The Doctor’s Advocate | Second Quarter 2021
An Ounce of Prevention

Telehealth Tune-Up: Preparing for Care After COVID-19

Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager II, The Doctors Company

Two years ago, none of us could have imagined the global healthcare upheaval headed our way in 2020. Practices struggled through the pandemic with temporary closures, limited elective procedures, PPE shortages, and daily COVID-19 updates, then quickly ramped up again when public safety permitted.

Federal and state regulatory relief and payer reimbursement changes made implementation of telehealth a viable option for almost any type of practice. The ensuing rapid deployment was unparalleled. According to the U.S. Department of Health and Human Services data, telehealth visits rose extraordinarily from 2,000 in February 2020 to a pandemic peak of 1.28 million in April 2020.¹

Patients needed healthcare and practices responded. Some practices added telehealth overnight. The speed of this change raises a number of questions: How thorough were these rapid implementations of telehealth? Was anything missed? Are workflows smooth? What are the opportunities for improvement?

If you have asked yourself any of these questions, the following strategies can help in evaluating five important components of your telehealth service.

Regulatory Compliance

During the COVID-19 pandemic, many states relaxed medical professional licensing requirements due to the public health emergency, while others implemented limited telehealth licensure and some made no changes. If licensure changes were made using emergency declarations, they will likely revert to prior requirements once the public health emergency is rescinded or expires.

To ensure your telehealth practice is compliant, pay attention to the status of public health emergency legislation in your state. The sooner you are aware of changes, the sooner you can respond. The Federation of State Medical Boards maintains a list of state licensure modifications related to COVID-19.

If you practice across state lines, anticipate changes. If you plan to continue providing care outside of your primary licensure state, consider obtaining full licensure in those additional states. Most states require the provider to be licensed in the state where patients are receiving care. Depending on locations, the Interstate Medical Licensure Compact may be an option. If nonphysician professionals in your practice have been providing telehealth services during the pandemic, make sure that their scopes of practice and licensure continue to permit them to do so.

Operations

Requirements for telehealth informed consent vary by state. That said, all patients should be made aware of the limitations of telehealth, their rights to have an in-person visit, and the security risks associated with using remote technologies. Using a telehealth informed consent form can facilitate this conversation.

In the electronic health record (EHR), include a telehealth documentation template that addresses informed consent, the modality being used, and the patient’s geographic location. Include space for any patient-provided health information, such as vital signs.

Ensure that clinical practice guidelines are in place for common conditions treated by telehealth. Revise them as necessary to reflect current experience and treatment recommendations. Clinical guidelines should be reviewed and approved by a provider at least every two years.

Provider Experience

Take a moment to evaluate how the providers in your practice are coping with your telehealth model. Ask them what their ideal telehealth practice model would look like. Develop telehealth workflows that are effective for both providers and patients. Many practices are beginning to consider a hybrid model in which providers may have a block of in-person visits and a block of telehealth visits. Some practices have identified telehealth specialists who focus solely on telehealth services.

Find out if the technology you are using is meeting provider and patient needs. Are you using a patchwork of video conferencing applications? If so, is it time to move to a single solution? Consider integrating your telehealth solution with your EHR to facilitate visit flow and patient safety. (For more information on this topic, read our article “Interoperable Telehealth: Patient Safety Considerations.”)

The American Medical Association’s Telehealth Implementation Playbook contains sample clinician and patient experience surveys. Use one or both to evaluate your system.

Patient Experience

Make sure your telehealth patient preparation process is consistent and effective. First-time patients should be given the opportunity for a “tech check” prior to the visit. Consider putting together a pretelehealth visit prep kit or checklist for patients. Include the informed consent form and frequently asked questions specific to your practice. Advise patients about what equipment they will need and what documentation they will need to have ready (such as identification). Instruct patients about providing health information (such as weight and vital signs). Patients need to know how diagnostic tests will be handled, what to do if technology problems arise, and that providers sometimes need to convert a telehealth visit to an in-person visit.

Patient distractions can decrease the effectiveness of a telehealth visit. For tips to identify and reduce patient distractions, read our article “Manage Patient Distraction During Telehealth Visits.”

Security

During the pandemic, the federal government eased HIPAA restrictions for “good faith provision of telehealth” using audio or video communication products such as Skype and Zoom.² Public-facing video conferencing products, which are not designed for the levels of privacy required for healthcare use, are vulnerable to hacks and errors. Although no recorded telehealth breaches have occurred in the United States (as of March 2021), Great Britain’s Babylon Health GP telehealth application experienced a breach in June 2020 that permitted unauthorized access to video recordings of patient visits.³

If you are still using free public-facing video conferencing applications, consider moving to an enterprise audio/video solution that offers healthcare-specific options, such as a private waiting room. Ensure that your telehealth system is encrypted, particularly its interoperability with your EHR.

Update your HIPAA security risk analysis to include your telehealth system and any medical devices and software applications that have been added to your network. These devices can increase your information technology system’s security risk exposure, making it more vulnerable to cyberattack. It is essential that your network systems have strong firewalls at every access point, use up-to-date antimalware software, and are monitored for any unusual incoming or outgoing activity. Look at your system’s backup, restoration, and downtime plans. If you do not have in-house security expertise, consider using an outside consultant.

As the pandemic wanes and public health measures bring the pandemic under control, it is a good time to take a careful look at the components of your telehealth implementation and fine-tune them if necessary.

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