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We sat down with Mr. Michael DiDonato, MSHCI, author of “Telemedicine Perspective from Ambulatory Care, Where We Are and Can Go,” to gain his insight on telemedicine and what it means for the future for physicians and patients, as Mr. DiDonato works directly with various telemedicine vendors, physicians, and patients.

1. You refer to telemedicine as a “virtual visit” mostly in your article, can you explain why?

Surely, this is a common question I am asked when speaking about telemedicine and digital health technologies as the technology is rapidly evolving. I always do my best when having a conversation with people to establish the language to be used as early as possible as sometimes there is cross over in terms and use. Within the ambulatory space, “virtual visit” is the wording to replace the typical office visit where the patient is seen in a virtual environment to receive care over a video and audio connection simultaneously.

2. So, is there a difference between Telemedicine and Telehealth?

We can see how Telemedicine and Telehealth can be used interchangeably. Telemedicine can be viewed as the remote transmission of electronic health information; such as the information from a home health device (i.e. glucose monitor) or even the remote patient monitoring of various vital sign types (i.e. blood pressure, weight, pulse, etc.). Telehealth has a larger scope and can encompass both Telemedicine and “virtual visits” as it regards the communication through any digital medium to provide patient care- that does not necessarily involve the patient (i.e. audio calls/messages, messages via patient portals, physician, hand-offs, etc.).

3. What advice would you give a healthcare organization that is selecting a telemedicine vendor?

When looking at vendor options to provide the technological solution choosing a vendor which will support the organization’s vision of the virtual visit program will be important, but mostly important is it must be adaptable to patients. The best way to ensure that a vendor’s product will not only support the business operations but also support requirements and supplemental features which will benefit the organization is to review multiple vendors. By doing so, an organization can follow similar check-lists and best practice guidelines just as if they were selecting an Electronic Health Record (EHR) system as laid out by The Office of the National Coordinator for Health Information Technology (ONC). My recommendation during this process would be to heavily engage vendors asking about all of their support levels for three main groups: patient, care team, and information technology staff. What happens if one of them calls? Is there an internal ticketing system? How are we made aware? Is there a rapid response center for major escalations which specific people can call? Asking these questions can help organizations formulate how much internal staffing will be needed throughout the implementation and maintenance post go-live.

4. How do you prepare in general to set up the Electronic Health Record (EHR) for telemedicine for both office and clinical staff?

With any change(s) to a software there are specific steps that should be followed: designing, testing, validating, implementing, optimizing; and the ever-continuous quality improvement life cycle. With legislation constantly changing at the local, state, and federal levels pertaining to this healthcare delivery modality; having a team who can rapidly respond to these updates and maintain them is key.

From an administrative perspective, ensuring that any workflows that are designed to replace a specific in-office visit process; such as obtaining consent forms being replaced with secure electronic means whenever possible (i.e. patent portal). From a clinical perspective, updating any documentation methods to accommodate a telemedicine visit is important. To prevent EHR confusion, clinical users should be educated about which form or document to use based on the visit modality and adding options to already established workflows with reasons such as “unable to obtain as visit is virtual” can satisfy reporting agencies when documents are reviewed and there are no vitals documented for example.

5. What is your recommendation regarding technology modalities (laptop vs mobile device) for clinicians to be able to engage with the patient virtually and EHR at the same time for best experience?

This is definitely important to remember when setting up a new clinician for telemedicine. With the immediate push I had in March at my current employer to send many physicians home or to remote offices, this was a challenge as most only had their organizational issued laptop. I would say that if we could do this all over again, we should prepare to send our clinicians home/remotely to see patients out of their standard office which have multiple screens already:

A. Ensure during the vendor review that there is a mobile application so that clinicians can run their telemedicine application on a tablet or smartphone, freeing up their laptop to access the EHR.

B. For clinicians that are comfortable with setting up a secondary workspace outside of the office; provide them (or use a personally owned) second monitor and ensure that there is Information Technology Help Desk support aware of a potential influx of request to assist with setting up dual screens. Possibly even give the Information Technology Help Desk a recommendation/model set up as well to help expedite.

One of the biggest pieces of feedback before the pandemic related to the patient experience and virtual visits is hearing that patients state their physician spent more time looking at them on virtual visits, I would hate to see this positive piece of feedback decline because we could not provide the best experience possible when shifting from one physical environment to host the virtual visit to another.

6. Do you have to be tech savvy to understand the concept of Telemedicine?

As both a Healthcare IT professional and a patient who has used telemedicine, I relate to the various modalities we use in the workplace; generally, you use one you have used them all as a user. If an organization ensures that no matter how the technology works in the background to integrate, report data, access information, etc.; as long as the priority is that the patient and care team can seamlessly connect together with the technology, you can take the “savviness” out of the equation when a simple solution is provided to all users.

Michael G. DiDonato is a Systems Analysts for Ambulatory Solutions at Nuvance Health located in the Hudson Valley of New York and Western Connecticut. Michael is a Healthcare information technology professional experienced in Ambulatory systems regarding implementation/optimization of new and current technologies. Michael emphasizes the use of data to assist in clinical decision making, promoting safe, effective, and meaningful use of health information technology, and effective evaluation of systems design to ultimately improve the Physician-technology relationship. Michael believes that streamlining Electronic Medical Records and health technologies available helps the care team and patient, as paper trails are detrimental to patient care in an ever changing and evolving digital care setting. With the use of technology in the Physician office and patient home’s increasing; providing data driven results about the solutions used can drive an increased trust with these evolving methods to deliver the medicine of the last 100 years into the next 100 years to provide the best in class, value-based care.

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