INTRODUCTION
The COVID-19 Pandemic has witnessed an explosion in telemedicine and telehealth. The positive reception by both patients and physicians has dramatically increased the interest of physicians in making the transition from an in-person to a virtual medical practice. The change provides many opportunities but also pitfalls for those who wish to make this transition. In this article, we shall discuss some important considerations in making such a transition and provide some advice along the way, as well.
CONSIDERATIONS IN TRANSITIONING FROM AN IN-PERSON TO A VIRTUAL MEDICAL PRACTICE
Some of the essential considerations include:
· What platform to use
· How to conduct a virtual patient encounter
· How to obtain informed consent
· Medical record-keeping
· Reimbursement issues
· How to ensure patient privacy and confidentiality
· Medico-legal issues
· State licensing requirements
· Reimbursement
· The use of remote monitoring devices
In this brief article, we shall only be able to discuss a few of these critical issues. An excellent review of ethical considerations in telehealth and telemedicine can be found here.
WHAT PLATFORM SHOULD YOU USE?
The main choice is between a consumer type of platform such as Zoom, Whatsapp, Facetime, etc. vs. proprietary platforms, of which there are many. It would be straightforward to begin to conduct patient encounters using consumer platforms because one could simply download the App and start using it at once without any specific sign-up for making medical practice visits. The drawback, however, is that one would have to answer all of the critical considerations we have listed above, oneself. Such a process could be time-consuming and complicated. If you should choose this approach, be sure that you select a platform that is HIPAA compliant.
That advantage of proprietary platforms is that they cover many, if not all, of the considerations we have listed so that the physician will not have to spend time, energy, and money in sorting them out.
There are a host of proprietary platforms available. In thinking about which one to choose, one should be sure that one understands how each platform deals with the considerations that we have listed, before signing up. A simple Google search will reveal many proprietary platforms from which to choose.
One excellent site to consider is Illuminate Health. Physicians can sign up and create an account using the Illuminate App with either iOS or Android. Before you decide to sign-up, you may want to examine these Frequently Asked Questions.
SUGGESTIONS FOR HOW TO CONDUCT A VIRTUAL PATIENT ENCOUNTER.
Although there are many similarities in conducting an in-person and a virtual patient encounter, there are also some differences. The most obvious difference is that there can be no physical contact to help establish a solid physician-patient relationship. Consider the following points when planning virtual patient encounters:
· Post a short biography that patients can review before your first encounter. A few words about key interests can help build rapport with patients and help draw patients to your practice.
· Wear professional clothing - similar to what you'd wear for an in-person visit. Wearing a white coat also facilitates a call, but is not essential.
· Approach the visit from a conversational point of view. With the Illuminate app, you can see a patient file beforehand with their chief concern and associated conditions, medications, and allergies. You can hone your conversation based on this information to help elicit a narrower differential diagnosis.
· After your visit, ask the patient if there is anything else that they would like to discuss. Patients and providers will require time to adapt to the new virtual flow, and sometimes patients may be hesitant to talk about certain things. Asking them if they have any additional concerns near the end of the call can help put them at ease and build rapport.
MEDICAL RECORD KEEPING AND INFORMED CONSENT
The electronic medical record (EMR) has been the source of much hype from the media and much consternation among physicians, but it is a way of documenting patient-physician encounters. An advantage of proprietary platforms is that they usually provide some type of EMR to memorialize patient encounters and to obtain informed consent. Consumer platforms like Zoom allow the possibility to record a meeting. Still, it is the physician's responsibility to decide whether or not to record meetings. If so, the physician must maintain such recordings and, of course, obtain the patient's consent for the recording.
Proprietary platforms such as Illuminate usually require patients to give informed consent when they create a patient account and before they engage in a physician encounter. If you, as a physician, are considering signing up with a proprietary platform like Illuminate, the good idea is to check with your malpractice insurance carrier first. Be sure that they and you understand what your scope of practice and medico-legal status is before you begin to participate in virtual patient-physician encounters.
SUMMARY
Telehealth and telemedicine provide a new and exciting way for patients and physicians to communicate. In this article, we have given you some critical information to consider as you transition from a traditional in-person medical practice to a virtual practice.
Ronald Young, M.D.
