For many physicians, the use of telehealth has become part of everyday practice. Prior to the pandemic, only 5% of patients used telehealth. According to the American Medical Association (AMA), approximately 25% of patients scheduled a telehealth visit last year. Patients and practitioners alike have realized the benefits of virtual healthcare and we anticipate its usage will only grow as technology advances.
As telehealth continues to expand, medical providers must be mindful of several issues related to telehealth such as HIPAA compliance, state licensure requirements, technology, documentation and the patient experience. Following are tips to keep in mind while using telehealth in your practice:
- First and foremost, protect your practice from privacy breaches. The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare providers to develop and follow procedures to ensure the privacy of protected health information. MLMIC Insurance Company’s William Hasset, Esq., provides advice for protecting your telemedicine practice from privacy breaches in his article “Telehealth and Cybersecurity Considerations.”
- Clinical Considerations. Another important aspect of telehealth is determining what type of patient visit is appropriate for a virtual encounter. Practitioners should always be mindful that the same standard of care applies to both telehealth and in-person encounters. As telehealth continues to evolve, it is necessary to consider what types of patients, as well as diagnoses, are easily managed in a virtual format. At the same time, you will also need to determine what types of visits must occur in-person. Creating a list of these considerations and updating them on a regular basis is prudent to the success of your telehealth practice.
- When choosing technology, keep it simple. Depending on your patient population, you may want to use a simple, but HIPAA compliant telemedicine platform. Platforms such as Zoom for Healthcare are easy to use and only require a patient to log in with a link. Whichever platform you select, confirm that the vendor will provide a Business Associate Agreement. This ensures the vendor will employ necessary measures to protect a patient’s health information stored on or transmitted through its platform.
- Decide what type of telehealth service you would like to offer. There are two types of services in telehealth. Synchronous telehealth provides healthcare in real time. This type of service allows the patient and the provider to speak directly with each other and most resembles the traditional office visit. Asynchronous telehealth gives a patient the opportunity to share their health information online or using a chat-based program. Asynchronous telehealth allows the provider to review a patient’s information anytime. This avenue for telehealth also allows the provider to share information with specialists and other physicians involved in a patient’s healthcare.
- Provide a patient-centric experience. Make sure that you are using a professional background, especially if you are treating a patient from a home office. Preferably, use a generic background. If you are new to telehealth, practice looking into the camera to ensure that you are not too close to the screen and that your face is centered. Sound quality is also an important consideration. As a provider, make sure your microphone is working properly and at an appropriate volume.
- Select the proper venue for your telehealth visit. To create a successful environment for a virtual appointment, both the provider and the patient must be situated in a private, quiet, comfortable environment without any distractions—like what you would experience in an exam room. If you are performing telehealth from home, make sure you are in a room with a closed door and ensure that there will be no interruptions from your family or pets. Additionally, take note of your patient’s location and confirm they are in a private environment. A patient should not attend a telehealth visit in an open workstation or public space.
- Contemplate introducing a scribe into your private practice. To stay connected with your patient, consider hiring a medical scribe. While the scribe is updating the electronic health record, you can stay focused on the patient, providing a more personalized telehealth visit. Some telehealth platforms allow a scribe to log on discretely and without a camera or microphone. Even though the scribe is participating in the telehealth visit remotely, the same privacy and security issues apply. The patient should be informed that a scribe will be participating in the encounter although he or she is not seen or heard by the patient. Utilizing a scribe will give the provider a better chance to stay engaged with the patient, creating a more meaningful experience.
- Determine whether your internet speed is appropriate for telehealth. When it comes to speed, the faster the better. An internet speed of 100 Mps or more is recommended for optimal performance and reliability. Deficient internet speed could result in poor video and audio quality, as well as drop-offs such as missed words.
- Consider implementing new forms of telehealth services such as remote patient monitoring. There has been an increase in remote patient monitoring (RPM) because of the pandemic. RPM involves real-time evaluation of a patient’s clinical status using video, devices or mobile applications. This is an excellent avenue in treating patients in rural communities, as well as underserved and vulnerable patient populations. According to the HHS, patients with conditions such as high blood pressure, diabetes, COPD and sleep apnea are candidates for RPM. The AMA states that it “expects to see more wearable technology and sensors, along with chat boxes and symptom-management tools” in 2023.
- State Licensing Requirements. Before implementing a telehealth practice, speak with your medical professional liability carrier to determine whether telehealth is covered under your policy. Telehealth encounters take place at the “originating site” which is defined as where the patient is physically located. If you are offering telehealth services to patients in multiple states, ensure that you are following the licensing requirements for each state.
MLMIC will continue to monitor the evolution of telehealth as part of our ongoing effort to inform and protect our policyholders. In the meantime, we encourage our insureds to explore our existing resources on this topic.
- Strategies to Optimize Telehealth Encounters
- Risk Management Tip: Effective Telehealth Patient Engagement
- Risk Management Tip: Utilizing Telehealth in Your Practice
- “Hybrid Future” for Telehealth and In-Person Care Requires Thoughtful Integration of Technology
- Evolving State Regulations Limit Practice of Telehealth
We also encourage our policyholders to contact us, should they have any questions regarding implementing a safe and successful telehealth practice.