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Telemedicine During the COVID-19 Pandemic: Risk Management Recommendations and Resource Links

Posted/Updated on 9/13/21 5:00 PM

Healthcare delivery disruptions by the COVID-19 pandemic, relaxation of telehealth regulations, and increased reimbursement rates have dramatically increased the use of telehealth modalities, particularly video conferencing with patients as an office visit alternative. It is important to remain mindful of the standard of care, which generally remains constant even within this alternative healthcare delivery environment. In fact, all of the risk mitigation and patient safety tools normally used in the delivery of patient care (e.g., thorough communication, care coordination, and documentation) should continue before, during and after a telehealth encounter. Consider the following recommendations:

  • If you are treating patients across state lines under a COVID-19 temporary state or federal licensure waiver or modification, follow licensure updates in those states to ensure you do not inadvertently violate licensure laws as a result of the expiration of an emergency waiver. The Federation of State Medical Boards website has a COVID-19 webpage that includes links to current state licensing requirements, including States Waiving Telehealth Licensure Requirements, the Center for Connected Health Policy (CCHP) maintains a COVID-19 cross-state licensing page, and the Alliance for Connected Care maintains a Telehealth and Licensure Flexibilities During COVID-19 and Current State of Emergency Waivers page. These resources appear to be regularly updated to reflect changes in state licensing laws.

  • Use a secure system and otherwise comply with HIPAA, even when using video telephony technologies that historically have not been considered compliant with HIPAA (e.g., FaceTime).
  • Ensure internet speed and bandwidth are adequate for video conferencing and other means of telehealthcare delivery. (More information is on the website at What is the recommended bandwidth for different types of health care providers.) Test your video conferencing capabilities with a trusted colleague to gauge patient experience and remedy problems.

  • Use hardware that provides patients with a technologically appropriate healthcare experience (e.g., ensure picture clarity is appropriate to accomplish an examination).

  • Communicate the availability of telehealth at your practice, the method for scheduling a visit, and a description of what a telehealth visit will entail.

  • Determine whether telehealth is appropriate for the particular patient.
    • Ensure the patient has the technology and connectivity necessary to be adequately examined, the capability to utilize the technology needed, and a condition that does not require an in-person visit. Have a back-up plan, such as switching to a telephone conference or rescheduling an in-person examination.
  • Ensure the patient is appropriately identified before delivering care or prescribing medication. 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, then 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 about prior medical history to determine if the patient responses match what is in the medical records
  • At the start of the telehealth visit, set expectations for the patient. For example, acknowledge that a telehealth visit may not feel as personal as an in-person visit, but emphasize that the patient is still receiving quality healthcare.

  • Bring structure to the telehealth visit by setting an agenda; asking for and identifying the patient’s primary concerns and priorities for the visit; and at the end of the visit, summarizing the plan of care, and emphasizing any follow-up concerns.

  • Document the telehealth encounter as you would any patient encounter, including all communications with or about the patient; tests and results; follow-up recommendations; and coordination of care, etc.
    • Document the informed consent process, 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 telehealth is not appropriate for the diagnosis and treatment of his or her condition.
    • Document any technical issues that interfered with, delayed, or complicated the telehealth encounter. For example, poor internet connectivity or signal quality, camera or device malfunction, patient inability to manage technical aspects of the exam, or peripheral device unavailability.

COVID-19 Telemedicine Resources

Topics: COVID-19

← Back to Pandemic: COVID-19 ExchaNGe

The information provided on this site offers risk management recommendations and resource links. Guidance and recommendations contained in this website are not intended to determine the standard of care, but are provided as risk management advice only. The ultimate judgment regarding the propriety of any method of care must be made by the healthcare professional. The information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney. NORCAL Group makes no representation regarding compliance with state or federal law by offering these resources. These documents and links are provided for your convenience and reference only, and the provision of these materials does not mean NORCAL Group is affiliated or associated with these organizations.