Are Patients Getting the Best Possible Care Through Telemedicine?

By Judy Klein, PA

Many medical professionals, including the CEO of the American Telemedicine Association, believe the future of healthcare delivery is a hybrid between telemedicine and in-person care. Providing remote consultations and treatments to patients has obvious benefits: It is convenient for patients, boosts provider availability, and increases care accessibility for underserved populations. Yet questions remain as to whether telemedicine provides the same quality of care as in-person visits and whether it should be granted a permanent modality in care delivery. Healthcare leaders should consider the potential risks and best practices before they implement or extend their telemedicine programs.

Benefits for patients and providers

A 2021 national telemedicine survey of the general public revealed that 23% of respondents had used telemedicine services. Telemedicine uptake soared throughout the COVID-19 public health emergency.

From the patient perspective, proponents claim that telemedicine increases care access for patients who live in remote areas or have transportation difficulties. Proponents also claim it improves compliance for patients, who are more likely to follow their care plan when they have more regular access to their physicians.

Telemedicine can also increase provider productivity by enabling healthcare professionals to see more patients in a day. In addition, it can enhance the work experience for providers, affording them greater control over their schedule and allowing them to see patients whom they otherwise would not be able to see.

The limitations of telemedicine as a statutory standard

Yet for all its benefits, telemedicine can pose risks to patient safety and present the potential for adverse outcomes. For example, patients may not have access to the same testing and care they would receive in person, which could lead to delays in diagnosis and treatment. Providers may not be able to assess a patient’s condition visually, instead relying on inaccurate or incomplete information from the patient. Providers also may not have the same level of access to a patient’s medical records or be able to schedule follow-up appointments easily.

Telemedicine technology can also present hurdles. For instance, providers may not be able to connect with patients properly if there are video or audio connection problems. There are also security concerns such as protecting patient privacy and vulnerabilities to hacking.

These risks can be material for organizations implementing telemedicine programs. A recent examination of Coverys closed medical malpractice claims shows that the frequency of telemedicine claims is rising.

A hybrid model to get the best of both worlds

The risks and benefits suggest a case for moving to a hybrid model of care, where providers look at the entire patient healthcare journey and determine how to best integrate the virtual and in-person experiences. Healthcare leaders considering a hybrid model should keep the following in mind:

  1. Target telemedicine to treat certain types of patients with certain conditions, to provide follow-up care, and to monitor chronic conditions. Not all conditions are well served virtually. Ensure that workflows clearly outline which conditions require an in-person versus a virtual visit.
  2. Centralize and focus on virtual care and training. Some organizations are designating a chief experience officer or chief digital officer to oversee virtual care. Others are building centralized virtual care centers. For example, Sanford Health, one of the largest U.S. health systems, announced a $350 million investment in a new virtual care center to support rural healthcare in the Midwest.
  3. Understand federal and state laws as well as licensure requirements. Regulations vary by state and continue to evolve. Patients may not be in the same state as the provider, which means licensure requirements in multiple states could be relevant.
  4. Invest in proper training on platforms and workflows. Staff must understand how to use and troubleshoot virtual care technology.
  5. Prepare patients ahead of the virtual visit. This enables physicians to focus on the patient during the visit, not technology-related issues.
  6. Conduct training to ensure providers’ on-camera presentation is up to the organization’s standards. Lighting, sound, camera angle, and attire are all important to ensure clear communication and professional conduct.
  7. Remind providers that it is OK to stop a telemedicine visit and reschedule it in person if necessary. There may be times when the patient needs to be seen in person to get a clearer picture. This might mean telling the patient they need to come in to receive a proper diagnosis.
  8. Maintain good documentation and informed consent practices. All notes, follow-ups, and informed consent should be documented during the virtual visit and integrated into the electronic health record.
  9. Prepare for cybersecurity attacks. Good security management, firewalls, and privacy protections will help ensure compliance with HIPAA and state and federal privacy laws.
  10. Reinforce the importance of follow-up during the visit. Do not rely on the practice’s systems to send follow-up information. Before the virtual visit is over, ensure the patient understands the next steps and document this conversation in the health record.

As medicine continues to merge with technology, telemedicine offers real value to healthcare organizations, practitioners, and patients. Convenience, access to care, and quality outcomes are some of the compelling arguments for offering virtual services. Taking a step back to consider key areas of potential exposure is essential to ensure a quality program that mitigates risk and decreases liability.

Judy Klein, PA, is manager of risk management at Coverys.