“The COVID-19 pandemic accelerated a transition to telemedicine that had been slowly underway for years. Defined as the diagnosis and treatment of patients through telecommunications technology, telemedicine holds great promise. It is important, however, to be mindful of the key principles of quality and the unique risks, opportunities, and potential unintended consequences of virtual care.”
~Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care1
As it hopefully appears that the Omicron variation of COVID-19 is beginning to loosen its grip, the medical community can take time to look at the lessons learned about providing care during times of extreme stress. One technology that came to the rescue of many private practices and their patients during this time was telemedicine.
During the pandemic, the use of telehealth may have been on an ad hoc basis to address the fact that patients were not even allowed to visit a doctor’s office for a very long period. Alert providers jumped on the bandwagon as one way to plug the leak in the service continuum, but really did not have the time to address the effectiveness of the process, or to look for the best ways to incorporate it as part of routine patient care.
The initial focus was on making sure that telemedicine could meet the same quality goals as in-person care. With its rapid acceptance, the industry is now taking steps to ensure that telemedicine fully embodies quality. The goals are to provide care in a manner that is effective, safe, patient-centered, efficient, timely, and equitable.
In 2020, IHI (The Institute for Healthcare Improvement) convened a virtual meeting of experts from around the world to develop a framework for delivering high-quality medical care through telemedicine. The panel’s goal was to address perceived gaps by providing recommendations for ways to improve virtual care.
A Framework for Telemedicine Effectiveness
“Health systems must avoid simply implementing telemedicine technology on top of current systems and instead reimagine the entire system, fully integrating telemedicine to ensure that it is safe, free from inequities, and truly responsive to the needs of patients, families, and the health care workforce.”
~Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care1
The panel convened by IHI developed a quality framework for delivering safe, equitable, and person-centered telemedicine that includes six elements:
To take advantage of everything telemedicine has to offer, both providers and patients need to have easy access to it. Basically, this means having the devices, connectivity, security, and online savvy to make the technology work. Most private practices can achieve this with some training, but the problem might come from the patient side of the equation. This could require outreach on the part of your private practice to determine a patient’s comfort level with audio/video telemedicine technology and the availability of necessary infrastructure. You may also have to provide some form of initial training to help the patient become more comfortable with the process. The guiding principle here is to respect patient preference and autonomy by making telemedicine available when it is desired.
Privacy should always be a big concern for patients and your practice. You need to ensure digital security so outsiders are not able to hack into your system and obtain access to confidential patient information. The exchange and safe storage of patient data is critical to maintaining patient privacy. In certain video visits, for example, the patient’s home environment might be visible. You may want to have your team explain safety precautions to the patient prior to the interaction. Any screens in your office which are used to view the patient should be in an area that is not accessible to non-involved personnel or other patients. If the patient is not in a private area, you may want to switch to an audio-only conversation.
Most providers are still more comfortable with visual observation and in-person interaction to form a foundation for their diagnosis. The use of telemedicine may mean providers will have to learn how to overcome this hesitancy and use the technology to its biggest advantage, while still being able to recognize when an in-person appointment is needed for a more accurate diagnosis. A video visit, however, also offers the opportunity to view patients in their home environment, so the provider can gain clues as to external factors that might be affecting mental or physical well-being. Some family members, who might not be able to attend an in-person visit, may be able to provide crucial insights, given the patient’s consent.
Providers who may be comfortable in person might not feel comfortable using the telemedicine setting. Since the patient is not physically in the room, it can make it feel like there is a distance between the two, making it more difficult to establish rapport. Provider training on key communication tactics can help replicate the warmth and feeling of awareness associated with physical closeness. One challenge lies in the technical area, so it is helpful for the practice to check its technology on a regular basis, and to have someone work with patients to help them learn how to connect to the service. This can avoid a lot of the “can you hear me” or “I can’t see you” time-wasters for those not familiar with the process. Be sure to find out if there are any other barriers to a successful interaction, such as language, vision or hearing challenges.
Psychological and Emotional Safety
Those in private practice who begin to rely more on the use of telemedicine need to recognize that there are psychological and emotional safety issues related to this process. Patients have to feel comfortable with the technology, but also need to believe that this is not some type of intrusion into their privacy. While some patients (and providers) may still prefer the in-person visit, there are those patients who will gravitate to the security of communicating from their own home. They might feel intimidated in a practice setting but could be more open when talking from the comfort of their living room or kitchen.
Human Factors and System Design
Despite its technical wizardry, it is still paramount to remember that people are at the heart of any telehealth interaction. The design of your telemedicine delivery system must be able to meet the goals of being reliable, safe, efficient, and person-centered. The most important human factor is that patients and providers need to be comfortable with the process and the technology, in order for telemedicine to function at its highest levels.
Co-designing the system with patients, staff and providers, while seeking ongoing feedback during implementation, can help to more easily instill this modern technology into the most ancient of caring and healing arts.
Balancing Safety with Quality in Telehealth
Telehealth is opening a whole new world in the delivery of medical care. On the one hand, it can increase patient comfort and decrease inconvenience, but it can also raise significant concerns about the quality of care delivered. Suggestions for implementing a balance between safety and quality include:
Careful Patient Selection
Despite all of its benefits, telemedicine is still simply not right for each patient and every situation. Carefully select those patients who have the best potential for benefiting from the interaction, and whose cases do not require high levels of in-person assessment. For some patients, such as those in chronic care situations, a balance of in-person and telemedicine care might best be able to meet their needs.
Clearly, telehealth is not the solution to every medical issue, but it can be a big player in the process. It is important, however, to clarify when and how to use this technology when dealing with patients. Decide which portion of your patient population is most likely to benefit, explore what types of visits and conditions are best suited for telehealth, and strive to maintain the goal of being patient-centered at all times.
Telemedicine is different from the type of medical care providers may have become accustomed to over the years. They may require specialized training in adapting their in-person skill set to the virtual environment. In addition to the actual technology, providers also need training on associated documentation and billing issues to ensure that the practice receives full remuneration for the services provided.
Have Support Processes in Place
Any type of technology is bound to have some glitches along the way, but it is important to prepare for these possibilities in advance. Make sure your practice works with vendors who provide support and training and appoint someone in your practice to troubleshoot technical issues as they arise.
Measure, Analyze, and Tweak
Set up Key Performance Indicators (KPIs) for your telemedicine system so you can find weak points and correct them. Possible areas for analysis include: utilization, outcomes, interaction quality, patient satisfaction, provider satisfaction, and cost.
Maintain Patient Focus
Remember that the primary goal is to improve patient care, not slip into some technical gadgetry world that loses the human touch. Use telemedicine to help your practice survive and thrive, but keep it focused on what is best for the patients at each step of the decision-making, implementation and analysis process.
Changing from Bedside to “Webside” Manner
It may be a new day and a new age in the way providers interact with patients. To make use of telemedicine as effectively as possible, follow these tips for developing a “webside” manner:
- Clearly explain expectations for the telehealth interaction.
- Be aware of special requirements and take appropriate adaptive actions.
- Be fully engaged in each conversation – maintain eye contact and focus even more on your listening skills.
- Find out the best way to interact with the patient’s technology comfort level.
- Use written follow-up when necessary to ensure patient understanding.
- Be aware of surroundings for the provider and the patient.
- Remember that you are a guest in the patient’s home.
- Engage caregivers and family members, as needed and when appropriate.
- Ensure clear technology connections before the visit.
- Make sure all providers understand the technology or have an assigned staff member available to troubleshoot.
Resources for Telemedicine Effectiveness at Amazing Charts
The explosion in telehealth during the pandemic has given rise to a new form of medical care delivery. It is still in its infancy, however, and providers will need to rely on available evidence and trusted vendors to inform them about how best to apply telehealth wisely in each individual independent practice.
Integrating telemedicine as an essential component of care in your independent practice can give you the opportunity to rethink and redesign your entire approach to healthcare solutions. It is important to utilize the latest tools which are available to help you deliver care in the most efficient way, provide better access, and reach more patients, but always with the highest focus on safety, value and quality.
In order to best serve the needs of your independent practice throughout the COVID-19 crisis and beyond, Amazing Charts has teamed up with two, HIPAA-compliant, secure telemedicine providers. We want to be sure you’re able to continue treating patients while reducing the spread of COVID-19. Some capabilities of these telehealth solutions include:
- Remotely deliver in-home patient care
- Initiate secure text conversations with patients instantly and easily
- Initiate telehealth video visits with the click of a button
- Maintain logs of chats and videos for billing and audit
Healthcare Technology Solutions Designed By and For Independent Practices
Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.