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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.1

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 enterprise-wide 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 single-source 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 single-source telehealth solution may include patient relationship management features 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 already provide imaging services may not have access to a picture archive and communication system (PACS). The video file problem is not insurmountable, but it adds data storage and another security endpoint to manage.
  • Remote patient monitoring: Remote patient monitoring (RPM) has proved to be a valuable adjunct to telemedicine. RPM collects clinical information that is useful to the provider for managing remote care. RPM works well for patients with chronic disease, those who are being managed immediately after hospital discharge, and patients in a hospital-at-home environment. Interoperability of the RPM device with the telehealth or EHR system is a requirement for Medicare reimbursement.
  • Workflow management: In the interim, workflows become even more important. If a disconnect exists between the patient visit and the record, providers may need more time to process the visit after the video interaction is complete. Documenting the visit in the record can be achieved by the provider in several different ways that include entering it directly, creating a separate telehealth note and incorporating it into the record, using speech recognition software for dictation, or using a scribe during the visit.
  • Care model: Regardless of whether your system is fully interoperable, the model of care delivery is important. During the pandemic, providers may have gotten used to working from home and may want to continue to do so, at least part time. Allocating a block of time for telehealth visits may facilitate a smoother experience for both providers and patients. Some providers may prefer not to practice telehealth and some providers may prefer to specialize in it. Flexibility is key.

For additional guidance, see our other telehealth resources and our on-demand education, Telemedicine to Telehealth: Trends and Emerging Risks, or contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.


Reference

  1. Office of the National Coordinator of Health Information Technology. Connecting health and care for the nation: a shared nationwide interoperability roadmap. Final version 1.0. 2015. https://www.healthit.gov/topic/interoperability

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J12819 04/21

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