By Emma James-Wilson
LHA Trust Funds
Telemedicine services have grown exponentially in the wake of the ongoing COVID-19 pandemic. Physicians are seeing significantly more patients via telehealth than they did pre-pandemic and it’s unlikely to change. Telemedicine solves many problems in a post-COVID world, allowing physicians to treat patients without the risks of face-to-face interaction while maintaining patient access to medical care.
While telemedicine has numerous benefits, the process can also have several pitfalls ̶ technology troubles, inadequate staff training, and, in the worst-case scenario, delays in necessary care that could lead to poor patient outcomes. That is why LHA Trust Funds has created a failure modes and effect analysis (FMEA) tool to help physician office practices assess potential risks in their telemedicine processes and procedures.
Download the FMEA and instructions on how to use it here.
The FMEA tool is designed to be customized to individual organizations and the examples given are simply a starting point to examine the telemedicine process. By its nature, telemedicine is made of many complex processes, from choosing a platform and training staff on its use to scheduling visits and conducting patient follow-ups. Ideally, a separate FMEA is used to address each aspect of the entire process.
“Many of the physicians who are now offering telehealth services didn’t have the luxury of taking six to 12 months to work out all of the potential issues,” LHA Trust Funds Vice President of Patient Safety & Risk Stacie Jenkins says. “An FMEA takes a proactive approach to evaluating potential process failures, ensuring that your organization is mitigating potential risks that may exist in your current process. It’s a way of anticipating what might happen and intervening ahead of time to prevent it from happening.”
Meeting The Challenge
The luxury of time was not something Lafayette General Health (LGH) had when COVID-19 hit. Chief Medical Information Officer Dr. Fallon McManus will never forget the first administrative meeting after President Trump’s national emergency declaration on March 13 where they discussed the best way to treat patients while keeping staff safe. While LGH had a telehealth platform already in place, the organization had not planned to start offering virtual visits at their clinics until the summer of 2020. Instead, LGH’s first scheduled virtual patient-doctor visit occurred on March 16, just three days later.
“COVID just pushed us right into the deep end, but we had the foundation in place to quickly roll out because we already had [telehealth platform] American Well ready to go when this happened. So we were in a very good position,” McManus says. “Prior to COVID, our urgent care was seeing about 30 patients a month. Our urgent care visits have now gone up to about 300 a month.”
In contrast, MD Clinics of Shreveport began a telemedicine program for patients once new guidelines were announced due to the pandemic, utilizing the Microsoft Teams platform already in place internally to expand its services to include video and audio calls. In addition to being cost-effective, the decision meant not having to implement and introduce a new unfamiliar system to both patients and staff.
“Most of those [telehealth] systems require the patient to download an app anyway, so why not deploy something much faster that we already have up and running that’s HIPAA-compliant?” MD Clinics Chief Compliance Officer Patricia Porter says. “If they have to download an app, why switch and introduce a whole new system that could delay our ability to launch telehealth?”
Once the platform decision was made, Porter says, creating a good process for scheduling and training staff to ensure appointments were fully integrated into the clinic’s EMR systems was seamless. The biggest external challenge came from the clinic’s less technologically-savvy patients, most of whom were without access to smartphones or even cell phones. Also, many patients could not download the telehealth app or properly log onto video sessions due to poor connectivity. With that feedback, the organization’s strategy shifted to make audio calls a cornerstone of the process, although video appointments are still available as well.
GastroIntestinal Specialists has included telemedicine in its strategic plan since 2017 and has partnered with two FQHC practices to also provide services for Hepatitis-C patients. Administrator Randy Rossi says that the practice did not encounter significant challenges in offering telehealth visits to patients and have received positive feedback on the service. “I think they [patients] were pleasantly surprised and amused at themselves that they could get it connected and they actually enjoyed the experience,” Rossi says.
Refining The Process
Patient satisfaction is crucial to all three organizations. Technical issues can be challenging because it can be difficult to pinpoint if bad connectivity is caused by the clinic or the patient’s device, McManus says. LGH is currently developing guidance on the phones and services that work best with their program, and so far, most patients ̶ and doctors ̶ are pleased by the results.
“I’m hearing from physicians who, four months ago, said they would never do a telemedicine visit to being the first ones asking to get set up,” McManus says. “They’re seeing the benefit of it and they’re seeing that they are able to be more accessible to their patients at better times. We’re seeing some really positive reviews on both sides.”
GastroIntestinal Services plans to add questions regarding their telemedicine services to the practice’s patient satisfaction surveys, conducted biannually through both their clinic and endoscopy center. “We will add the survey to the clinic because we do see telehealth continuing in whatever shape, form or fashion that it comes out once the payers reset the rules when this [COVID-19 pandemic] is all over,” Rossi says.
Once MD Clinics embraced telemedicine as an option due to the pandemic, Porter says, understanding current regulations and creating a traditional telehealth plan were imperative. Communication with the staff and providers implementing the program is also the key to ongoing telehealth improvement and growth.
“It’s really uncovering and auditing, making sure we know what those hiccups are,” Porter says. “We met with our providers several times within the first months just to survey – What were your biggest problems? What worked? What can we fix? What things do we need to do for the patients? Then we try to implement those things in real-time so we can constantly improve.”
By continuously evaluating their telemedicine procedures, these three organizations are ensuring that patients receive the best quality medical care regardless of whether their appointment is in-person or through a video screen. Using a performance improvement tool such as an FMEA can help uncover possible failures in a process, determine the likelihood and severity of adverse events and assist in developing a plan to address those issues. This method allows physician office practices to continue improving patient safety while potentially minimizing risk to their organizations.