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Enhancing and Safeguarding Your Telemedicine Practice

Written by Azeen Sadeghian, MD, FAAD

gettyimages_1205448274_telemedicine_patient_copy.jpgThe COVID-19 crisis has brought with it the onset of an unprecedented healthcare situation. The Centers for Medicare and Medicaid Services (CMS) have broadened Medicare telemedicine services to promote access to care without subjecting patients to unnecessary viral exposure. As a result, telemedicine visits are increasing due to an attempt to keep most patients at home and limit the spread of the virus within our population. 

Consider following these tips to enhance your telemedicine practice.

1. Do your research

  • Although many insurance providers typically follow CMS guidelines, various insurance carriers typically have differing stipulations.
  • Insurance and reimbursement guidelines also vary nationally due to new legislation passed by individual states; these legislations mandate protections and allow for more relaxed protections around protected health information for medical providers who are using telemedicine platforms.
  • Many national and specialty medical organizations are posting their own quick guides or telemedicine tool kits as references.

2. Triage first and request additional information upfront

  • Know that not every patient is a good candidate for virtual care.
  • Ensure your office has an appropriate triage system to help determine who can be rescheduled, who needs a telemedicine visit scheduled, or who needs to be seen in person urgently.
  • If a patient is appropriate for a telemedicine visit, then let them know how it will be billed so that the patient knows what to expect.
  • Be sure to request any useful data, photo, or lab/imaging/biopsy reports to help make your visit more efficient and comprehensive.

3. Ensure your workspace and computer are as HIPAA compliant as possible

  • Enforcement is being relaxed so that providers can quickly relay appropriate, safe patient care; as a result, non HIPAA-compliant platforms are momentarily allowed due to this unprecedented national health emergency. However, avoid using public social media platforms such as TikTok or Facebook.
  • Let your patient know if your internet connection or technology is not secure.

4. Don’t wing it

  • Practice a trial run with your office staff to identify possible issues in advance.
  • Establish who can assist you with any technological issues.
  • Know which type of virtual care is best for you and your patient. Click here to download a telemedicine workflow infographic.

5. Understand the 3 main types of interactive care

  • Medicare telehealth visits (aka virtual visits): A visit that uses an interactive telecommunication platform between a patient at home and a provider. These are similar to visits that would be held interactively in person. Instead, these are performed via telecommunication if deemed appropriate by the provider.
  • Virtual check-ins: A brief 5-to 10-minute two-way communication with established patients for the purpose of triaging. This includes a remote evaluation of video and/or images submitted by an established patient.
  • E-visits: Communication between patient and provider through their online patient portal.

Telephone encounters when technology issues arise of patients do not have access to a smartphone or computer. Learn more about the 3 types of visits as classified by CMS here.

6. Follow the same clinical steps as you would in person

  • As some of these visits are in lieu of complete in-person visits, it is appropriate to document a thorough and complete visit. Obtain chief complaint, history of present illness, review of systems, medication list, etc.
  • Document the method of the visit as well, ie, real-time two-way audiovisual, and any disclosures you may have made to the patient.

7. Aim for a high-quality experience

  • Ensure you and your patient have the appropriate technology to proceed.
  • Give your patient guidance on how to take appropriate images:
    • Emphasize proper photo techniques, such as well-lit without glare or shadows, or photographing in natural outdoor light. Ensure photos are in focus. Take multiple images, including parallel and at set predefined angles. Take close-up images and overall anatomic images. Avoid busy backgrounds.
    • Click here  for a VisualDx teledermatology guide.
  • For the provider room, choose a well-lit space with limited clutter within the patient’s view. Ensure there is no glare and limited visual or audio distractions. Have easy access to anything that may be needed during the exam such as a desktop computer, smartphone, notepad, pen, medical reference tools, etc.
  • If video or image quality is poor and you’re unable to ascertain a lesion, take necessary steps to improve quality.
  • If there are technology limitations, let the patient know, then reattempt the visit or appropriately triage the patient for another means of care.

8. Consider your blind spots

  • Because these are not in-person visits, be cognizant of increased blind spots or a chance of erroneously narrowing a differential or premature closure.
  • Take time to think about your differential and don’t hesitate to reach back out to the patient if you need to see them in person.
  • Confirm your diagnosis and increase your confidence by entering the patient’s symptoms or image into VisualDx. Remember, artificial intelligence does not make a diagnosis for you but can help support your clinical decisions.

9. Re-triage and consider appropriate next steps

  • If you feel the patient will need an in-person visit or urgent medical care, direct them to do so.
  • Review warning signs in which a patient would need future in-person medical care, urgent care, or emergency care.

10. Ensure the patient has timely and appropriate follow up

  • After counseling is performed, it can also be helpful to email or message the patient a digital handout about their condition. 

The COVID-19 pandemic is an urgent situation impacting all specialties and traditional models of delivering healthcare. There is no one-size-fits all approach, but hopefully these tips will be useful to those engaged in telemedicine patient care.

About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at www.visualdx.com.

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