Telemedicine has great potential to deliver just-in-time physical therapy. While it’s not appropriate for all situations, where it is, it can be a cost effective way to stay connected to patients and deliver service.
Our previous recap from the American Physical Therapy Conference session featured Just-In-Time Management principles including telemedicine. There was so much good advice in the session we’d expand on some of the best practices for telemedicine outlined by Carol Jo Tichenor, Director Physical Therapy, at Kaiser Permanente.
Where to Implement Telemedicine
First consider where telemedicine can augment, improve, or streamline your practice. For Kaiser Permanente, telemedicine was very effective treating students who were part of Kaiser’s system in California but attending out-of-state colleges. A British study found that using telephone calls as an intial screening for back pain resulted in shorter wait times for patients, and fewer missed appointments.
As you consider where you might include telemedicine, ask yourself whether you have patients who:
- Are remote or need to travel long distances for treatment.
- Are ‘road warriors’ and travel frequently for their profession.
- Have work schedules that make it difficult to schedule appointments.
- Have physical difficulty getting to the clinic but are not candidates for home care.
- Might need a short-check in rather than a full-scheduled visit.
How to Implement Telemedicine
Successfully implementing telemedicine, or any technology into your practice for that matter, requires not just a technical implementation plan but also a people and process plan. Technology projects fail if they are not integrated into the way people work.
Some things to consider.
- Will you offer virtual appointments to all patients or just some who meet a certain criteria?
- Will you use virtual appointments for pre-screening or will you require a face-to-face visit first? There are pros and cons to either approach. Pre-screening might help get patients to treatment faster. Face-to-face allows a hands on assessment and the ability to establish a rapport with the customer.
- Do you have space in your clinic to run the telemedicine sessions? You will need a quiet location with good lighting.
- What technology will you use? Does it work on existing computers? This could be an entire blog post in itself. A few key points for you to consider:
- Is it secure? Skype and FaceTime do not provide the security required for HIPAA or other personal data protection laws. These are consumer technologies that will not guarantee that data is passed securely.
- Is it easy for the provider and the patient to use? Does the patient need to install plug-ins?
- How many people will need to use it?
Thinking about the way people work, do you have some providers who are better than others at patient communication? Telemedicine removes some forms of communication, so only your best communicators should probably participate. When will you schedule appointments? During the day or before or after office hours? If the equipment is shared, how do you make sure it’s available for an appointment.
Also think about how you will make technology adoption as easy as possible for practitioners. What types of training programs will you offer for them to learn the technology? How will you make sure it’s available?
How to Run the Session
With the adoption of telehealth there are starting to be best practices on how to conduct a session. Here are a few things for you and your practitioners to consider.
- If possible, start with an in-person visit to establish rapport.Consider how you can make the technology adoption as easy as possible for practitioners.
- Plan what is possible for the visit. Telehealth is better for check-ins than to establish a new program with a patient.
- Practice using the technology before the session, and if you don’t have a lot of personal experience with video calls with consumer technology like Skype or FaceTime, make sure to do some practice calls first.
- Start the session with some small talk to make communication easier.
- Look at the camera. Make eye contact.
- White coats add too much glare and it’s hard for the other person to see you.
- Try not to move around too much.
- Keep the background clear of distracting clutter.
- Keep the patient aware of what you’re doing. If you’re looking something up or thinking about a response, tell them. Video calls often miss these queues.
Telemedicine might not be for every practice, however, increasing costs coupled with increasing expectations of consumers and patients, it will most likely become a key service in healthcare delivery.