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Telemedicine: Risk Management Recommendations

Posted/Updated on 6/10/20 2:00 PM

Many practices are investigating the use of telemedicine to offer services while minimizing risks to their patients and staff.  For those practices that have not established telemedicine, there are several key elements that should be considered.  Telehealth and telemedicine may be defined by state laws and regulations, but the specificity may vary widely.  In addition, compensation for providing telemedicine services will also depend upon the patient’s insurance provider, therefore impacting reimbursement.  In addition, the use of technology to communicate with and evaluate patients requires attention to privacy and security practices as well as assuring the standard of care is met. 

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Risk Management Recommendations

As more and more healthcare providers begin to use telehealth to care for their patients, it is important to always remain mindful of general patient safety, the individuals’ clinical care needs, and what would always be your fundamental guiding light--the standard of care for your clinical decisions. Utilize all the risk mitigating and patient safety tools you would normally use—that of thorough communication, coordination of care, and documentation of both, as well as your clinical thinking and decision-making process.

  • Ensure the patient’s condition can be appropriately examined via available telehealth equipment. Determination of telehealth appropriateness will need to be made, e.g., can the patient be adequately assessed without information normally obtained during an office visit.

  • Ensure the patient has the technology and connectivity necessary to be adequately examined and the capability to utilize the technology needed. Have a back-up plan in case something goes wrong, i.e., have a telephone number for the patient in case the video visit does not work.

  • Recognize that some patients might not be comfortable with a video visit and might require a phone visit or in-person if available.

  • Ensure that you are examining and prescribing for the correct patient. Some ways to authenticate the patient include:
    • Asking the patient to hold up a driver’s license to the camera and comparing the information on the identification card to the information provided by the patient.
    • Running an insurance eligibility check, confirming the patient’s name, address, date of birth and Social Security number.
    • If the patient has been seen before, asking a series of questions on prior medical history to determine if the patient responses match what is in the medical records.
  • Thoroughly document the encounter as you would any face-to-face encounter, including all communications with or about the patient, review or ordering of tests / results and follow-up recommendations, coordination of care, etc.

  • Document the informed consent process and confirmation, including that the patient agrees to and understands the limits of confidentiality when communicating via an electronic medium and that it may be determined that telemedicine is not appropriate for the diagnosis and treatment of his or her condition.

  • Document any technical issues that interfered with, delayed or complicated the telemedicine encounter. For example, poor internet connectivity or signal quality, camera or device malfunction, tele-presenter unavailability, patient inability to manage technical aspects of the exam, or peripheral device unavailability.

Telehealth and the Patient Experience

In addition to ensuring that the process aspects of telehealth are adequately addressed, physicians can take additional steps to improve the patient experience.

  • Clearly communicate with patients that telehealth is available, how to schedule a visit, and what the visit will look like.

  • Set expectations with patients regarding telehealth visits. Acknowledge with patients that a telehealth visit is not as personal and will feel different than an in-person visit. Emphasize that although the visits look different, the patients are still receiving quality healthcare.

  • Be especially conscious of your tone and convey warmth and empathy when appropriate.

  • Address the emotional needs of patients by acknowledging the impact of the COVID-19 pandemic and the uncertainty of the times.

  • Bring structure to the telehealth visit by setting an agenda. Ask for and identify the patient’s primary concerns and priorities for the visit. At the end of the visit, summarize the plan of care and emphasize any follow-up concerns.

  • Ask the patient open-ended questions to encourage communication and allow time to address questions from the patient.

Telemedicine Resources

National Resources

Specialty Specific Resources

Telemedicine Operations Resources

Topics: COVID-19