A decade ago, telehealth seemed like a complicated, inefficient way to deliver care. With advancements in technology and the COVID-19 pandemic, telehealth has grown into a vital tool for emergency medicine physicians.
At CORD Academic Assembly 2021, EMRA’s Administration and Operations Committee partnered with the Informatics Committee to host “The Future of Telehealth in Emergency Medicine” panel discussion to gain an in-depth look at the implementation opportunities and barriers facing telehealth and what this could mean for its future within the field of emergency medicine.
The telehealth experts who joined for the panel included:
- Aditi Joshi MD, MSc, Thomas Jefferson University Hospital
- Emily Hayden, MD, MHPE, Massachusetts General Hospital
- Sari Lahham, MD, MBA, Kaiser Permanente
Throughout the COVID-19 pandemic, telehealth has emerged as an effective venue to deliver high-quality patient care. While several institutions implemented telehealth initiatives prior to the pandemic and were well-positioned to expand their efforts, many others started from scratch at the onset of COVID-19. Their ability to adapt quickly to the demands forced upon them by the pandemic affirmed the exciting opportunity for growth in telehealth. However, it also exposed some of the challenges that telehealth continues to pose to patients and physicians.
5 Important Considerations for Telehealth
1. Workflow can make or break telehealth.
Dr. Hayden discussed how it is important to acknowledge the barriers to adopting telehealth for both patients and physicians, and how to address these barriers. Some patients may not have the access to the hardware, software, or internet services that are required for a virtual visit. Additionally, Dr. Joshi noted that the telehealth interface for the physician must be user-friendly in order to reduce resistance to this new form of patient encounters.
2. Balance patient satisfaction and patient care.
Dr. Lahham emphasized how telehealth visits should mirror normal in-person visits as much as possible. It is important to educate the patient on their visit and train physicians on how to address patient concerns virtually.
3. Integration of virtual care and electronic health records.
Dr. Hayden shared how most video systems for virtual visits are separate applications from electronic health records, which ultimately leads to the need for double-documentation by physicians and staff. For telehealth visits, documentation remains an important part of the visit and should be consistent and detailed. Physicians must always include their recommendations during a virtual visit.
4. Consider patient and physician privacy.
Dr. Joshi explained how, even during virtual visits, HIPAA privacy laws still apply. It is necessary to ensure that both the patient and physician are in a location that maximizes privacy. The platform on which the virtual visit occurs also needs to be securely encrypted.
5. Be transparent about billing.
Dr. Lahham discussed how, with changing laws surrounding telehealth, billing has become complicated, as virtual visits require different codes than in-person visits. Importantly, Dr. Hayden noted that it is critical to inform patients that virtual visits are billable so they are not surprised upon receiving an invoice.
In addition to existing considerations, the panelists shared up-and-coming telehealth projects. Dr. Hayden discussed utilizing specially trained paramedics to help with managing patient care in the prehospital field through telehealth platforms. Dr. Joshi shared a new system at her hospital that allows the emergency department to virtually triage patients from their home. Lastly, Dr. Lahham explained how utilizing telehealth can help emergency departments across the country manage high patient volumes by virtually seeing patients in the waiting room.
Even with the exciting possibilities that telehealth offers, it is important to remember that it is a relatively new addition to the field of emergency medicine. As such, there will likely be increasing needs to improve medical education and training for medical students and residents in telehealth. It also requires improved access to technology and data management, both for patients and physicians. These challenges are multifactorial, and their solutions will depend on institutional commitment, community requirements, and financial investment in telehealth as a critical driver for quality patient care. While there may not be a one-size-fits-all approach for each organization, flexibility will allow institutions to remain creative and nimble in providing additional telehealth services to their patients.
Moreover, given the explosive growth and opportunity to shape the field, all the panelists advised that the current moment is a great chance for medical students and residents to get involved. Dr. Joshi recommends joining institutional or national committees devoted to telehealth projects. For students and residents who have an idea for a project, reach out to an attending faculty member who may be interested in driving growth in the telehealth space for your healthcare system. Additionally, Dr. Hayden suggested advocating on a national level - whether through EMRA, ACEP, or another organization - to help improve telehealth access and security for patients. Telehealth is a rapidly growing field of medicine, making this an exciting opportunity to get involved at all levels of training.
*This paper is paraphrased based on the panel discussion at CORD Academic Assembly 2021 and does not contain direct quotations.