VBCare Network Health Centers have telehealth capabilities to make it easier for their patient to access primary care services. Unfortunately, many patients do not take advantage of virtual consults.
Telehealth is the delivery of medical services long distance or remotely via electronic communication or information technologies. This includes clinical services provided by physicians as well as nurses and pharmacists. These tools monitor, diagnose, treat, and counsel patients.
Telehealth access has expanded significantly over the past few years. Much of the expansion was driven by the COVID-19 pandemic and concerns about potential exposure which resulted in a significant rise in the utilization of telehealth services. The improvement in and expansion in internet availability was driving increases in telehealth use before COVID. Much of the increases in the use of telehealth estimated at 60% to 90% of patients using some sort of telehealth services was driven by young adults.
Implementing telehealth services can feel overwhelming for a practice. Fortunately, as telehealth continues to expand, more and more organizations are developing best practices for telehealth implementation. Telehealth is one of the ways to expand healthcare access and improve patient outcomes.
Telehealth During COVID-19
In 2020, Covid became a global health crisis, and Health and Human Services (HHS) instituted new rules and temporary waivers to help the medical community respond to the pandemic. One of the systems that was put into place was an expansion of telehealth services and the expansion of remote patient monitoring. Telehealth was viewed as an effective way of limiting patient exposure to individuals who may have been exposed to or contracted the SARS-CoV2 virus. This also limited the exposure of providers to potentially infectious patients and expanded the reach that providers had to care for patients in more remote areas with limited access to services.
Benefits of Telehealth
Telehealth has several benefits. It has the potential to provide remote patients with increased access to services. In some cases, it allows the healthcare provider to see the patient in their home environment. Decreased risk of spread of infectious illnesses is also a benefit, as mentioned before.
Barriers to the Use of Telehealth
There are barriers and risks associated with telehealth as well. One of these risks is limited access to technology or patient discomfort with technology. Providers are often reticent to use telehealth. Technology platforms for healthcare are protected but not completely immune to security breaches. Another potential risk stated by providers is the increased risk associated with misdiagnosis. The accuracy of the physical exam can be affected by the quality of the internet connection.
Any time there is a new development in medical technology, it can take time for the medical-legal world to catch up. There is uncertainty about reimbursement related to the use of telehealth.
Medicare continues to reimburse for Telehealth but may in the future limit how it is utilized. AHCCCS continues to reimburse providers for telehealth but will continue to verify it effective use and will make changes to reimbursement if it determines there is abuse or misuse.
Managing an Effective Telehealth Program
Management telehealth program requires planning and resources to support both the provider users and patient users. Community health workers can be effectively used to assist patients with the set and use of telehealth. Telehealth can be effective in reducing emergency care, managing chronic conditions, and for behavioral counselling.
Health center should consider expand the use of telehealth to include:
- Sick care
- Follow-up to ER visits
- Lab review
- Remote patient monitoring
- Mental health counselling
- Management chronic conditions
- Patient education
- Specialist consultations
- Inpatient discharge and transition of care
Telehealth technology has become very simple to use today. You’ll also need to train providers and have a dedicated telehealth coordinator to effectively utilize this tool.
Once you have the technology and services in place, you’ll need to assure patients have assistance to set up their end to participated in the telehealth consult.
Best Practices for Telehealth
To make sure that you are implementing telehealth in the safest, most effective manner possible, you need to ensure certain things to get the best possible outcomes.
Patient Safety and Access to Care
Telehealth reduces the risks of patients being exposed to illness. Patients, especially ones that are high-risk, may benefit from decreased exposure to illness. Telehealth can also improve access to primary care for individuals that do not have transportation or have other access challenges. Patients can be triaged to determine if they are appropriate for telehealth services. Telehealth visits with sick patients keep them out of your waiting room and keep the in-person patients safe from illness. In rural areas telehealth can provide greater access to primary care.
Emergency Follow Up and Transition of Care
It is important to train the providers and staff on the use of telehealth and to help them triage which patients are most appropriate for telehealth visits. Strategies also need to be present to help patients who need extra help with technology can connect so that providers can have the best information available to make an accurate diagnosis.
Escalation Protocols
Protocols need to be in place to help determine when a telehealth patient should be transitioned to in-person care. These protocols should cover a range of scenarios to escalate a patient to higher levels of care, such as the need for testing, imaging, or emergency care. This helps ensure consistency in care and addresses the limitations of telehealth.
Precharting
Providers should review their schedules to determine if patients can be converted to telehealth visits or need to be transitioned to in-person care. This will also help identify if things like lab services or imaging (such as for diabetes) can be done ahead of time to facilitate the patient’s care.
Quality Assurance
In any healthcare program, whether in person or conducted via telehealth, quality assurance programs should be in place to ensure positive outcomes. Medical staff can hold patient huddles and review positive and negative outcomes so that the telehealth program can be improved.
Telehealth can be an effective way to help improve patient access to care, but it should be systematically implemented with appropriate staff training to ensure positive outcomes, patient safety, and satisfaction.
