Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers

Natalie Laub,Anish K Agarwal,Catherine Shi,Arianna Sjamsu,Krisda Chaiyachati

doi:10.1007/s11606-020-06395-9

Abstract

BackgroundCare delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today’s exponential adoption of telemedicine.ObjectiveThe objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine (“tele-urgent care”) from the perspective of clinicians experienced in telemedicine.ApproachWe conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach.Key ResultsAmong the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important.ConclusionAs telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.

Highlights

In March 2020, the novel coronavirus (COVID-19) pandemic resulted in federal and state de-regulation of telemedicine policies to help facilitate health care’s accelerated shift towards telemedicine to prevent viral spread and maintain access to care for patients where inperson outpatient practices were limiting who could be seen in-person.[3,4,5]
A national survey of chief executive officers of US health care systems indicated that 38% of health systems had no digital health strategy in 2019.6 Even in health systems with digital health strategies, greater investments in technology infrastructure will be required to support clinicians with higher volumes of telemedicine visits, local information technology (IT) expertise to support their ongoing technical needs, and clinicians will need to develop proficiencies and clinical skills when caring for patients using telemedicine
The objective of this study was to identify barriers and facilitators to providing effective, high-quality urgent care using telemedicine (“tele-urgent care”) from the perspective of clinicians experienced in telemedicine

Summary

Introduction

Care delivered using telemedicine—virtual visits connecting patients and clinicians through videoconferencing—has been steadily growing in the USA but represented a small fraction of overall visits as few clinicians were historically offering telemedicine to their patients.[1, 2] In March 2020, the novel coronavirus (COVID-19) pandemic resulted in federal and state de-regulation of telemedicine policies to help facilitate health care’s accelerated shift towards telemedicine to prevent viral spread and maintain access to care for patients where inperson outpatient practices were limiting who could be seen in-person.[3,4,5]The monumental transition of the US health care system towards telemedicine has been and will continue being a challenge for clinicians. Understanding how experienced clinicians have practiced telemedicine can inform how we train and support clinicians who adopt telemedicine into if they are to provide high-quality, safe, and evidence-based care.[7]. We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. CONCLUSION: As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future

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