I have previously written an article on telemedicine regarding its benefits and its potential value as a component of a successful patient practice. Given the current climate in the medical community due to the COVID-19 pandemic, this seemed to be an appropriate time to write a follow-up article regarding the implementation of telemedicine within your practice.

While many have been forced to transition their practices overnight to telemedicine, there are some clear benefits for many of your patients. In the ideal situation,  virtual visits should not replace face-to-face communication or a good physical exam where appropriate. However, prior to the pandemic, while technically virtual visits were an option, their utility was quite limited due to restricted access by many insurance plans.

My sincere hope, which is a feeling shared by many others across this blog and social media in general, is that telemedicine as a platform will be legitimized across the larger medical landscape once the dust settles. The rise of more mainstream telemedicine may be a small silver lining gleaming through the darkness of this pandemic. With a groundswell of patient support, one can hope that the convenience, efficiency, and increased access to care will be undeniable benefits, and therefore CMS, in addition to the major insurance providers, will make better long-term commitments to coverage of Telehealth medicine.

There are many platforms from which to choose, and each one has its merits.  You may find that your EHR already has telehealth functionality that you can utilize and save an additional expense, or you might find another provider who can give you and your patients a more robust experience, such as the ability to transfer documents, text messages, or even emails HIPAA securely. Ultimately you may have to try a few different platforms to find the one that is the best fit for you.

At the moment, HIPAA regulations have been relaxed, and commonly used end-to-end encrypted video services such as FaceTime and WhatsApp, among others, have been approved to use without the threat of HIPAA violation. While this is definitely an option available to any practitioner, I would caution that you will be providing personal information to the patient (your phone number), and once the pandemic has ended, you may no longer be allowed to use the services due to HIPAA concerns. If you are going to take the time to learn a new method of patient interaction, and spend the time and effort to implement it within your practice, it would make sense to utilize a service that you can continue with in the future.

So what are some tips and tricks to be able to implement telemedicine within your practice in a smooth fashion with good patient outcomes? Actually, many of the best practices to consider are true for both the provider and the patient equally.

1.  Make sure you are using a computer or a phone with a strong, stable internet connection

2.  If you are using a computer, you should have a good camera and an external microphone such as a lapel microphone in order to improve audio to your patient

3.  If you or the patient will be video chatting via phone, it is always best if they can use an external headphone or mic (such as a Bluetooth earpiece).

4.  Choose an area with good internet coverage, as well as a quiet space. This is both to avoid their personal health information being overheard by other individuals, as well as improving audio on both ends of the conversation

5.  Sometime before the visit is initiated, the patient should verify that their Hardware is set up for a successful telemedicine visit. There’s nothing more frustrating to both a provider and patient than initiating contact and finding that you can’t see the patient or can’t hear them (or vice versa). I have employed in my practice a standard that for any new virtual visit patient, a staff member will contact them 24 hours prior with a demo visit to make sure that it goes smoothly. Otherwise, they will be able to troubleshoot ahead of time. This allows me to stay on schedule during visits.

6.  You should ask patients to restart their device before the scheduled time of their visit. It is good for you to restart your device as well when you start seeing your virtual patients for the day. There may be background processes running that may be utilizing your camera or microphone that you were unaware of, or just, in general, slowing down your machine.

7.   Make sure to familiarize yourself with the various rules and regulations regarding the coding of virtual care. This is a great time to start as currently, it is relatively straightforward with a few modifiers. However, be aware that before the loosening of regulations recently, it was very important to know which codes on which insurance plans are approved for telemedicine coverage, with which modifiers.

8. Most important: Do not get easily frustrated. Seeing patients over video is often not the same as having the same conversation in an office setting. It will take time to develop a new flow for these kinds of visits. As you get more familiar with your platform, you will also gain confidence and the ability to troubleshoot small issues on the fly in order to keep your visit smooth.

Take the time to find the best platform for you. If you feel pressured to start seeing patients right now virtually and don’t have the time to figure it out, there’s always the option, as I mentioned above, to use closed-end video chatting for the moment. We will all be waiting with bated breath to see how the chips fall in regard to payer coverage and reimbursement,  and I, for one, am hoping, but this is a paradigm shift that will persist in the future as a complement to traditional care.

Stuart Akerman is a gastroenterologist and can be reached at his self-titled site, Stuart Akerman, MD.

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