Medical/Legal
Interoperable Telehealth: Patient Safety Considerations Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager II, The Doctors Company
As efforts to connect patients and providers through telehealth have accelerated, enabling technology systems to communicate and exchange information has become increasingly important. National Goals for Obtaining Interoperable Electronic Systems In 2015, the Office of the National Coordinator for Health Information Technology (ONC) released a roadmap for advancing health information exchange and the interoperability of electronic systems. ONC’s interoperability roadmap includes three main goals: 1. 2015–2017: Send, receive, find and use priority data domains to improve health care quality and outcomes. 2. 2018–2020: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs. 3. 2021–2024: Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access. Although these goals have not yet been definitively achieved, much progress has been made toward the first goal—the ability by providers and patients to view, download, and transmit health information. Given the challenges experienced in 2020,
we are still working on the second goal’s expansion of the interoperable health IT ecosystem and now the third goal’s nationwide learning health system.
Telehealth’s Expansion Telehealth is a perfect example of expanding data sources and users, but it adds several layers of complexity to the already difficult challenges of interoperability—getting computer devices to share information. The first important component would be interoperability between the provider’s computer and the patient’s, a connection that is usually accomplished through the use of a software application. Before the pandemic, a single-source tool was most often used for enterprisewide telehealth due to strict privacy and security regulations. These regulations were relaxed during the 2020 pandemic, which led to the use of a patchwork of video communication applications, such as Skype, Zoom, and Facetime. The selection of the application was largely based on what practices and patients could manage.
Interoperable Single-Source Telehealth Solution Needed It rapidly became clear that a singlesource solution for telehealth that would be interoperable with the electronic health record (EHR)—and perhaps even embedded in it—would be necessary to maintain telehealth visits on a large scale. The benefits of an interoperable singlesource telehealth solution may include patient relationship management features
4 | Escambia County Medical Society in conjunction with Santa Rosa County
such as scheduling, a private “waiting room,” and the ability for the provider to share screens with the patient while discussing diagnostic results and delivering education. Many of the major EHR vendors have the option of integrating a telehealth platform. Enterprise solutions often include technical support, an option or feature that can be very helpful when systems do not function as expected. When surveyed, providers reported that having the ability to easily view the EHR during a telehealth visit facilitates better care and rapport with the patient. In addition, the provider can easily create a visit summary and transmit it to the patient with any orders for diagnostic tests or referrals. Some practices may not have the ability to integrate the telehealth solution into the EHR. The lack of interoperability may be on the side of the EHR or on the audio/video application used for telehealth. It may be possible to achieve an integrated system with an interface. Practices that are at this stage of decision making will want to consider the risks and benefits of all available options carefully by using a consultant or a structured decision-making process such as failure modes and effects analysis (FMEA).
Additional Considerations In addition to interoperability of the telehealth solution with the EHR, we are faced with several other considerations. Imaging files: In some cases, telehealth visits are recorded. The EHR may not be capable of storing large video files, and a physician practice that does not
