Considerations for Clinicians Providing Telehealth Services
Posted by: Sanford Goldberg M.D. and Philip Robbins M.D.
Co-Chief Medical Officers for EmPRO Insurance Company
As you are aware, telehealth services expanded greatly during the pandemic. Many rules regarding HIPPA privacy regulations were relaxed and reimbursement rates were adjusted to allow patients continued access to care during the pandemic emergency.1 The New York State Department of Health (NYSDOH) defines telehealth as the use of electronic information and communication technologies to deliver healthcare to patients at a distance. This includes modalities such as store-and-forward technologies, remote patient monitoring, and telemedicine. According to the NYSDOH, telemedicine uses two-way electronic audio-visual communications to deliver clinical services to a patient at an originating site by a telehealth provider located at a distant site. Telemedicine is sometimes referred to as the “virtual visit.” Telehealth advantages include increased patient convenience and improved access to care, particularly in rural areas.
Although telehealth can be utilized for delivering many types of healthcare, it is a particularly good fit for intercurrent monitoring of patients with chronic illnesses such as diabetes, CHF and hypertension. In addition, it is well suited for certain specialties such as dermatology and psychiatry. It is likely that telehealth will continue to be an option for providing care for the foreseeable future.
Currently, there have been a small number of medical liability claims arising from telehealth. However, there is a concern that “failure to diagnose” claims may arise because of the restricted ability to perform a complete physical exam during a virtual visit. There is also concern that clinicians may not obtain a sufficient history during the virtual visit.
The following are points to keep in mind when providing telehealth services:
- Standard of Care is the same for telehealth and in-person encounters
- Ideal method for patient contact should involve video technology (rather than audio only)
- Relevant history should be obtained and documented (synchronized access to EMR for existing patients is optimal)
- Recognize that there are limitations of virtual physical exams (patient should be seen in person when a physical examination is needed)
- When prescribing medications be cognizant of the potential for drug allergies and drug interactions
- Limit/avoid prescribing opioids (except for established patients when necessary)
- Documentation of the visit should indicate type of visit (in-person or virtual) and should be equivalent to an in-person visit
- Maintain awareness of current state and federal regulations regarding the security of platforms used to communicate with patients (be aware that rules have been relaxed and may be subject to change)
Telehealth creates the need to have a proper “Webside Manner”. The following considerations are offered:
- Reliable internet connection is important
- Work from a private location where others cannot distract or interrupt
- Professional appearance by clinician: sit upright and fill the screen; dress appropriately (preferably wear a white coat)
- Confirm the patient’s identity and ensure the patient is in a private space (not at work or in a room with family members where others may overhear the conversation)
- Be cognizant that the patient may record the visit
As telehealth services have become a routine part of patient care it is important for the clinician to understand that the same principles apply to both in-person and virtual encounters.
We welcome your comments and feedback.
Sanford Goldberg M.D. S.Goldberg@medmal.com
Philip Robbins M.D. P.Robbins@medmal.com