The COVID-19 pandemic will shift more practices to using telemedicine...to keep patients at home.
Now prescribers can expand virtual care for Medicare patients through the 1135 waiver...temporarily allowing for e-visits instead of typical office visits. Other payers are following suit.
Plus telemedicine...via computer, tablet, telephone, etc...improves access to care and clinical outcomes for some conditions.
Consider these tips to optimize telemedicine visits.
Rely on your care team to do a “test visit” with patients to troubleshoot technology issues...and to send online forms (review of systems, etc), collect vital signs, update med lists, etc.
Explain visit expectations and goals up front.
Advise having someone (family, home health, etc) with the patient if possible...as a second set of ears, to help with the exam, etc.
Treat virtual visits like an office visit...and be aware of “webside” manner. For example, look into the camera for “direct” eye contact with patients. And let patients “hear” you smile on the phone.
Continue to ask open-ended questions and have patients summarize what they’ve learned...since it may be hard to pick up on body language.
Provide acute care, such as assessing UTI symptoms and e-prescribing an antibiotic if needed. Or titrate a loop diuretic for a heart failure patient with mild shortness of breath and weight gain.
And manage chronic conditions...using available info. For instance, you may need to adjust diabetes meds based on home glucose readings, if patients can’t come in for an A1C.
Suggest home monitoring tools, such as peak flow meters or pulse oximeters, to help with assessment. Also use tools patients have on hand...a flashlight to view rashes, a smartwatch for heart rate, etc.
Continue to use face-to-face visits for patients needing a more in-depth exam or further testing...but consider using telemedicine to gather info PRIOR to the visit, to decrease time spent IN the office.
See our resource, Telemedicine: Tips for Connecting With Patients, for more ways to optimize your e-visits.
- www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet (4-29-20)
- www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice (4-29-20)
- www.aafp.org/patient-care/emergency/2019-coronavirus/telehealth.html (4-29-20)
- https://effectivehealthcare.ahrq.gov/sites/default/files/cer-216-telehealth-evidence-summary.pdf (4-29-20)
- J Med Internet Res 2020;22(3):e16791