Practical Pearls: Telemedicine and the Patient Experience

Telemedicine is Here to Stay
Telemedicine is a valuable tool for patient care, but one that has been underused and underdeveloped for many years. When COVID-19 interrupted daily life as we knew it, telemedicine abruptly entered the mainstream of healthcare. It is estimated that provider networks are performing between 50 to 175 times the level of telemedicine that they were pre-COVID. The telehealth industry is here to stay, so understanding how to best incorporate this tool into clinic workflows and following best practices is now a necessity. With effective planning, telemedicine can be delivered efficiently and with high quality.

Choose the Right Technology
Telemedicine does not fit all purposes in patient care delivery, of course, but it is a natural fit for most lipid clinics where physical exams and procedures are not always needed during a visit. History taking, conversation and education can be adapted to an effective virtual visit. The first lesson our practice has learned from telehealth is to choose a technology that is easy for patients to access. If your practice or institution has chosen a technology that fails patients more often than it serves them, it is time to reassess your options. With the urgent need in March and April of 2020 to get televisits up and running, many practices hastily chose programs that may not have been optimal. I am dismayed to say that our practice has tried no less than 7 technologies over the past several years. None is perfect but some far outweigh others. In retrospect, perhaps one simple question, “How many successful telemedicine visits have been conducted on your technology?”, will tell you whether a vendor has perfected a technology that works across several devices, geographies and demographics. Another important tool is identifying whether the telemedicine vendor offers pre-visit electronic forms. Integration into electronic health record workflows can also be key to efficient visits.

Consider Your Setting
Once you have a quality technology that will allow you to connect well with the patient, it is important to consider your setting. During the pandemic, many healthcare professionals have found themselves conducting telemedicine visits from their homes or from less-than-ideal office settings. As you look forward to future telemedicine visits, I encourage you to consider creating a setting that makes the patients at ease and conveys professionalism. While patients will tolerate a dog barking or an occasional interruption, it should not be the longterm setting for conducting visits. Patients want to meet with a provider who is focused on their care, without external distractions. They want to know their visit is in a confidential setting. Other things to consider in the setting include quality of microphone, camera, and lighting. Allowing a patient to clearly see your facial expressions and look in your eyes while hearing your every word will improve their experience immensely. Similarly, you can observe the patient’s facial expressions, and with appropriate lighting, identify signs of very high cholesterol such as xanthelasma. With the current standard to wear masks for all in-person visits, if you can provide an excellent telemedicine visit, one could argue it could surpass the inperson experience during a pandemic.

Staff Workflow
The staff workflow of telemedicine visits is also something to consider. Some technologies allow for a medical assistant or nurse to enter the room first and check the patient in before the provider sees them. If not, then the provider must get accustomed to reviewing medications, past history and a review of systems as part of the visit flow. Establishing a mechanism to collect this information electronically through pre-visit legal and history forms can streamline this process if they are done with a user-friendly technology . Since
telehealth visits are often shorter in length than in-person visits, an efficient workflow is key to optimizing the visit.

Be Prepared
It is also important to consider your own preparation

• Are you entering the room prepared?
• Do you have their lab results and chart in front of you?
• Do you have to turn to a separate screen often during the visit or are you able to access their information without interruptions?

While telemedicine visits can be conducted within a busy in-person clinic day, we have found that sequestering separate hours for telehealth ensures that visits are started on time and that we can enter the visit prepared and in the proper mindset for a televisit. If optimizing time schedules by scheduling televisits during the day in between in-person visits is a necessity, then it is still key to 'center yourself‘ and enter the visit mindfully. We owe the patients a full, focused visit without interruptions. Much of the care we deliver to reduce cardiovascular disease risk centers around lifestyle assessment and counseling, education on medication options (which now includes lipid-lowering agents as well as novel agents for reducing residual risk), assessing adherence and monitoring the efficacy of medications and adverse effects. Most often these important components of the clinical encounter can be accomplished during a telehealth visit.

Plan Follow-up
Leaving the visit and setting up follow-up is also an important part of the patient experience.

• Do they receive an electronic summary?
• Will the lab results be mailed to them or available in a portal?
• Do you have the ability to send educational handouts or website links to them?
• If you have asked the patient to selfmonitor (e.g., blood pressure) or keep diet or physical activity logs, will he or she be able to submit these to you via the patient portal?

As you develop a long-term telehealth program these are all essential tools to make the visit truly one that rivals inperson’ care.

Telemedicine is an exciting opportunity for lipidologists. Our expertise can now reach a much wider audience. The opportunity to grow our practices and serve patients in a setting that is convenient and safe for them is a long-term strategy worth embracing.

Disclosure statement: 
Dr. Liebeskind has no financial disclosures to report.