The coronavirus disease (COVID-19) pandemic has changed the way doctors, nurses and other healthcare professionals interact with patients and each other. During the pandemic, every face-to-face encounter between healthcare professionals and patients presented an opportunity to spread virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To safely treat patients and stop the spread of COVID-19, a growing number of hospitals, clinics and doctor offices are turning to telemedicine as a means of social distancing while providing care. Many are unsure of the steps they need to take to transition their existing system into a telemedicine system.
Telemedicine as a form of virtual healthcare is growing rapidly. More than 75 percent of hospitals used the technology in 2017, according to American Hospital Association, up from 35 percent in 2010. COVID-19 greatly accelerated the transition to telemedicine in pulmonary critical care, neurology, psychiatry, and other specialties in the inpatient and outpatient space. While COVID-19 creates a pressing need to move towards telemedicine quickly, many doctors, clinics and hospitals feel they are wading into unfamiliar waters during public health tsunami.
Benefits of Telemedicine
Diving into telemedicine can help healthcare professionals keep their heads above water during the COVID-19 pandemic and in calmer times.
Telemedicine reduces office visits in high-risk patients, such as older adults. People who are 65 and older are more likely to develop serious COVID-19 disease, according to the U.S. Department of Health and Human Services’ Administration for Community Living. Hospitals, clinics, and offices can use telemedicine systems. This prevents overcrowding, reduces human exposures, and facilitates high-quality care. It can be done while still providing the guidance and reassurance that patients seek.
Telemedicine visits also save vital resources, especially personal protection equipment (PPE), such as gloves, masks, and gowns.
A Stepwise Approach to Transitioning to a Telemedicine System
The American Telemedicine Association (ATA) defines telemedicine as “the remote delivery of health care services and clinical information using telecommunications technology,” such as internet, wireless, satellite and telephone media. While some organizations parse out unique definitions for telemedicine and telehealth, the ATA uses the two terms interchangeably.
Identify the problems telemedicine should address
Assess the current state of your clinical care, and identify the areas telemedicine could address. For example, you may wish to reduce the risk of COVID-19 transmissions between patients and staff by decreasing the number of office visits.
Determine the services you wish to provide
Telemedicine is an umbrella term that covers a wide range of services and mechanisms to provide those services. These services may include:
Primary care and specialist referral services – consultation between a primary care provider and patient or specialist using live interactive video. It also includes the sharing of diagnostic images and/or video clips, vital signs and patient data for later review
Remote patient monitoring – involves the use of devices to remotely collect and send data, such as vital signs, blood glucose or ECG, to a clinician or remote diagnostic testing facility for interpretation. Such services can supplement the use of visiting nurses
Teladoc services – Teladoc connects patients with a network of licensed primary care physicians who diagnose routine, non-emergency medical problems
Providing health information and peer-to-peer support – uses the internet and wireless devices that allow consumers to obtain health care and public health information. These include targeted texts, and notifications about disease outbreaks. It also allows them to participate in online discussion groups
Medical education – telemedicine can provide those in rural areas and other healthcare professionals with access to continuing medical education (CME) and medical education seminars
Identify ways to measure change
Establish metrics to describe your baseline and goals. Parameters may be as simple as:
“zero telemedicine visits at baseline with a goal of 10 telemedicine visits per week after 30 days.”
Plan for change and identify solutions
Identify stakeholders you need to engage to help your telemedicine program succeed. Then identify barriers and solutions to those barriers. Finally, anticipate changes in technology and workflow.
Anticipate barriers
Certain barriers can interfere with the implementation of a telemedicine system. Common barriers on the patient side include reluctance to interact with physicians online and the fear of receiving poor care. They may also have a lack of access to reliable internet or cellular service, lack of confidence in the safety and security of virtual care, having the technical knowledge to use telemedicine services. Healthcare providers worry about the ability to conduct a physical examination using telemedicine. They may also worry about lack of technical knowledge to implement and maintain telemedicine systems. Finally, some subgroups of healthcare professionals and patients will never embrace telemedicine.
Identify changes in your schedule
Determine how much time you anticipate using your telemedicine program each day. Then decide the types of appointments you will use it for. Lastly, decide the conditions you will treat using telemedicine, and the types of patients that can use the system. Set aside a portion of the day to use telemedicine, or intersperse the use of telemedicine throughout the day. Consider offering telemedicine visits on evenings or weekends for patients who cannot come in during office hours.
Identify means of reimbursement
In the wake of COVID-19, a growing number of insurance providers are adding telemedicine to their coverage.
State and federal laws and regulations have recently evolved to facilitate reimbursement for the adoption and use of a variety of telemedicine models, including those that use non-physician providers. The CARES Act reauthorizes the Telehealth Resource Center grant programs at $29 million per year through 2025, encourages the use of remote patient monitoring for home health services in Medicare, widens support for expanded broadband services, and provides funding for new telemedicine initiatives for Department of Veterans Affairs and the Indian Health Services.
The $8.3 billion emergency funding measure from Congress gave an additional boost to telemedicine when the measure loosened restrictions on the use of telemedicine to treat patients covered under Medicare. Prior to this, Medicare could only pay clinicians for telemedicine services in which they provide care for patients living in rural areas. Furthermore, the beneficiary would not be allowed to receive telemedicine services in their home. Clinicians can bill Medicare immediately for dates of service starting March 6, 2020, according to CMS.
The COVID-19 pandemic brings many changes to the way healthcare professionals deliver care to their patients. Telemedicine will likely be one of the most significant – and beneficial – changes in healthcare. With a little pre-planning, integrating telemedicine into a practice is easier than you might think.
