3 Tips to build a relationship with your patients in telemedicine setting

Build relationship with Patients by using Telemedicine
Build relationship with Patients by using Telemedicine
Build Relationship with Patients

Being a medical provider requires more than just medical knowledge. Emotional care in the providers’ approach is equally important. Providers around the world take pride in patient care. Gaining patient’s trust and establishing a positive relationship with them are the key components of providing the best care to the patient. Over time, as the patients and providers get the opportunity to build up a positive relationship with one another, providers can deliver more personalized care and increase the likelihood of achieving a better outcome. Having an established relationship will allow a patient to confide in provider, while also trusting that the treatment and guidance provided will help them achieve the best outcome possible.

With the rise of the COVID-19 global pandemic, providers, many of which have never used telemedicine before, have turned to technology to provide the best patient care possible at these unprecedented times. At the same time, many patients that have previously never used telemedicine are booking virtual appointments. When it comes to in-office visits communication, both patients and providers have certain expectations. However, with telemedicine, not only that the patient has a harder time establishing a relationship with the providers, but also the experienced providers with many years of patient care under their belt struggle. How to gain patient’s trust while remotely communicating via mobile devices? Providing a better patient experience in a virtual setting is a skill and requires time and practice to perfect. Furthermore, there are several things to keep in mind when starting to offer remote patient care.

First, spend time educating your patients on telemedicine. The concept of telemedicine is still foreign to an average patient, especially the elderly. Make sure that you discuss the virtual visit with your patients beforehand. Ask them how comfortable they are with the telemedicine setting, if they have a device compatible with the telemedicine tool you are using, and if they have good connectivity to join-in for their appointment. Answer their questions and provide them with a guide on how to prepare for their appointment.

Secondly, anticipate the chance of experiencing technical difficulties. Prepare a course of action in case your patient is experiencing an issue. Will you connect on a phone call or will you reschedule? Will a staff member help troubleshoot the patient’s issue or is there a troubleshooting guide provided by the telemedicine provider you are using? Minimizing the unknowns will make your patients feel more confident and open to trying out this new form of communication.

Thirdly, do not forget eye contact. Maintaining eye contact can be hard when you are trying to look at different screens and notes. Make sure to tell your patient what you are doing so that they do not feel uncomfortable when you are looking at EMR or take notes.

Ultimately, telemedicine is a tool to help better patient care. As telemedicine becomes more incorporated in the healthcare system, the comfortability and confidence of both patients and providers will grow.

Sources:

1. Toh, Nathan, et al. “Telehealth and Patient-Doctor Relationships in Rural and Remote Communities.” Canadian Family Physician Medecin De Famille Canadien, College of Family Physicians of Canada, Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5154642/.

2. M;, Dorr Goold S;Lipkin. “The Doctor-Patient Relationship: Challenges, Opportunities, and Strategies.” Journal of General Internal Medicine, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/9933492/.

3. Kelley JM;Kraft-Todd G;Schapira L;Kossowsky J;Riess H; “The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.” PloS One, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/24718585/.

4. Olsen, Russell, et al. “How to Create a Patient-Focused Telehealth Experience.” MedCity News, 4 June 2020, medcitynews.com/2020/06/how-to-create-a-patient-focused-telehealth-experience/?rf=1.

How to Minimize Patient Leakage and Attract New Patients

telemedicine growth graph
telemedicine growth graph
Telemedicine Growth Chart

Consumers today are driven by the idea of utilizing technology to maximize efficiency and convenience in every aspect of their lives. Getting adequate medical care is no different. More and more consumers are seeking medical care outside of the traditional in-person office visits. Telemedicine is appealing to consumers, as they can get the treatment for routine needs without unnecessary travel and waiting time with just a few clicks on their devices from the comfort of their homes.

Become more accessible to your existing patients while attracting new ones by offering the convenience of telemedicine platform. Start offering telemedicine today at https://vivadox.life.

Telemedicine in The Post-COVID-19 World

Telemedicine in the post-COVID-19 world
Telemedicine in the post-COVID-19 world
Telemedicine in the Post COVID-19

This year has challenged many sectors to seek ways to continue their operations while complying with stay-at-home orders and social distancing guidelines.

When it comes to non-urgent medical care, providers turned to the practice of telemedicine. Before COVID-19, there were many strict regulations in place governing how and where telemedicine can be used. Telemedicine regulations govern many things including which providers can bill for telemedicine services, what acceptable originating site (patient location) for telemedicine appointments are, etc. Consequentially, many patients did not have access to telemedicine because they did not fall under the categories listed in the policies.

As the COVID-19 emerged, many of the regulations and policies governing telemedicine have been loosened and continuously updated to accommodate the current state of emergency. These changes brought an unexpected outcome of establishing the benefits of telemedicine by helping patients continue their treatment with doctors remotely without the risk and fear of virus illness contraction. Many patients that would normally not be able to access telemedicine were able to receive care from the comfort of their homes and get timely follow-ups and refills.

However, most of the current regulations allowing access to telemedicine are only temporary and will not be valid once the COVID-19 public health emergency is over. There is a strong need for congress to make access to telehealth permanent and update the pre-COVID-19 telemedicine regulations.

Virtual care has proven to be beneficial and can have a critical role as a supplemental tool in the future of medical care.

ATA has provided a document listing variety of issues regarding telemedicine practice, the policies and regulations governing them before and during COVID-19, as well as their recommendations for new policies for the post-COVID-19 world.

If you want to learn more about how regulations have changed, please visit ATA permanent policy recommendations on telehealth services.

The Beginnings of Telemedicine

The beginnings of telemedicine
The beginnings of telemedicine

The unexpected global outbreak of COVID-19 has undeniably influenced the increased usage and awareness of telemedicine in providers and patients that may have never used or heard of telemedicine before.

When introduced to telemedicine, many believe that it is a modern invention. This assumption is understandable considering all of the technology that modern telemedicine incorporates — video calls, mobile and smart devices, remote robotic surgeries, internet connectivity, etc.

However, the concepts of telemedicine and remote patient care, as well as the need for it was recognized hundreds of years ago. The home-based remote patient care was mentioned as early as 1879. An article published in Lancet, one of the world’s oldest and best-known peer-reviewed general medical journals, mentions the use of the telephone in patient treatment to cut down unnecessary in-person visits.

In the 1920s, the world was introduced to groundbreaking technological innovations including radio and broadcasting. Innovators quickly started utilizing new technologies to create designs and prototypes. One of them was a man called Hugo Gernsback, an inventor and a publisher passionate about technology, who made significant contributions to the growth of early broadcasting. In 1925, Gernsback wrote an article on a device he named “teledactyl”. In his article, he described how teledactyl would allow the doctor to use radio signals to receive a video feed of the patient and remotely control robotic arms to examine the patient. Gernsback’s designs were precursors to the modern telemedicine tools we know today.

The invention of the radio also facilitated the ability to conduct remote consultations between clinics on ships and experts on the mainland, resulting in improved patient treatment. Similarly, the remote consultations via radio allowed providers in remote areas to seek advice from their peers.

Today, we have the capability of utilizing universally available phone service and internet connectivity to conduct phone and video visits envisioned by Gernsback. The continuous improvements in network speed and latency made robot-assisted remote surgeries possible.

Technology is still advancing and the possibilities for the future of telemedicine are endless. The constant advances in telecommunications and technology will keep influencing the transformation of the healthcare system that we know today. Telemedicine can help us overcome the barriers of location dependencies in healthcare.

It is important to note that the growth of telemedicine is constrained by the existing regulations and policies in place. However, with the rapid growth of telemedicine, it is expected that the regulations governing telemedicine will be constantly updated and expanded to include new technologies and use cases.

References:

  1. “The Evolution of Telehealth: Where Have We Been and Where Are We Going?” The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary., U.S. National Library of Medicine, 20 Nov. 2012,
    www.ncbi.nlm.nih.gov/books/NBK207141/.
  2. Novak, Matt. “Telemedicine Predicted in 1925.” Smithsonian.com, Smithsonian Institution, 14 Mar. 2012,
    www.smithsonianmag.com/history/telemedicine-predicted-in-1925-124140942/.

Role of Telemedicine in COVID-19

Build relationship with Patients by using Telemedicine

The US Federal government took a number of significant steps to increase the availability and use of Telemedicine during the Covid-19 pandemic. Although these measures are temporary and subject to revision in future, the widespread use of Telemedicine as a useful tool to fight the constraints of the pandemic is expected to help establish its viability as a mainstream healthcare service.

The US department of Health and Human services (HHS) introduced flexibility in allowing consumer communications applications such as FaceTime, Zoom, Skype etc. without any risk of penalties imposed for HIPAA violations. However. it also encourages providers that seek additional privacy protections to use technology vendors that provide HIPAA compliant platforms. Vivadox.life has been built incorporating advanced encryption technologies to ensure privacy protections.

The Centers for Medicare and Medicaid services (CMS) made it easy for enrolled patients to use Telemedicine from their homes. To encourage providers to offer the Telemedicine option, CMS will be reimbursing telemedicine virtual appointments at par with many in-person appointments and has significantly expanded the list of services eligible for Telemedicine. Providers are also allowed to offer their Telemedicine services across state lines subject to any specific requirements set by states for the duration of the Covid-19 Public Health Emergency. Providers are allowed to see new patients via Telemedicine and not just established patients.

More details can be accessed here

Family doctor online.Parents and a child consult a doctor using a laptop at home.

All major private payers including UnitedHealthCare, Cigna, Aetna and Anthem have announced significant telehealth coverage options including parity with in-person visits, waiver of patient cost sharing for in-network providers as well as originating site restrictions.

More details can be accessed here as well as directly with the private payers.

When Telemedicine made difference – Success Stories

Telemedicine Success Stories

Assessing the benefits of telemedicine and telehealth overall and using them to enhance existing courses of treatments can make a huge difference. Telemedicine allows you to continue monitoring your patients even when they are out of your reach.

A great example of how telehealth can make a huge difference in the patient outcome is Harris County Public Health that has implemented telehealth tools to help tuberculosis patients stay on track with their treatment. Tuberculosis can be spread though air via coughs or sneezes. In 2017, when Hurricane Harvey hit Texas badly, they were able to provide continuous treatment and support to the patients. Patients would record themselves taking their therapy for the staff to review at a later time. In addition, patients had a way of reaching their case manager quickly in case they faced any issues. As a result, not only that the 97% of the patients took their treatment as instructed, but the disease was also not spread in the community.

Family doctor online.Parents and a child consult a doctor using a laptop at home.

Similarly, New York Presbyterian specialists used telemedicine to help treat the victims of Hurricane Maria in Puerto Rico as a part of emergency response. On-site team helped set up telemedicine equipment that enabled the communications with the specialists in New York. In this scenario, telemedicine was used for consultation – the New York specialists consulted local specialists on patient treatment, while also being able to see and hear the patients. This set up helped establish trust between both the providers and the patient.

These are examples of how telemedicine helped when traditional medicine was out of reach. We are still to see how powerful impact of telemedicine can truly be.

Tips for successful adoption of Telemedicine

Medical technology concept. Doctor working with mobile phone and stethoscope and digital tablet laptop
Family doctor online.Parents and a child consult a doctor using a laptop at home.
After the implementation, the work is not done. In order to assess any gaps and improve, it is important to continuously monitor and reevaluate the telemedicine platform and your workflow.

Start a conversation

Telemedicine is new to you, your team, and your patients. Ask your colleagues about their experience with telemedicine so far. They may have some concerns or questions, but they may not be comfortable starting the conversation about it. Or they may have some suggestions on how to make telemedicine even a bigger success for your practice. Seek feedback from your patients as well. You may get some valuable insights and learn about things you can improve in your processes to make your patients’ virtual visits better.

Introduce your patients to telemedicine

Spend time talking to your patients about the telemedicine option you are offering. If appropriate for their case, offer them to try it for their next appointment. Provide them with sufficient information on what telemedicine is and how it works and be prepared to answer any additional questions they may have.

Use telemedicine capabilities to the fullest potential

Understand how to get the most out of the chosen telemedicine platform. Learn about features that you maybe did not initially considered, but that may help you make your processes more efficient and improve patient care. Communicate your feedback and any new requirements to the chosen telemedicine platform vendor to get improvements that will allow you to provide even better care with telemedicine.

Find ways to measure the impact of Telemedicine

As a practice that is just starting to use telemedicine, it is important that you have a way of telling if and how telemedicine has impacted your practice – both in the context of patient care and revenue. Metrics will help you understand where you are comparing to where you want to be. Some of the metrics you can easily gather and analyze are:

  • How many telemedicine appointments have you conducted as a practice (or per provider)? This metric can tell you if your patient is comfortable using telemedicine practice as well as if your investment in such telemedicine platform is justified. Have in mind that it will take some time for both you and your patient to get used to the idea and become more comfortable booking telemedicine visits.
  • How many patients were satisfied versus unsatisfied with this form of interaction? If the platform you are using allows for the patient to rate how satisfied they are with their telemedicine experience you can use this information to see if your patients find this service valuable.
  • How many patients did cancel their scheduled appointment or never showed up? This information can indicate whether or not your patients are confident in using telemedicine. This parameter can be a good indicator if you need to educate your patients more on what telemedicine is and how it works, as well as to reassess if you are picking the right type of patients for these visits (and right type of conditions).

Designing an optimal workflow with Telemedicine

Build relationship with Patients by using Telemedicine
Build relationship with Patients by using Telemedicine
In order to best utilize telemedicine tools and capabilities, you need to make sure they are adapted to and implemented successfully with your current ways of working internally and with your patients to help achieve improved patient outcomes and operational efficiency.
The key to getting the most out of Telemedicine implementation is to have a well-planned out workflow that addresses your entire virtual care process. Make sure that you incorporate compliance to privacy laws and security standards that address any regulatory risk and liability. Your flow should include any actions that you need to take before, during, and after the telemedicine appointment with your patient. It is important to make sure that you consider any adjustments your existing workflow and practices might require to the new telemedicine setting. Try simulating the workflow and patient interaction with your colleagues to assess any gaps and become comfortable with the process.

Prior to the visit:

Scheduling

It is important to understand where in your schedule you are booking telemedicine visits. Are they going to be in-between regular appointments, or do you have a certain time frame blocked off in your schedule just for telemedicine appointments? How will your patients book telemedicine appointments? Make sure that you include the booked time in the existing scheduling system you use. Share any appointment details and information on how to join in for the appointment with the patient ahead of time.

Patient Education

In this part of the workflow include activities such as educating patient on telemedicine and what they should expect from their visit. It could be as simple as forwarding a “patient flyer” detailing the steps to join virtual appointments before their first telemedicine appointment. Check if they have any one of the supported devices for the virtual appointment, as well as if they understand the steps, they need to take to connect with you. Patients might have different levels of comfort with technology and some things that may seem straight forward and easy to you might not be easy for them. Ask questions like “Do you understand how to access the link in the text and join for the appointment?”; “Do you have a device that has access to the internet?” ;“Do you have stable internet connection at home/place you are planning to use when attending the appointment?”

Regulatory Compliance

Make sure you understand the telemedicine policies and regulations governing patient under private or public payer systems. If patients are across state lines, additional considerations with respect to state laws need to be made. Practitioners may only provide care in the states they are licensed to practice. In addition, ensure that telemedicine is covered in the liability insurance of the practitioners that will be performing the virtual appointments.

During the visit:

Connecting and troubleshooting potential issues

To begin telemedicine appointment, connect with the patient and make sure that they can see and hear you. Have a plan of action in case either side experiences technical difficulties with their devices or internet connectivity. Do you have necessary information to troubleshoot the issues? Will you switch to a phone call or will you reschedule?

Conduct the appointment

Start the appointment by validating patient information and making sure that the patient is comfortable with the set up. Interact with the patient and take notes that you will use to update their EHR records and to create a follow up care plan.

After the visit – The Follow-Up:

Codes and Billing

Be familiar with the CPT codes that are used for telehealth interaction to provide complete information for the billing processing.

Patient Follow-Up

Share any follow up care plans, issuing prescriptions, regimen to follow, or information on the condition with the patient.

Reference for this section: Telehealth Implementation Playbook, American Medical Association

Getting reimbursed for telemedicine appointments

The reimbursement policies governing telemedicine visits vary based on the type of the insurance the patient has and the state regulations. Due to COVID-19, many existing guidelines have been changed and coverage expanded.

Centers for Medicare & Medicaid Services (CMS) has been regularly making changes to their guidelines to reduce the need of patient visits or hospital stays post procedures with the goal to minimize COVID-19 infections. In addition, they introduced parity for Telehealth services allowing using the same POS code for Telehealth and in-person visits. They also included remote patient monitoring, remote supervision, hospice care and nursing homes in their scope.

Guidelines vary from state to state. Some states allow only the specific patient setting for telemedicine appointments (like home, schools, or schools-based health center), while some have specific reimbursement criteria covering only specific types of providers. In addition, states have different parity laws, which can significantly impact the costs and reimbursements. This is why it is crucial to understand applicable laws and procedures in the states you are practicing telemedicine.

Private insurance covers the largest segment of health insurance coverage. The adoption of telehealth in private insurance plans was relatively low until COVID-19 but has been significantly increased since.

Assessing your needs and choosing the correct Telemedicine platform

Regulations Governing Telemedicine
Build relationship with Patients by using Telemedicine

There are many synchronous and asynchronous telemedicine solutions available. It is important to correctly identify and assess your needs as well as understanding your options before starting telemedicine practice.

When choosing a telemedicine platform consider the following questions:

Do you have the hardware and connectivity needed for telemedicine software?

Check if your practice has sufficient devices that are up to date with the latest version of applicable browsers & operating systems. In addition, consider whether practitioners will use their personal devices to conduct telemedicine appointments. Check the connectivity requirements needed for the selected telemedicine software and ensure any system prerequisites such as a specific browser etc. are also taken care of.

Do you need a telemedicine solution that will allow you to monitor your patients’ biometrics data coming in from their wearable devices?

If the answer is yes, seek out telemedicine solutions that include or integrate with remote patient monitoring systems. Check which systems and type of devices they support, and if those devices are in line with the ones your patients are using. If none of the telemedicine solutions currently support the preferred integrations, it is important to look for telemedicine solutions and vendors who provide a path to adding those functionalities in the future.

Will your patients benefit from you offering telemedicine?

There are a number of ways your patients benefit from Telemedicine such as easy follow-ups, timely adjustments to their treatment plans, medication prescription renewals, and better management of chronic diseases and conditions. It is important for you have a program to educate your patients on the benefits of Telemedicine and help them transition into an integrated in-person and virtual care model.

Does the telemedicine solution you are considering offer free trial to try it out before committing?

It is beneficial that you do a trial run on the telemedicine solution before deciding to use it. Check if the telemedicine solution you are considering offers free trials.

Is the telemedicine platform easy and quick to use for your patients who might not be tech savvy?

Choose a telemedicine platform that is intuitive and does not involve too many complicated steps to execute a virtual appointment. The telemedicine platform should be simple enough such that any first-time user of any age and having minimal experience in using computer or mobile applications can use it with no additional guidelines and handholding.

Can you and your patients conveniently use this telemedicine platform from different devices like mobile phones or tablets?

Gather information on the devices and browsers that the platform supports. Some patients may want to join via tablet, a MacBook, a smartphone, or a PC. Some of them might involve downloading the app or additional software while others might just work on existing browsers on your devices. The more diverse set of devices and browsers the selected telemedicine platform supports the better it is with regards to convenience and flexibility.

Does the telemedicine platform you are considering offer you a plan that fits your ways of working? Does it allow requests for enhancements and customization based on your needs?

Every practice has different needs. Before choosing a telemedicine platform, look into the plans it offers and asses how each of them ranks against your needs. Additionally, make sure that they respond to customer feedback by discussing and delivering the requested features that will add value to you and other users of the platform.

Is the telemedicine platform compliant with HIPAA, PHI, and PCI regulations? Are they following the best security practices?

One of the key hurdles practitioners face for telemedicine is the security concerns involving privacy and data. This is why it is important that you seek a telemedicine platform that describes in detail how it assures security and compliance with respect to applicable regulations. Attention should be paid in particular to HIPAA compliant hosting architecture on enterprise level hardware or Cloud systems, architecture with separate web and database environments, password encryption, encrypted link between a server and a client at all times, amongst many others.

Does the telemedicine platform you are considering offer online or in-person training for your team?

Selecting and implementing a telemedicine platform is the most important step in the process of embarking on a telemedicine program. However, if you and your team do not know how to use the tools to its full extent, you will not benefit from telemedicine. You and your team receiving adequate training is very important step in running a successful telemedicine practice. Make sure that the telemedicine platform you are selecting offers the training that fits your needs and preferences. Most common practices for training can consist of online tutorials and documentation, scheduled online sessions with an expert, or in-person workshop. However, in-person support is the most preferred and helpful mode of training and implementation assistance.

Does the telemedicine platform you are considering have extensive online tutorials and resources to help you get started easily?

In addition to training, it is good to have access to online resources that can help you quickly get the information you need. Video tutorials covering different modules can assist you while you are getting started with the telemedicine platform or when you simply want to learn more about a feature of the telemedicine platform. In addition, frequently asked questions can be a great resource when you need to clarify something or when you are facing an issue.

Does the telemedicine platform offer tutorials and help content for your patients as well?

As patients will be joining for their appointments from their homes, you may not always be able to assist them if any issues arise. Additionally, patients may be accessing the telemedicine system from a different kind of device than yours. Hence, it is necessary that the telemedicine platform has resources for the patients, instructing them how to join from different devices or browsers that the telemedicine platform supports. In addition, an easily accessed FAQ (Frequently Asked Questions) section for patients and the ability to contact application support for help can improve patient adoption of telemedicine.

Does the telemedicine platform you are considering offer easily accessible support and maintenance for both you and your patients?

It is important that the telemedicine platform you are choosing is offering accessible support for both you and your patients. If you are experiencing any issues with the telemedicine platform, there should be resources that you can look into including frequently asked questions and tutorials, as well as a support email and/or a phone number you can contact for assistance.

Is Telemedicine expensive?

Telemedicine Success Stories

Telemedicine used to be onerous and expensive earlier and restricted to specific scenarios of treatment when it was not possible for the patient to be seen in-person. The patient also needed to be in certain approved locations for the Telemedicine session to be recognized by payers. However, with the widespread availability and affordability of digital connectivity and devices, Telemedicine becomes a very affordable technology for healthcare providers to introduce as a convenient option for their patients.

Vivadox.life has “zero” startup costs for healthcare providers and competitive pricing plans to help them implement a successful Telemedicine program. With continuous progress in both coverage and payment parity made across all payers, Telemedicine is an attractive way for healthcare providers to expand their revenue opportunities.

Family doctor online.Parents and a child consult a doctor using a laptop at home.

For patients, Telemedicine does not cost them any more than an in-person visit. It saves them time and money by avoiding the commute. It is also less disruptive to their personal and professional work schedules resulting in greater patient engagement. Telemedicine is also safer for patients minimizing any chances for cross infections from other patients in the waiting rooms.