Telehealth is becoming a staple in American healthcare. More than 76 percent of U.S. hospitals utilize the technology in one form or another. Almost every state Medicaid program has some telehealth coverage, and private payers are approving coverage for many services. Additionally, telehealth solutions are being used heavily throughout the current COVID-19 crisis since regulations and requirements were loosened to allow safer, more efficient patient screening and triaging.
The advance of telehealth as a virtual communication medium is breaking new ground for the industry, which must ensure it aligns with HIPAA compliance regulations, guards patient and provider safety, fosters good clinical outcomes, and is always improving patient satisfaction and patient experience.
In this post, we will take an in-depth look at telehealth — we’ll often refer to it in broader terms as “virtual communication” — including its history, advantages and challenges to its use, and best practice guidelines for clinical settings.
Virtual Communication Defined
Because virtual communication in healthcare continues to evolve, it’s helpful if we make a distinction among the three terms most commonly associated with the technology: telehealth, telemedicine, and mHealth.
The American Telemedicine Association treats “telemedicine” and “telehealth” as interchangeable. Others, however, prefer to differentiate between the two.
Telehealth can refer to the entire spectrum of remote health care services delivered via telecommunications and virtual technologies. Telemedicine, on the other hand, can refer to a subset of telehealth that provides clinical and medical services to patients through technology, such as video conferencing, text messaging, and audio.
A third term, mHealth (shorthand for mobile health), has also come into use. It is a form of telemedicine that involves the provision of clinical and medical services through cell phones and other wireless mobile devices.
Virtual Communication History
The use of technology in home-based healthcare settings has a longer history than you might imagine. For example, an 1879 Lancet article talked about using the telephone to reduce office visits; a 1925 cover of Science and Invention magazine showed a doctor diagnosing a patient by radio; and the 1958 NASA Mercury space program pioneered the use of physiologic monitoring over a distance.
Telemedicine has also been used in clinical settings for decades. Telemedicine, as we know it today, however, was first conceptualized in the April 1924 issue of Radio News magazine, which portrayed the use of a television and microphone for a patient to communicate with a doctor. It even included the use of heartbeat and temperature indicators.
(The idea was a vision of the future, of course, as U.S. residents did not yet have televisions and radio adoption was just gaining momentum.)
The first uses of telemedicine to transmit video, images, and complex medical data took place in the late 1950s and early 1960s. In 1959, the University of Nebraska used interactive telemedicine to transmit neurological examinations, widely considered the first case of a real-time video telemedicine consultation.
The advent of the internet in the 1990s allowed support for all the information and traffic needed for telemedicine, including patient education (text, images, video), medical images (x-rays, scans), real-time audio and video, and vital signs and other measurements (e.g., ECG, temperature).
Virtual Communication Advantages
The advantages of being able to communicate with patients in a different physical location are many.
According to a policy statement from Healthcare Information and Management Systems Society, Inc (HIMSS), text message communication between healthcare providers and consumers can address the issues of transparency as well as allow for more timely communication cost-effectively.
“Through the implementation of the text messaging policy, services will improve health, be efficient and not increase spending, while addressing the needs of the healthcare consumer,” HIMSS says, adding that “expected costs to implement a text messaging policy and utilization of the same are minimal.”
A survey conducted by the Massachusetts General Hospital Center for Telehealth reported that physicians feel virtual video visits are superior to office visits for timely scheduling of patient appointments (70.5 percent) and visit efficiency (52.5 percent).
Healthcare technology company eVisit lists as advantages five reasons to use telemedicine: it reduces hospital readmission rates, affords better medication adherence, makes post-operation follow-ups more efficient, extends access to specialty care, and improves care outcome.
The National Center for Biotechnology Information lists even more advantages to virtual communication’s use:
| Benefits of virtual communication | Standpoint, n (%) | |
| Yes | No | |
| Provides quicker and more efficient communication between physicians | 167 (70.2) | 71 (29.8) |
| Decreases nonurgent telephone calls | 126 (52.9) | 112 (47.1) |
| Reassures patient about disease | 120 (50.4) | 118 (49.6) |
| Allows patients to share similar experiences (e.g., on blogs and forums) | 112 (47.1) | 126 (52.9) |
| Allows better patient education | 101 (42.4) | 137 (57.6) |
| Creates continuous access to health care system | 87 (36.6) | 151 (63.4) |
| Helps monitor patients’ health and improve treatment compliance | 81 (34.0) | 157 (66.0) |
| Allows physicians to handle larger number of patients | 40 (16.8) | 198 (83.2) |
Lastly, the current COVID-19 situation has showed the industry a massive additional benefit of telemedicine services: protecting both patient and provider safety by decreasing contact during pandemics.
Virtual Communication Challenges
While the benefits speak for themselves, that doesn’t mean virtual communication in healthcare is without challenges.
Text messages, for example, can remain on mobile devices for an indefinite amount of time, and without proper precautions, could be exposed to unauthorized persons.
An ACP Internist article cites Allan Goroll, MD, MACP, a general internist and professor of medicine at Harvard Medical School and Massachusetts General Hospital in Boston, who said ad hoc consults via video when the doctor doesn’t have any prior relationship with the patient, “risk misdiagnosis even in seemingly straightforward circumstances.”
“One might argue that a rash is a rash is a rash, and it doesn’t matter who sees it,” Dr. Goroll said. “But knowing the patient is critical to a successful virtual visit. Not knowing the patient makes a virtual visit susceptible to misdiagnosis and the need for excessive testing.”
HIMSS, in its policy statement regarding texting, warned that the inherent risk of texting and potential PHI breaches raises issues of concern and the need for direction before using texting within the healthcare arena.
Virtual Communication Requirements
Physicians who engage in text messaging or any form of virtual communication hold the same ethical responsibilities to patients as they do during other clinical encounters, says the AMA, which advises physicians to talk with their legal counsel and information technology experts to understand their obligations.
The Department of Health and Human Services has also offered specific advice to physicians and other health professionals on how to follow privacy and security standards while using mobile phones for patient care purposes.
Medical professionals who wish to comply with the HIPAA guidelines on telemedicine must adhere to rigorous standards, which stipulate:
- Only authorized users should have access to electronic protected health information (ePHI);
- Hospitals should implement a system of secure communication to protect the integrity of ePHI;
- Hospitals should also implement a system of monitoring communications containing ePHI to prevent accidental or malicious breaches.
Basically, we can summarize adherence with the following: know the rules, gain patient consent, establish clear boundaries, maintain professionalism, proof carefully, keep records, and refrain from including identifying information.
Virtual Communication Best Practices
It’s smart to adhere to best practices for engaging in communication virtually, especially when teleconferencing by video, to improve patient experience. The guidelines provided here are no different than in-person interaction, although some are unique based on the technology.
Dress Professionally
Dressing professionally, just as you would for an in-person visit, will not only make the patient more comfortable but also legitimize the visit.
Ensure Privacy
Spaces allotted for virtual communication should maintain the same level of safety, privacy, quality of care, and patient experience as you would expect for an in-person. That includes the use of soundproofing and ensuring the patient signs informed consent to participate (if required).
Set Expectations
Set expectations for the virtual visit, including visit length, scope of service, communication, technical overview, and follow-up.
Collaborate with the Presenting Site
If communicating with a care team or patient within a hospital, know the staff and workflows at the collaborating site, who to contact, and what local resources and referrals are available to you and your patients.
Use Good “Bedside” Manner
Treat the patient as you would if you were at the bedside or in the home in person. Introduce yourself, make eye contact, speak directly to patients, and let them ask questions. Greeting people with a smile and use their name will go a long way in improving patient satisfaction.
Avoid ‘Doctor Speak’
Simplifying medical terminology isn’t always easy but using everyday language with patients pays off. Patients who better understand their conditions and your recommendations are more likely to ask questions, follow recommendations, and feel less intimidated—making for a better overall patient experience.
Provide Telehealth Practice Guidelines
Provide pertinent professional guidelines and standards for telehealth practice to the patient.
Key topics for review include confidentiality with electronic communication, emergency plan (especially for those patients without a staff member present), conditions for which telemedicine services may be terminated, an in-person care referral made, and protocols for contact in between visits.
Talk About How Telemedicine Works
HIMSS advises that before the first telemedicine visit, providers should explain to patients how telemedicine works, any limits on confidentiality, the possibility for technical failure, protocols for contact between virtual visits, prescribing policies, and coordinating care with other health professionals.
Choose One Platform to Communicate
“Instead of inundating patients with messages from multiple platforms, choose no more than three communication channels, and [use] them well,” AMA recommends.
Know the Technology
Be comfortable with and knowledgeable about the technology and care workflow processes. Familiarize yourself with room setup, devices available and software, and establish contingency plans should technical breakdowns occur.
Additional Best Practice Guidelines
Calli Smith, RN, who runs SCP Health’s 24/7 clinical Care Coordination center, shared these best practices:
- Have as much information as possible handy and keep track of what patients are saying; pay attention;
- Always use the patient’s name;
- Give the patient a number or way to get back in contact with you;
- Comfort patients; let them know someone is there to help them.
Conclusion
Major market challenges and worldwide pandemics are driving hospitals and health systems to rethink their care delivery models, and many are turning to telemedicine as a solution.
The advantages are numerous and the challenges few. When implemented and managed properly through best practices such as those outlined here, hospitals can provide more cost-effective specialized care to healthcare consumers while maintaining care quality, documentation compliance, and patient satisfaction.
SCP Health has a consumer-facing telehealth solution called Care2Me, which offers a convenient, 24/7 answer for patients in need. We provide resources, tools, and expertise to enable you to offer your own telehealth program, keeping patients in your network. Contact us to learn more.