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PM Hack #20: Identifying And Overcoming Workflow Challenges In Telemedicine

EHR benefits

Telemedicine Creates Its Own Workflow Challenges

Currently, 31% of healthcare organizations use video-based telemedicine services, and 34% offer remote patient monitoring, according to a recent KPMG survey conducted by HIMSS Analytics.

Demand for telemedicine services varies by region, specialty, and other variables, but there’s potential across the nation for more of it. In a study of more than 2,000 consumers, 64% of respondents said they would be willing to have a telehealth visit with their doctor via video. That survey, conducted by the Alliance for Connected Care, also found that telehealth visits for acute care represent $126 in savings over in-person visits, and patient issues are resolved 83% of the time during an initial telehealth visit.

Three concepts characterize workflow in a telemedicine context, according to a 2009 Journal of Biomedical Informatics article. First, it is inherently a technology-mediated intervention. Information and communication systems are integral to the process from inception. Second, the encounter with the patient is the central event. Third, there is less of a prescribed workflow, leading to variation in practices.

Robust telemedicine system workflows are built on these fundamentals:

Identity & Verification Management

A telemedicine-based physician must have a reliable way to verify the identity of the patient, and the patient must be able to verify the physician’s identity and credentials. The physician must also provide patients with his or her physical location and contact information.

Privacy And Security Compliance

HIPAA dictates that telemedicine video and data transmissions be made over a secure, private network.

Real-time vs Stored or Forward Technologies

Real-time telemedicine technologies include live streaming and video. The real-time approach is the choice for practitioners who see many patients, conduct frequent follow-up visits, or provide immediate advice to patients. In contrast, store-and-forward services don’t require live interaction with patient data as it is being collected. Practices such as radiology, ophthalmology, dermatology and others frequently use store-and-forward applications to share information such as MRI scans, test results, X-rays, or patient records.

Integrated Systems

Integration is key to ensuring that videoconferencing with patients doesn’t disrupt providers’ workflow. When the telemedicine platform connects to the EHR, for example, patients can initiate virtual visits through a patient portal.

Mechanism For Reimbursement

Confusion over how Medicare, Medicaid and commercial payers reimburse for telemedicine is a major reason some providers are reluctant to adopt telemedicine technology. For example, private insurers do not reimburse for non-real-time consultations performed via telemedicine (i.e., store and forward), and Medicaid legislation varies by state.

Managing Scalability

Establishing a common platform and standard tools to deploy will be more cost-effective over time and allow for more efficient support. Practices should seek out vendors that allow in-depth testing so prospective customers can determine what features work in their offices and remove unneeded functions. The initial test system should be able to scale up for office-wide testing before deployment.

Before investing in one-off solutions that must be integrated, it’s important for a practice to fully understand what its core EHR vendor provides and what that vendor intends to provide in the future. Cloud-based EHR technologies can adapt to fast-changing capabilities—and regulations—and efficiently manage telemedicine workflows in this rapidly evolving market.

  1. Healthcare IT News, August 2, 2017, “Comparing 11 top telehealth platforms: Company execs tout quality, safety, EHR integrations,” by Bill Siwicki,
  2. American Well, November 16, 2015, “Telemedicine Reimbursement: A Guide to Getting Paid,” by Kofi Jones,
  3. Telemedicine and e-Health, September 2014, “The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management,” by Rashid L. Bashshur, PhD, et al,
  4. Journal of Biomedical Informatics, August 2009, “Understanding workflow in telehealth video visits: Observations from the IDEATel project,” by David R. Kaufman, et al,
  5. Center for Connected Health Policy, “Store and Forward,”
  6. GCN, August 26, 2016, “Telehealth success depends on integration with electronic health records,” by Stephanie Kanowitz,
  7. Healthcare IT News, July 11, 2017, “8 tips for telehealth success,by Sue Schade,

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