Telemedicine readiness
This guide is designed to assist a client’s inquiry into the risks and benefits of telemedicine. The terms “virtual,” “telehealth” and “telemedicine” are often used interchangeably. In general, the various terms imply that the provider and the patient are in different locations and not in a practice/office setting.
Whether considering telemedicine as a new service or an offering your practice would want to refine, the following talking points address the possible issues that virtual care can bring forward. In addition to assessing the patient’s social situation, such as accessibility to technology and computer literacy, are key in providing for a comfortable, safe and seamless telehealth experience.
Your patient may be connecting to the virtual visit via computer or data on their mobile phone. Equipment reliability may be an issue. Internet connectivity also comes into play since not all Internet connections are equal.
It may be that the equipment is not reliable or the connection itself is spotty. The patient may have a good Internet connection but poor phone reception. If the phone is the only “computer” to which they have access, one bar of connectivity may not suffice to provide them with the data needed, as some telemedicine applications require a more robust connection.
Asking the patient a few questions in pre-appointment about what their experience has been using technology within their home will help identify problematic issues in advance.
Another issue is that of equity and proficiency. Not all patients will have the most current computer or phone. Some may not have a good handle on keeping these items updated resulting in challenges when the patient is trying to connect. Some rural settings may not have the proper broadband to support telehealth as well. Some patients live alone and may not have the needed assistance with technology readily accessible to them.
Conducting a pre-appointment assessment assessing telemedicine readiness with the patient will help identify their current state and offer opportunities to mediate any problematic scenario in advance.
Remember to introduce yourself to the patient. This is a simple suggestion but an important one that may be assumed. Say hello to the patient and call them by their name. At the start of the call, obtain a call-back number should the virtual visit disconnect. Although, when working remotely from the comforts of your home and leisure, outfits may rule, the provider and other caregivers who can be seen on video during the virtual appointment should be dressed professionally. Avoid taking another call or interruptions during the virtual care visit unless there is a true emergency. Do not eat and chew gum during the patient encounter.
At the start of the call, check with the patient to ensure they can hear and see you. Let them know if they experience any technical difficulties, what the next steps will be should that scenario occur. Offer to pause and answer questions at any point during the call. Summarize the agreed upon next steps and follow-up care instructions at the conclusion of the call. Remind the patient that they may obtain a copy of the after-visit instructions by logging into the patient portal or by contacting the office directly.
Work to make your telemedicine process as streamlined as possible for the patient. Provide clear instructions as to what the virtual visit will offer, the extent of what can be done via a virtual visit and who the members of your team are that can help the patient with troubleshooting.
Verify with your carrier that telemedicine is covered in your policy. Understand the limits and exclusions that are written into your policy and those requirements you may be subject to, should a claim arise. Contact your carrier or broker with any questions.
A frequent question is: Can the provider practice when the patient is in a state other than where the provider is licensed (Cross State Licensing). At the start of the virtual visit, always confirm where the patient is physically located to validate that the provider can practice in that state. Although some states have waived state requirements during the pandemic, this is not something that can be assumed as waivers are now expiring.
Once you have confirmed with the patient where they are physically located, document the discussion with the patient as to their location in the medical record. Even if the patient is away and out of the state of residence for the weekend, be cautious in such an instance. To avoid problematic issues with various state’s Board of Medicine, a better course of action may be to send the patient to a local urgent care or emergency department. Check with the Interstate Medical Licensure Compact for rules and regulations in your states and those states where your patient may reside.
One of the first steps in the virtual appointment is to ensure you are speaking to the intended patient. Confirm their identity by asking and document their response. This is not a situation we can police, but it is something that can be documented. Also check in with the patient as to who else may be present during the appointment or within ear shot of your discussion and if they have the patient’s permission to be there. Acknowledge those present and document their names in the medical record.
Determine if the patient is in a safe and private place and be ready to discuss options should that not be the case.
As already noted, with the rapid implementation of telehealth with the onset of COVID-19, virtual care has now become an expected part of the health care landscape.
The company’s compliance program and strategic plan should address (in writing) the expected opportunities and challenges that telehealth will bring forward.
Having a method for auditing the fair and equitable use of telehealth in your organization, practice or program is essential. Know what your teams are doing and how well the program is being received by your patient population.
Informed consent in the virtual setting is no different from connecting with the patient during in-person encounters. A good understanding of what to expect in a virtual visit, including any limitations, will be important to the patient, and true informed consent will help guide the process. The informed consent process includes not only the conversation but also capturing the conversation in the medical record. Discussing the risks, benefits and alternatives is essential and demonstrating that any questions that the patient may have, have been addressed.
In some states the provider must see a patient in person before telemedicine visits can begin. At that first appointment the informed consent discussion should occur and the consent form signed. If an in-person visit is not required, consider sending an informed consent packet of information via mail or portal before the appointment.
Ensure that your informed consent form covers and addresses the virtual visit. Should the patient refuse care, the discussion of the refusal, reasons for the refusal and all efforts to assist the patient in understanding the possible consequences of the refusal will be important.
When thinking about the setting where the virtual appointment will take place, privacy and comfort are key. Ensure the setting is free from distractions, such as other staff moving through the space, office clutter and unshaded windows. Consider offering a standard corporate background with the company logo. Lighting should be adequate and afford the patient a good view of their provider.
Set standards or protocols for when a call needs to conclude and emergency medical services contacted.
For the most updated references on state-specific laws, please see the Spring 2023 Summary Chart of Key Telehealth Policies areas from the Center for Connected Health Policy.
Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
