Beyond the Brick and Mortar

Telemedicine has played a major role in providing healthcare and managing chronic health conditions during the ongoing pandemic. Physicians and their staff have had to implement some type of telemedicine program in their practices to avoid the health risks of face-to-face encounters. These once-underutilized tools and technologies quickly became staples in the medical practice, accelerating their prominence and expansion in the ongoing delivery of care.

While the past year introduced many new challenges, it also served as a testing ground as a result of the government’s emergency orders and waivers, allowing physicians and healthcare professionals to provide care via virtual mediums without HIPAA restrictions and receive near equal reimbursement for services provided. Keeping waiting rooms from overcrowding during lockdowns and still being able to diagnose and treat homebound patients was one of the primary purposes of easing regulations around telemedicine programs. Not to say all remote visits were met without difficulty. Many practitioners and patients experienced IT issues associated with broadband and cellular accessibility, among others.

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In a post-pandemic environment, physicians and patients alike see the advantages of continuing to offer telemedicine as a means for care. When the government lifts the emergency orders, physicians will want to be prepared as all HIPAA safeguards are reinstated and will want to make sure to have a secure, HIPAA-compliant telemedicine platform in place that works best for their patients and their practices. There is continued pressure on the federal Medicare program and private insurers not to turn back reimbursement for telemedicine services once the emergency orders are lifted; the final word is pending. 

In today’s environment, consumers want “on-demand” care. How can physicians shift from a short-term intervention to a long-term strategy? Can telehealth enhance the care you provide? How can you keep what you have but expand the services you provide?

Here are a few tips to consider:

1. Define your goals

Will telemedicine improve efficiency? Improve service to patients?  How does telehealth fit into your overall care model?

2. Create new roles for staff in a hybrid model

Assess the workflow that is best for practitioners and patients. How can you blend virtual and physical environments together as part of how care is delivered?

3. Define which patients are to be seen virtually

Telemedicine should provide the same physician-patient relationship as in-person visits. Determine which patients need to be seen in the office (visit type, diagnosis, demographics).

4. Learn the best way to do a physical exam

Review your webside manner and provide the same level of care and treatment consistent with clinical impression or working diagnosis.

5. Don’t eliminate the telephone

Follow up with check-in visits. Review lab and/or diagnostic results using secure texting and monitoring applications.

Remote Patient Monitoring

Remote patient monitoring (RPM) is the next step to improved telemedicine provision of care and improved outcomes. Chronic disease requires patients to be involved in their care. Devices are used to engage patients in their own health by helping them manage their chronic conditions and stay on track. These patients need more than three to four in-person visits per year. RPM may be used to promote proactive patient self-care, monitor patients’ key measures, and allow physicians and patients easy access to information about health issues.1

Remote patient monitoring offers the following benefits

1.    Physicians can closely monitor patients outside the office, identify potential problems earlier, and perhaps prevent hospitalizations while improving overall patient health and containing healthcare costs.

2.    Devices can help physicians perform routine tests to monitor chronic diseases: checking a patient’s weight and BP (CHF), blood glucose (DM), pulse oximetry and respiratory rates (COPD), and send real-time data to the physician’s office to titrate medications or determine the need for an in-person visit or urgent/emergent care intervention.

3.    Devices and apps can be worn, like a skin patch or watch, to monitor vital signs and transmit data to the physician’s office. A parent can send high-quality images of a child’s throat or ear to a physician. Virtual second opinions or connections with specialists outside a local area can eliminate the burden of travel time and other obstacles.2

Let us not forget that there are risks associated with advancing technologies that need to be considered for safe patient care, including:

Data Breaches: HIPAA violations can occur if patient information and data sharing are not properly encrypted.

Viruses and Malware: Physicians must take steps to safeguard patient information within their network by installing antivirus software, firewalls, and monitoring the network for unauthorized use.

Device Malfunction: Stay up to date on the latest information for the device, including FDA approval, manufacturers warnings, the device's safety record, and approved uses. Read thoroughly all contracts with medical vendors, including who is responsible in the case of device malfunction or failure.

Inadequate Staffing: Who will handle the incoming data? What will be done with it? Have written guidelines and protocols regarding when the device will be monitored; which members of the care team will monitor the data at each point in time; under what circumstances will the appropriate provider be alerted to potential problems; and education of patients regarding device monitoring and  physician follow up.

Be aware of “alert fatigue”: Do not ignore critical alarms.

Patient selection should depend on each person’s motivation to actively manage his or her health, as well as the person’s ability to understand and use the technology. As the physician, you should ensure that a complete and thorough informed consent process is conducted with the patient and documented in the patient’s medical record. The patient’s education should include:

1.    What the device is for and what is it measuring.

2.    How to use the device.

3.    Elements of the treatment plan, such as what times the device will be monitored and how alerts will be handled by the healthcare team.

4.    What device failure or malfunction looks like, and what the patient should do if that happens.

5.    How to properly maintain the device.

Telemedicine and telehealth are here to stay. Innovations in access to services, increased patient engagement in their own well-being, and costs of healthcare will continue to be the future of medicine and value-based care.   

Deborah Kichler is a Senior Risk Manager for CAP. Questions or comments related to this article should be directed to dkichler@CAPphysicians.com.

Footnotes:

1Niecko-Najjum, L.; Iams, Sara; Johnson, Bruce A. (December 2019) “Remote Patient Monitoring Opportunities and Risks for Technology Vendors and Providers," from https://www.polsinelli.com

2Ratnam, Gopal. (June 3, 2020) “Remote Devices for Telehealth See Surge in Demand," from https://medicalxpress.com/news/2020-06-remote-devices-telehealth-surge-d...