By Jeanette Ball, RN, PCMH CCE and Dana Bensinger, MSN, RN-BC
The benefits of telemedicine are becoming increasingly known, even if not fully leveraged in every practice yet. Providers recognize the value of telemedicine to perform COVID-19 check-ins, limit the spread of viruses to staff and patients, and provide medical support for vulnerable patients while safe at home. They also see the value post-pandemic in using telemedicine as part of an overall population health strategy for managing chronic conditions and other infectious concerns.
However, although the technology has been around for years, we are only now by necessity acting to make it a daily mode of care delivery. As such, the current reality with telemedicine has yet to catch up to its potential. To realize the advantages more quickly in your practice, consider integrating telemedicine from three main perspectives—the actual technology, workflow adjustments, and measuring the impact of telemedicine on patient outcomes and practice revenue.
A core aim for every telemedicine visit should be to control as many technology variables as possible. Internet connectivity is one of the first such variables that come to mind—and not every patient has a reliable internet connection. Or every provider, for that matter. Yes, most clinics do, but what about providers who are conducting a visit from their home?
The ideal environment for telemedicine is for the provider to conduct the encounter from the clinical practice, with the patient at another clinical setting or home. In this scenario, the provider has access to the patient’s secure health records, has a reliable internet connection with potential in-house IT support, and can ensure HIPPA and patient privacies are protected. Importantly, the clinic can also ensure workflows are in place to address IT issues with the patient before the call—either by contacting the patient directly or through a third-party telemedicine help desk.
Not surprisingly, patients and providers experience greater satisfaction with telemedicine in this scenario. Patients are in the privacy and comfort of their own home, or a conveniently located satellite clinic, while receiving efficient, competent care.
The other obvious technology consideration centers around how to actually conduct the visit. Many practices, out of need to quickly roll out telemedicine, are using enterprise versions of Zoom. This is a very user-friendly format for patients. EHR vendors are also integrating telemedicine into their systems, making it increasingly simple to schedule and conduct a visit all from the patient portal.
Another form of telemedicine, known as asynchronous or “store and forward” technology, may negate or reduce the times when a live video or phone call is not practical. The patient enters information in an online app at any time of their choosing. The information is then “stored” and “forwarded” to a provider. From there, the provider responds back with next steps, which could include a video or phone consult, or an in-person visit.
Workflow basics for every tele-visit
Prior to conducting your first telemedicine visit (or from this moment on), make sure risk and liability are properly addressed. Be clear on privacy and security requirements and incorporate them into your telemedicine workflow.
Then, when developing your organization-specific workflow, consult the following “Workflow Design Checklist.”
Before the first visit:
- Identify the most appropriate patients for telemedicine within your populations
- Determine how telemedicine will fit into the practice schedule
- Make patients aware of offering
- Create your core telemedicine team—and stay current on who is assigned to key roles such as team messaging; outreach/transitions; referral and test tracking; triage; and scheduling
During the visit:
- Consider workflow enhancements that involve care teams for patient intake and rooming
- Prepare for technology troubleshooting with clear staff guidance
- Focus best practices on provider—patient communication
- Know the most up-to-date coding for telemedicine
- Integrate coding and modifiers into EHR
- Share summary of visit and follow-up care
- Survey patients on their experience
Measure your results with a PDSA (“Plan-Do-Study-Act”) cycle. It’s important to measure progress with telemedicine in order to make continuous improvements to patient satisfaction and reimbursement. Metrics and key performance indicators will vary across practices, but some common ones include patient satisfaction scores, patient adherence to care, and number of telemedicine visits the practice is able to perform on a daily or weekly basis.
This is by no means an exhaustive reading of telemedicine best practices, but is a good starting point for organizations ready to improve on the model. Given telemedicine’s undeniable benefits, making the most of it will improve your practice as a whole.
Jeanette Ball RN, PCMH CCE, is a Client Solution Executive at CTG and can be reached at firstname.lastname@example.org. Connect with Jeanette on Linkedin at https://www.linkedin.com/in/jeanette-ball-62125212/
Dana Bensinger, MSN, RN-BC, is a Nurse Informatics Specialist and Client Solution Executive at CTG and can be reached at email@example.com. Connect with Dana on Linkedin at https://www.linkedin.com/in/dana-bensinger-msn-rn-bc-5b09619/