Dr. Zünkeler performs telemedicine IMEs (tele-IMEs) for examinees who are physically located in Maryland at the time of the tele-IME.
Dr. Zünkeler has been working in teleneurosurgery since 2012 and currently conducts tele-IMEs via Microsoft Teams (previously Skype for Business) for secure video conferencing.
Participants (i.e. the examinee, one physically able adult who can help the examinee, and one authorized remote participant of the examinee’s choice, e.g. the examinee’s legal representative) can use their camera- and microphone-equipped smartphones, tablets, laptops, or desktop computers to dial into a virtual exam room at the time of the tele-IME. Participants are encouraged to use the Microsoft Teams app, which requires advanced setup to register their e-mail addresses with Microsoft. In cases in which examinees have difficulty with the app, conferencing can also be done through a modern web browser (e.g. Chrome). Regardless of the type of electronic device used, the examinee should be prepared to use a charging cable to connect the device to an electrical outlet during the tele-IME to avoid battery depletion and interruptions. Dr. Zünkeler’s office will provide a list of preparation instructions, including household items that will be needed during the examination part of the tele-IME.
Tele-IMEs require some organization and cooperation. To allow the examinee and our office staff the necessary time to complete all the necessary steps, we recommend the following time line before the scheduled tele-IME:
- 1 business week before – Dr. Zünkeler’s office staff sends our office questionnaire and consent form to the examinee and the examinee’s legal representative via secure e-mail.
- 3 business days before – The examinee returns the completed, electronically signed forms to Dr. Zünkeler’s office via secure e-mail.
- 1 business day before – The examinee contacts Dr. Zünkeler’s office staff to test the connection of the video conference link (sent via e-mail).
- The day of the IME – The examinee will need to be physically present in Maryland and available to start the tele-IME at the scheduled time.
A tele-IME conveniently takes place in the privacy of an examinee’s home or another appropriate location (e.g. the home of a family member or friend with good high-speed internet access). There is no need for a potentially lengthy and uncomfortable car ride to Dr. Zünkeler’s office, which makes this type of IME very attractive to those living at greater distances.
Dr. Zünkeler is preparing instructional videos to demonstrate how the examination proceeds and how the examinee can prepare for the exam, such as wearing appropriate clothing, making sure that the lighting is adequate, and correctly positioning the camera-equipped device. Safety is paramount, and examinees are strongly encouraged to ask a family member or friend to be present to provide help, if needed. Examinees should tell Dr. Zünkeler if they know that cannot accomplish a particular maneuver and should not take any unnecessary risks. Simply saying “I cannot do that” is enough.
The examinee’s legal representative is welcome to review all the materials provided by Dr. Zünkeler and to attend the tele-IME remotely. Dr. Zünkeler, the examinee, and the remote observer (or any other participant) will agree not to make or store any audio or video recordings unless this is expressly agreed upon by all participants.
Although the Centers for Medicare & Medicaid Services (CMS), prompted by a March 2020 presidential order, loosened the licensure requirement for Medicare and Medicaid patients for the duration of the COVID-19 national emergency, professional licensing restrictions remain in place for other telemedicine interactions. For this reason, the examinee will need to state that he or she is physically located in Maryland before the tele-IME can proceed.