- Independent and family practice doctors looking to launch a successful telemedicine practice should not make choosing a vendor their top priority.
K. Michael Rodriguez, MD, a family physician at Broadlands Family Practice in Ashburn, Va., and vice president of the 13-office Fairfax Family Practice Centers board of directors, says newcomers to the world of telemedicine need to first know what their goals are and what their patients want. Choosing the right product, he says, comes later.
Most importantly, he says, make sure the patient is at the front and center – both literally and figuratively.
“I need to be the Amazon of medicine for these folks,” he says. “If they’ve got a problem, I’m there.”
Rodriguez offered a list of 10 keys to telemedicine success during a recent webinar, most of them centered around making sure the patient is happy and the doctor’s workflow isn’t adversely affected. Make sure things are simple for the patient, he said, both in logging into the system and getting before the doctor. And don’t just assume every patient knows how to use an online platform – send along an e-mail or text with simple instructions ahead of time, just to make sure.
It’s safe to say Rodriguez has learned from his mistakes. He launched his first platform in 2003, figuring then that it would be best to create an online service that connected his patients right to him. But that platform, he says, ignored his office staff, messed up his own daily workflow and wasn’t efficient for his patients.
That led to his first ‘a-ha moment.’
“Be prepared to revise your needs and change gears pretty rapidly,” he said.
So Rodriguez started over. He started with a new platform that brings patients into a waiting room and allows his two-nurse staff to handle the administrative tasks. He also created an online consent form that shows his patients just what he can and can’t do, so that they know what to expect. Once that’s settled, the virtual visit begins.
Above all else, he says, “you’ve got to engage the patient.” Making them an active part of their care builds trust and leads to collaboration, which in turn produces better clinical outcomes.
In addition, Rodriguez says, a doctor has to “put a fence around the patient,” setting guidelines so that both doctor and patient know when an online visit isn’t doing the job and an in-person appointment is necessary. Patients understand and will respect a doctor who acknowledges that a virtual visit isn’t a success.
Rodriguez estimates that 90 percent of his virtual visits are stand-alones – the patient is diagnosed in one visit - and he expects that many doctors are surprised what they can and can’t treat. An ear infection is difficult, he says, because it involves looking into the ear – a difficult task for most patients who don’t have access to remote devices. A stomach ache, headache or fever is easier, because it can be diagnosed through simple and straightforward questions.
“We end up using our ears a whole lot more in a different way – in listening to the patient,” he says, adding an old maxim that 90 percent of a diagnosis is based on a patient’s medical history.
In terms of workflow, Rodriguez advises doctors not to set aside time during the day for virtual visits – rather, integrate those encounters into the regular daily routine, so they’re not disruptive. But do set aside a room for conducting those virtual visits.
As for the legal and financial issues with telemedicine, Rodriguez advises doing a lot of research in advance. Talk to a good lawyer about state laws regulating telemedicine – each state has its own rules and guidelines – and about licensure, especially if treating patients across state lines. And talk to payers and health plans to determine who reimburses for telemedicine, and what specific services are covered.
“You may need to talk about this with all your payers and understand your contracts,” he says.
Rodriguez’s top 10 list is as follows:
- Know your goals up front – what do you want to accomplish with telemedicine?
- Know what your patients want. “Patients are pretty savvy and you really have to study them,” he points out.
- Identify your workflow – “your most precious resource” – and create a platform that integrates with that workflow, rather than supplementing, replacing or interrupting it.
- Choose a platform. Make sure it’s EHR-agnostic and scalable, and it meets your needs, rather than giving you something that you have to adjust to.
- Get good legal advice.
- Keep things simple, especially for the patients.
- Let gravity be your guide – if patients are doing too many different things to meet with you online, they’ll end up dropping things. You’re not giving them what they want, and they won’t be satisfied. They might even go somewhere else.
- Engage your staff and make sure they’re on board. “The biggest tool you have,” he says, “is to have your own folks excited.”
- Throw patients a lifeline – make sure that initial point of online contact is very easy.
- Make sure your patients are active in their own care.
Rodriguez says he expects telemedicine will become a standard of care in most offices as doctors become used to the technology. In time, he says, that will include easy access to mobile diagnostic and monitoring devices in the home, more services made available online and more reimbursement.
“Remote medicine is happening,” he says. “It’s going to happen. You might as well be on the ground floor for that.”