to our standard in-person genetic counseling practice. However, overall, patients are relieved they can still be evaluated and we, the genetic counselors, are equally relieved we can continue to provide an integral service in a safe setting for our patients. With the onset of COVID-19, there was a quick realization that the adoption of telehealth was our only path forward, at least for the foreseeable future. What was initially projected to last two weeks obviously proved to be anything but, and the Basser Center’s genetic counselors continue to serve our patients from computer screens.