By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD
March 21, 2018
If you aren’t already offering some form of telehealth services, you might need to look into doing so soon. In 2016, Kaiser Permanente announced that they had officially seen more than half of their patients virtually as opposed to an in-person encounter, and that was well over a year ago. Here are key points you should know about, and plan for, to optimize telehealth.
Telehealth is a reality. The question is not will it be used. The question is how involved with telehealth will you become? With telehealth we need to become familiar with new terminology such as “origination site” versus “remote site” and “face-to-face via digital device” versus “in-person.” We will also need to become familiar with reimbursement fee schedules for telehealth.
At the 12th annual Vision Monday Global Leadership Summit, Latoya Thomas, director, State Policy Resource Center, American Telemedicine Association, stated that, according to ATA’s data, 34 states and Washington, D.C., are “embracing telemedicine.” At the VM Summit it was emphasized that there is not just one approach to telehealth. It ranges from managing care with your existing patients to delivering and managing care remotely for new patients.
The American Psychiatric Association and the American Telemedicine Association created a white paper on Best Practices in Videoconferencing-Based Telemental Health. This document is a “… consolidated update of the previous APA and ATA official documents and resources in telemental health to provide a single guide on best practices in clinical videoconferencing in mental health.” This document is helpful in identifying many issues we need to consider before becoming involved in telehealth.
In this document the two organizations state:
“Telemental health in the form of interactive videoconferencing has become a critical tool in the delivery of mental health care. It has demonstrated its ability to increase access and quality of care, and in some settings, to do so more effectively than treatment delivered in-person.”
It makes sense that telehealth could “become a critical tool in the delivery of … health care.” It also makes sense that telehealth can “increase access.” But the phrases that jump out as perhaps exaggerated are that telehealth can “increase quality of care” and “in some settings to do so more effectively than treatment delivered in-person.” It is important to not become a cheerleader for new approaches to care, but to make sure that we clearly understand the limitations of any new technology we embrace.
Here are some of the issues this document raises that we need to consider.
• Laws in the state in which the patient is physically located during a telehealth session and where the doctor is located.
• Malpractice coverage.
• Due diligence ensuring compliance with state licensing board regulations.
• Ensuring the standard of care delivered via telehealth is equivalent to in-person care.
• Incorporating professional association standards and clinical practice guidelines.
• Following local, state and national laws regarding verbal or written informed consent.
• Making the patient aware of, before commencement of initial services, any and all financial charges that may arise from the services to be provided.
• Having Standard Operating Procedures or Protocols.
• Emergency protocols and after-hours coverage.
• Quality improvement and performance management processes.
• All persons at both sites must be identified to all participants at the beginning of a telehealth session.
• Communication with other health care professionals and organizations involved in the care of remotely seen patients.
• The video conferencing applications must have the appropriate verification, confidentiality, and security parameters necessary to be properly utilized for telehealth.
• HIPAA and state privacy requirements must be followed.
As you can see, this is a complex topic that requires a lot of work before the first patient is seen. Looking at the list of issues above, many of these apply to our own practices right now without telehealth. Go back through the list and see how many of these issues are being managed effectively in your own practice. Two examples would be: (1) do you have written standard operating procedures/protocols, and (2) do you have quality improvement and performance management processes in place your practice?
This is a topic that continues to evolve and grow. We will keep you informed of the changes and issues. The quote attributed to Leon Megginson is appropriate here: “It is not the strongest, or the most intelligent, who will survive, but those who can best manage change.” Don’t put this off, instead prepare to manage change.