TELEHEALTH
Maximizing Telemedicine Benefits Establishing work flow integration BY ELIZABETH A. KRUPINSKI, PHD
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he United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency, due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. With the onset of the pandemic, in many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. The rapid uptake of telemedicine was facilitated at the state and federal levels by widespread waivers and measures to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements. Those of us who have been in the field for a long time are hopeful that many of these measures will stay in place, but there are clearly some that will or already have expired. We are additionally hopeful that even though in-person practices are clearly coming back full-tilt, that everyone has seen and/or experienced the benefits of telemedicine and will continue to use it to some degree as feasible and appropriate with their patients.
Moving forward, providers will be faced with new challenges as they transition their pandemic generated telemedicine process to a new world of hybrid services. As noted, some things will still be allowed (e.g., certain billing codes) but others will likely return to pre-COVID status (e.g., use non-HIPAA-compliant devices and software platforms). In addition to finding the best software for future telemedicine applications, there are other things to consider when trying to maximize telemedicine benefits. From my perspective, although the technology is critical, telemedicine success has very little to do with the technology and everything to do with the people and the environment within which they practice. Thus, in order to maximize telemedicine, what follows are elements one should consider and focus on in addition to carefully selecting the most appropriate technology for your practice and providers.
Success requires planning First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The use cases need to be clearly defined and must match an identified need. Then the who, what, where, why and when must be carefully delineated. Who needs to be involved (e.g., providers, billing, scheduling, IT, legal, administration), what clinical tasks can be accomplished via telemedicine, where will the technology and/or providers be located (e.g., clinic, home), where will the patients be (e.g., primary care provider office, home, work, school), why will telemedicine be offered as an option (e.g., lack of sub-specialty providers, patients need to travel long distances, no show rates are too high) and when will telemedicine be offered (e.g., certain days/times, any opening in the schedule)? All of this can be accomplished by plotting out in a workflow diagram what the current practice is and how it needs to be adjusted in order to integrate telemedicine into that workflow. Again, the expectation is that although some practices might remain essentially virtual, the majority are going to evolve into a hybrid practice – but such a hybrid will not happen overnight or automatically. Workflow integration is going to be just as critical as integrating telemedicine technologies into a practice – it really is all about the people, setting expectations and establishing standard operating procedures and protocols for everyone who is going to be involved. Another thing that can be done to maximize a telemedicine practice is to properly train everyone involved on standard operating procedures and protocols, especially the providers who will be interacting with the patients. Currently there are only a few states (e.g., Washington) that require providers to be trained in order to provide telemedicine services and oversee at the compliance aspect. For the most part training requirements are at the institutional level and are overseen by some sort of telemedicine oversight committee. For example, at Emory University a training program was developed by the Virtual Care Executive Team and all providers engaged in telemedicine are required to complete the on-line course before interacting with patients. It will be interesting to see what happens in the future as programs become more established. It is possible that insurance
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JULY 2021 MINNESOTA PHYSICIAN
