Interoperable Telemedicine: Patient Safety Considerations



Efforts to connect patients and providers through telemedicine have accelerated, making technology systems increasingly important for communicating and sharing information. During the pandemic, it quickly became apparent that a one-stop telemedicine solution, fully integrated with the electronic health record (EHR), was required to sustain large-scale telemedicine visits.

Benefits of an interoperable single-source telemedicine solution include patient relationship management features such as scheduling, a private “waiting room” and the ability for the provider to share screens with the patient while discussing diagnostic results and providing patient training. In a survey, providers indicated that displaying the EHR during a telemedicine visit easily facilitates better care and a better relationship with the patient. In addition, the provider can easily create a visit summary and send it to the patient with any diagnostic orders or referrals.

Remote patient monitoring (RPM) has proven to be a valuable addition to telemedicine. RPM gathers clinical information useful for the provider to manage virtual care. RPM works well for patients with chronic illness, patients treated immediately after discharge from the hospital, and patients who are hospitalized at home. The interoperability of the RPM device with the telemedicine or EHR system is a requirement for Medicare reimbursement.

When considering integration, decide whether to record and retain records of telemedicine visits. The EHR platform may not be able to manage large video files, and a doctor’s office that does not already offer imaging services will likely not have access to a picture archive and communication system (PACS). The problem with the video files isn’t insurmountable, but it adds data storage and another security endpoint that needs to be managed.

Practices that are currently unable to integrate the telemedicine solution into the EHR can achieve integration via an interface. Organizations at this stage of decision making should carefully weigh the risks and benefits of each of the options available. With the help of a consultant or a structured decision-making process such as failure mode and impact analysis (FMEA) adds care to the process. In the meantime, workflows are becoming even more critical. If there is a break between the patient visit and the record, providers may need more time to process the visit after the video interaction is complete. The provider can achieve clinical visit documentation in the EHR in a number of ways, including creating a telemedicine template in the EHR and documenting care after the visit, using speech recognition software to dictate, or using a scribe during the visit.

Regardless of whether your system is fully interoperable, the nursing care model is essential. Allocating a block of time for telemedicine visits can enable a smoother experience for both providers and patients. Some providers may prefer not to do telemedicine, and some providers may want to specialize in it. Flexibility is the key.

Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager II, The Doctors Company



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