COMMENTARY

How to Start Doing Telemedicine Now (In the COVID-19 Crisis)

Neal Sikka, MD

Disclosures

March 25, 2020

Should You Use a Smartphone or a Computer?

The hardware component of telemedicine is becoming less critical. You need access to your EHR and access to video. This might be a single desktop or laptop with multiple screens or it might be two devices—one device for the EHR and one for video, such as a laptop, tablet, or mobile phone.

Many EHR systems, including Allscripts, Cerner, and Epic, provide basic telemedicine functions. However, platforms that are part of EHR systems are usually not as robust as self-standing telemedicine software purchased separately.

Self-standing platforms may provide such features as appointment scheduling; managing upcoming patients waiting their turn; e-prescribing; sharing lab and imaging results; and controlling devices on the patient's end, such as a remote camera, a digital stethoscope, and other scopes.

Vendors include Doxy.me, Zoom, and companies that also function as telemedicine providers and share their own platform technology, such as American Well, eVisit, Sherpaa, and Teladoc. Platforms range in cost from free for relatively simple solutions to more robust software that starts at around $200 a month.

The more expensive self-standing products provide extra services, such as 24/7 customer support. Vendors charge extra for a "white label" option, which puts the practice's logo on everything the patient sees.

The downside of self-standing platforms is that they may not integrate with your EHR system or your patient portal, meaning that patient records have to be managed separately, and patients may need to download a second app to make a connection.

In these cases, you can manage your end of the transmission by setting up two screens for the telemedicine visit: one screen for the telemedicine connection and the other to enter documentation into your EHR.

Some telemedicine systems can be integrated into certain EHR products, however. For example, the American Well platform integrates with Cerner.

Use of Basic Teleconferencing Is Now more Permissible

Some doctors like to use basic videoconferencing tools, such as Skype, FaceTime, and Google Hangouts, for telemedicine. These modalities are free and easy to use. Previously they did not fully comply with HIPAA, but those concerns are no longer an issue in this time of crisis.

Consider that the workflows you put in place to start seeing patients virtually during this public health emergency are ones that you will probably want to develop in such a way that you can continue them once the crisis is over. Some of these platforms, while easy to use, are not designed for healthcare and may reveal your personal email address or phone number.

HIPAA requires that patient data be secure from hacking when they are transferred. All three of these services encrypt their data, but other HIPAA compliance issues remain under dispute. Specifically, HIPAA directs that the vendor must monitor data that are stored during transfer.

To vouch for this and other HIPAA compliance requirements, vendors provide customers with a BAA, which takes responsibility for any breaches under their watch. Note that Skype, FaceTime, and Google Hangouts do not offer BAAs for basic service. They say that they don't need to because they merely act as a "conduit" of data and do not store data.

There are no known lawsuits challenging this contention, and many small practices still use these platforms or telemedicine. However, some insurers won't pay for telemedicine care that uses the non-BAA platforms, and some large organizations don't allow their doctors to use these platforms. Look for no-cost and low-cost alternatives that do issue BAAs available to physicians. Again, this issue is currently waived during the public health emergency, but keep in mind that after the crisis, you will probably want to keep doing telemedicine. Select a platform with which you will eventually be able to sign a BAA.

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