Introduction

Telehealth program implementation

Existing electronic medical record infrastructure

Alternative audiovisual platforms

Institutional IT support

Provider and patient investment in hardware

Provider and staff training

Patient education and participation

Eligibility, coding and billing integration

Non-physician staff telehealth encounters

Discussion

Conclusions

References

Abstract

Objective: In the novel coronavirus disease (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a significant backlog of patients once stay-at-home restrictions are lifted. In practices that are naive to telehealth as an alternative option, providers and staff are experiencing challenges with telemedicine implementation. We aim to provide a comprehensive guide on how to rapidly integrate telemedicine into practice during a pandemic. Methods: We built a toolkit that details 8 essential components to successful implementation of a telemedicine platform: Provider and staff training, patient education, an existing electronic medical record system, patient and provider investment in hardware, billing and coding integration, information technology support, audiovisual platforms, and patient and caregiver participation. Results: Rapid integration of telemedicine in our practice was required to be compliant with our institution’s COVID-19 Taskforce. Within 3 days of this declaration, our large specialty-care clinic converted to a telemedicine platform and we completed 638 visits within the first month of implementation. Conclusions: Effective and efficient integration of a telemedicine program requires extensive staff and patient education, accessory platforms to facilitate video and audio communication, and adoption of new billing codes that are outlined in this toolkit.

Introduction

Telemedicine was previously touted as an opportunity to expand healthcare access to rural1,2 and underserved populations3 but has urgently been adopted as a safer means of providing medical care during the novel coronavirus disease (COVID-19) pandemic 4 . The Centers for Medicare and Medicaid Services (CMS) rapidly facilitated this change through the 1135 Waiver, allowing clinicians to provide telemedicine services in broader circumstances4,5 . In addition to reducing the potential risk of infectious disease transmission, telemedicine visits have achieved similar health outcomes compared with in-person patient visits in several primary care studies6 , and have ancillary benefits of reducing travel costs and time away from work 7 . Subspecialists across multiple disciplines have also used telemedicine to increase access for patients seen in rural clinics. This has been associated with high levels of satisfaction among both patients and their primary care physicians7 . In a study from the Veterans Administration, patients seeking care from the Greater Los Angeles area rated their satisfaction as “very good” to “excellent” in 95% of cases8 . On average, patients saved 277 miles driven, $67 in travel-related expenses, and $126 in missed opportunity costs per telemedicine appointment8.