Major Challenges, Benefits, and Suggested Strategies for Telemedicine Visits
| Variables | Suggested Strategies for Telemedicine Visits |
|---|---|
| Challenges | |
| Telemedicine leaves out some groups of patients | Practice level Offer technological assistance to all patients before their appointment Offer telemedicine visits via whichever technology is available to the patient (smartphone, computer, or tablet) Offer easy access to telemedicine visits that does not require downloading an application or accessing a patient portal System level Partner with internet and smart-device providers to provide patients with technology required to engage in telemedicine Provide patients with maps of free Wi-Fi locations Partner with phone companies to waive data charges for telemedicine-related services |
| Lack of physical examination can be problematic | Develop guidelines for schedulers and physicians to guide decisions about types of visits that are appropriate for telemedicine versus in person Establish a “virtual rooming” process immediately before physician visits during which medical assistants gather information normally obtained during in-person visits, including patient home vital signs Teach patients to check their vital signs using home equipment (eg, blood pressure monitor, pulse oximeter, thermometer, scale) and bring measurements to telemedicine visit Train physicians to hone diagnostic skills when seeing patients via telemedicine |
| Physicians lament the lack of personal connections and touch during telemedicine visits | Perform telemedicine visits in private spaces to minimize interruptions Establish rapport at the beginning of visits by smiling Ensure that patients can see the video feed and hear the physician Show patient your face (without face mask)* Ensure eye contact by looking directly into the camera (not the monitor) As time permits, make small talk as during in-person office visits Promote the use of in-person visits for new patients |
| Telemedicine visits tend to be shorter than in-person visits | Actively solicit additional patient concerns Give patient ample time to raise concerns Inform patient of expected visit duration Consider devoting extra time to patient counseling |
| Workflows incorporating telemedicine visits need careful consideration to avoid physician burnout | Allow physicians to individualize decisions about how telemedicine and in-person visits are scheduled to match their desired workflow Reserve blocks of time devoted solely to telemedicine or solely to in-person visits Support physician ability to set boundaries to prevent scheduling of telemedicine visits outside normal working hours If offering primary care telemedicine visits after hours or on weekends, allow physicians to work in shifts |
| Benefits | |
| Enhance patient access to healthcare | Inform all patients about the availability of telemedicine, particularly those who live far or have limited physical mobility Offer mix of video and in-person visits for all patients amenable to telemedicine visits |
| Decrease patient no-show rate | Call patients within 30 minutes before a scheduled telemedicine appointment to remind them of the appointment and to ensure that they are able to join the visit |
| Many conditions can be adequately managed via telemedicine | Consider telemedicine for visits focused on counseling, such as review of laboratory results and mental health care Consider telemedicine for chronic disease management follow-up visits that do not require physical examinations, such as for diabetes management Consider telemedicine for medication reconciliations because patients will have medication bottles available |
| Seeing patients’ homes and families enhances patient care | Look at patients’ home environments to gain a better sense of their hobbies and living conditions Engage and meet family members and pets when they are present |
↵* Requires further consideration if face masks and face shields are being used for in-person visits.