The COVID-19 pandemic accelerated the adoption rate of telehealth technologies and virtual care. Five best practices for telehealth clinicians have emerged as the healthcare industry adjusts to this new normal.
By Vikram Savkar, Vice President & General Manager, Medicine Segment, Health Learning, Research & Practice
During the COVID-19 crisis, telehealth usage expanded manifold as patients stayed home to comply with social distancing orders. Telehealth usage in late March 2020 was 154% higher than the previous year and in September 2020, telehealth claim lines were 2,980% higher than September 2019.
Hospital systems and clinicians responded to the explosion of telehealth with creativity and dedication. Although telehealth presents significant challenges to the traditional healthcare delivery ecosystem, the resulting solutions to many of these challenges are already circulating as new best practices within the community. Here are five that our Wolters Kluwer team identified as we prepared for our new Lippincott TelemedInsights solution.
Develop “webside manner” with patients
Transitioning from the clinical setting to a virtual environment can be awkward at first, so it’s important to start building a trusting relationship with the patient through an explicit focus on “webside manner.” As we’ve all come to recognize during the pandemic in business, education, or social gatherings, relationships are not fundamentally about proximity but about dialogue, listening, humor, asking questions, observations, and shared history - all of this is possible via telehealth.
It’s also important to consider the presentational aspects of webside manner. Clinicians should dress for a telehealth consult in the same way that they would in-person - no clinician would show up to a personal consult in a t-shirt or a baseball cap. Lighting, camera angles, and sound are also important to maintain a level of professionalism and quality. Patients will likely judge the credibility of their clinician on their presentation over the web.
Analyze determinants of health over virtual calls
Telehealth provides a unique opportunity for clinicians to see aspects of a patient’s home life that can help inform decisions on overall treatment and care, and analyze broad determinants of health, including social determinants. As an example, in a traditional in-person consult, clinicians will ask their patients about their diet but have no way of confirming whether the answers they receive are accurate. In a virtual context, clinicians can ask their patients to walk over to the fridge and see whether the patient’s diet includes vegetables or not.
Similarly, clinicians can potentially utilize a broader set of cues to understand patient’s mental health and well-being through telehealth than in person. When delivering difficult news via telehealth, for instance, clinicians can see when patients fall back on traditional coping mechanisms - such as petting a dog or holding a pillow – giving them insight into patients’ stress levels when receiving a diagnosis. This in turn facilitates recommending mental health treatment.
Take advantage of the growing availability of digital health tools
Clinicians can take advantage of the many tools in the market known as “digital therapeutics” that can monitor patients’ glucose levels or medication levels, and so on. These tools must be vetted carefully by clinicians as they are still new and likely will be regulated, but the reliable ones can make a significant difference in patients’ lives. Instead of having to take a day off from work or find childcare to have their readings checked by their doctors, patients can have their information sent automatically. Digital tools can also help reach underserved or less accessible patient populations by tending to health needs in their own homes.
Understand and monitor changing telehealth regulations
Because telehealth is different from in-person consults, the regulatory framework is new and constantly shifting, and therefore be quite confusing. Our team heard about a range of regulatory challenges while preparing for Lippincott TelemedInsights. In one example, a doctor licensed and located in Pennsylvania who traditionally held in-person sessions with a patient who would drive to the office from Delaware. When the pandemic struck, she was uncertain whether she was permitted to treat the patient in his home in Delaware over the web.
Another example is the question of consult length - how long do you need to be on the phone with a patient to be able to submit a consult to Medicare for reimbursement? One doctor we interviewed described how after wrapping up a 7-minute phone call she discovered that the minimum to bill in her state was 8 minutes - one missing minute cost her practice an entire billable session. As healthcare continue to shift to telehealth, it’s crucial for hospitals and practices to train and educate clinicians on the changing regulatory parameters.
Be resourceful about diagnoses
Despite all the advantages of telehealth, it’s still difficult to perform some activities that would be routine in an office setting, like a cranial nerve exam or an eye exam. But we heard from clinicians that there are resourceful solutions to almost all these challenges.
One doctor mentioned performing a cranial nerve exam virtually using household items: coffee to smell, ice cubes for sensation, a standard flashlight for visual acuity. Another clinician described assessing gait by asking a patient to stand up and walk around the room but using a family member as a companion in case of falls. We’ve heard similar stories about nearly every kind of diagnostic activity - there are limits, of course, but we can do much more via telehealth than it may seem.
As the COVID-19 pandemic subsides a bit in the US, and we resume in-person consults, most clinicians believe telehealth in some form is here to stay – as clinicians, it’s important to stay creative, knowledgeable, and resourceful as tools and technologies advance so as to best serve patients wherever they may be.
Read Vikram’s full interview with Authority Magazine and learn about the new Lippincott TelemedInsights solution for clinicians.