Virtual care gained popularity last year during the COVID-19 pandemic, as many people were hesitant to go to the doctor’s office or other healthcare setting where they feared exposure to the coronavirus. Health systems and doctor’s offices quickly transitioned to telehealth and telemedicine to provide access to care.
While telemedicine isn’t new, the pandemic surely put the spotlight on the role of the technology. In many cases, patients could remain safely at home, yet be “seen” by their physicians and have certain aspects of their health “checked” by remote patient monitoring.
More people will become vaccinated in coming months and the pandemic will start to wind down, but the renewed popularity of telemedicine is here to stay. Moving forward then, how do healthcare providers make the decision of when an in-person visit is warranted vs. a telehealth visit?
A recent NEJM Catalyst article discussed UCLA Health’s approach to developing telehealth-specific primary care triage protocols to ensure that providers continue to deliver, and patients continue to receive, the right care, at the right time, via the right medium.
When UCLA Health asked their primary care physicians how to determine an in-person vs. telehealth visit, doctors said the ability to deliver high-quality care via telehealth is driven by unique patient factors and clinical concerns. The decision on whether an in-person or telehealth visit is scheduled should be based on careful assessment of the risks and benefits associated with each approach. Outside of the pandemic, UCLA PCPs said there were circumstances in which telehealth should not be used, such as a patient with chest pain or abdominal pain. UCLA Health estimates that approximately 7% of all of their telehealth visits from March to September 2020 could have been considered inappropriate during non-pandemic times – that is, the presenting symptoms may have been more effectively and safely addressed through an in-person visit.
Based on their experience with a high volume of telehealth visits, UCLA Health offers these “pearls” for health systems that are considering a triage-style approach for scheduling telehealth visits:
1. Make virtual care a priority. Create a multidisciplinary team, including clinical, operational, and financial stakeholders, to evaluate and implement changes that enhance a health system’s ability to provide high-quality virtual care.
2. Incorporate telehealth into your triage protocols. Consider the risks associated with both virtual care and in-person care, particularly during active pandemic surges, when developing triage protocols. Collect input from providers, operators, and patients to identify red flags indicating whether virtual care is appropriate.
3. Check and refine. Develop performance metrics and gather regular feedback from physicians, staff, and patients. Use this information in a continuous improvement framework to refine your triage protocols.
A key piece of advice they also recommend is to “seek the perspective of frontline staff and patients to inform the design of a telehealth-specific triage protocol because these individuals are in the best position to communicate the unique needs of the population being served and the current capabilities of health technology.”
Lastly, your telehealth system should have the capability of tracking and reporting telehealth audio and interactive consultations in order to facilitate your monthly billing.