Determining Telehealth/Telemedicine Best Practices

Background:
Adoption of telehealth in response to the COVID-19 pandemic has predicted virtual healthcare services to reach 1 billion by the end of 2020.1 As Medicare relaxed regulations, telehealth claims increased more than 11,000% in a six-week period.2 Accelerated telehealth utilization presents opportunities to generate evidence and improve services. Given the scarcity of educational resources to assist clinicians in delivery of remote wound care, we aimed to identify wound care-specific telehealth best practices.

Methods
Five wound full-time clinicians working with telehealth in different roles/settings (inpatient/outpatient/post-acute/telehealth technology development) were asked to share challenges and solutions they experienced in wound care-specific telehealth across 3 dimensions: patient, clinicians/staff, and implementation. Secondary sources (e.g. literature/webinars/Medicare) were analyzed, to complement/contrast with clinicians and identify best practices.

Results:
Challenges(‚Åé) and solutions(‚Åë) in each dimension were compiled into a best practice document. Highlights include:
Patients:
‚ÅéNot all patients are suitable for televisits
              ⁑First-time consultation should preferably be in-person.
              ⁑Televisits are ideal for simple follow-up care, patients who cannot come in, triaging of urgent issues, and               
                interprofessional consultations/communications.
              ⁑Identify barriers (e.g,, no internet/smartphone) and remedy by assessing patient’s technology and comfort on first
               appointment.
             ⁑Educate patient/caregiver.
‚ÅéTechnology/patient issues preventing proper assessment
             ⁑Submit pictures prior to televisit.
             ⁑Have intermediary clinician/family assist with visit.
             ⁑Adapt documentation to acknowledge limitations.
Clinicians/staff:
‚ÅéVariable documentation among providers
            ⁑Use documentation templates; be audit-ready
‚ÅéNon-HIPAA compliant messaging/televisit solutions
            ⁑Use certified compliant platform that fits into wound-specific workflows
            ⁑Offers a business associate agreement
 ⁎Clinicians stressed if patients having difficulty
            ⁑Educate clinicians/patient
            ⁑Identify specific staff to troubleshoot technical issues prior to visit
Implementation:
      ⁎Overspend and/or purchase software that does not integrate with workflow/patient ease.
            ⁑Investigate and compare platforms.
            ⁑Use a platform requiring no downloads or installation.

Conclusions
As payers/patients/clinicians prepare to make telehealth a permanent modality, implementation of best practices will ensure patient and clinician/staff satisfaction.

Trademarked Items (if applicable): N/A

References (if applicable): References:
1. US Virtual Care Visits To Soar To More Than 1 Billion.[Internet]. Forrester Research. 2020 [cited June 24, 2020]. Available from: https://go.forrester.com/press-newsroom/us-virtual-care-visits-to-soar-…
2. Pifer R. Medicare members using telehealth grew 120 times in early weeks of COVID-19 as regulations eased.[Internet]. Healthcare Dive. 2020 [cited June 24, 2020]. Available from: https://www.healthcaredive.com/news/medicare-seniors-telehealth-covid-c…