Key Concepts About Appropriateness and Motivators Expressed by Clinicians and Patients
| Key Concept Category | Concepts from Clinicians | Concepts from Other Key Informants |
|---|---|---|
| Potentially Appropriate for Telemedicine | Care coordination | Care coordination |
| Chronic condition management | Chronic condition management | |
| Diabetes | COVID-19 testing decision making | |
| Diagnosis is known already | Medication reconciliation | |
| Education | Mental health counseling | |
| Get acquainted with new doctor | Minor things | |
| Goals of care are clear | Post discharge | |
| Medication reconciliation | Preoperative low risk procedure | |
| Mental health counseling | Preventative medicine/cancer screening | |
| Minor things | Refills | |
| Musculoskeletal | Returning results | |
| Neurological | Symptoms can be described completely | |
| Non-emergent | To replace an Urgent Care visit | |
| Other sources of information | With “extenders” in community | |
| Post discharge | ||
| Preoperative low risk procedure | ||
| Preventative medicine/cancer screening | ||
| Pt education | ||
| Rash | ||
| Refills | ||
| Sensitive issue | ||
| Substance use disorder | ||
| Symptoms can be described completely | ||
| When home measures available and valid | ||
| With “extenders” in community | ||
| Potentially Inappropriate for Telemedicine | Abdominal pain | Check-up/physical |
| Bad news | Driven by desire to bill | |
| Check-up/physical | Need for exam | |
| Diagnostic dilemma | New condition/detect a change | |
| Genital examination | Preoperative | |
| Lymphadenopathy | Severe issue | |
| Musculoskeletal | Substance use disorder | |
| Need for a procedure | ||
| Need for exam | ||
| Need for specimens collected by clinician | ||
| Need for vaccination | ||
| New clinician | ||
| New condition/detect a change | ||
| New patient | ||
| New symptom in complex patient | ||
| Pregnancy care | ||
| Preoperative | ||
| Risk of unsuccessful transition of care | ||
| Sensitive issue | ||
| Severe issue | ||
| Substance use disorder | ||
| Unintended weight loss | ||
| Motivating Towards Telemedicine | Ability to share screen | Allows avoidance of travel/parking |
| Allows avoidance of travel/parking | Allows rapid access | |
| Allows environmental assessment | Avoid infectious exposures | |
| Allows rapid access | Avoid copay of office visit | |
| Avoid infectious exposures | COVID-19 | |
| Caregiver present | Gets care/visit more quickly | |
| Clinician is paid for time | Good if mobility challenges | |
| COVID-19 | Helps avoid higher level of care | |
| Doctor is focused on patient | New model of care | |
| Doctor stays on schedule | Patient has comfort with technology | |
| Efficiency (time saving for patient | Patient is care giver for homebound | |
| Family support | Transportation issues | |
| Gets care/visit more quickly | Value based copay adjustments | |
| Good if mobility challenges | Well established relationship | |
| Helps avoid higher level of care | ||
| Improves visit adherence | ||
| Information sharing | ||
| Managing uncertainty/anxiety | ||
| Medications readily available for review | ||
| Patient has access to technology | ||
| Patient has comfort with technology | ||
| patient isolation/access to social network | ||
| Reducing low value services | ||
| Transportation issues | ||
| Well established relationship | ||
| Motivating Away from Telemedicine | Absence of needed information for decisions | Absence of needed information for decisions |
| Adds visits that might not usually happen | Adds visits that might not usually happen | |
| Distracted patient | Doctor-patient relationship/trust | |
| Doctor-patient relationship/trust | Inequities driven by copay differences | |
| Harder to ask questions | New work flows not in place | |
| Inability of patient to retain information | Taking personal amity out of relationships | |
| Missed diagnoses | Technology limitations | |
| New work flows not in place | Unintended harm on subpopulations | |
| Office visit is a social event for patient | ||
| Privacy | ||
| Taking personal amity out of relations | ||
| Technology limitations | ||
| Unnecessary antibiotics | ||
| Other Contextual Factors Expressed as Influencing Decision-Making | Clinician comfort/preference | Algorithmic triage |
| Doctor selects visit type | Clinician comfort/preference | |
| Nurse triage process | Doctor selects visit type | |
| Patient preference | Driven by reimbursement and/or co-pays | |
| Reimbursement considerations | Patient preference | |
| Telemedicine as default | Patient selects visit type | |
| Recommendation from professional society | ||
| Reimbursement considerations | ||
| Standards of care |