Unfortunately, the biggest negative I have experienced is not being able to auscultate lungs or heart. Is it clean? Dirty? Cluttered (offering clues to fall risks)? Stairs? Etc. One positive of the tele visits that I have experienced is being able to see the patients environment. The hands on portion helps to establish that 10-20% still in question after the history is taken. However, for the most part 80-90% of diagnoses can be determined WITHOUT the hands on portion of the exam. Standards of care do not change between tele and in person visits. As a Nurse Practitioner and primary care provider, I have definitely seen a spike in the number of telehealth visits. Certain patients will require in-person care, regardless of any desire to minimize COVID-19 exposure and it is critical that providers explain the safety procedures in place to make patients comfortable in this new environment. Providers must be vigilant about patient follow-up and confirming diagnostics and treatments. Clear protocols for follow-up care are necessary. The doctor has the same obligation to provide safe care to the patient. There is no difference in the standard of care when a medical appointment is conducted by Telemedicine. Confidentiality risks: Housemates or family members may be nearby.Diagnostic testing and " continued need to ensure patients are able to receive all necessary services when appropriate (e.g., labs, x-rays, procedures).".Language barriers and interpreter services must be accessible.Providers must be certain that " accommodations are in place for patients who are deaf, hard-of-hearing, or are blind or have low vision.".Patients lacking broadband or ability to access Telehealth safely and adequately.Alternative plans for patients who need care above and beyond the services Telehealth can provide, such as further testing and access to additional resources.Provider inexperience with Telehealth technologies and routines.There are patient safety concerns to be aware of when considering Telehealth visits, including: As reported by Meg Barron, the AMA’s vice president of digital innovation, it is "estimated that 60% to 90% of physicians are using some sort of telehealth services." Also, since COVID-19, half of them are using Telehealth for the first time, meaning that a lot of doctors are treating patients in a very unfamiliar technological landscape. The number of providers utilizing Telehealth visits to treat patients expanded rapidly in 2020. As reported by one company, " Doctors Company's data shows that we had 38 closed claims involving telemedicine from 2007 to 2018, out of 27,559 claims." In fact, " the overall safety of telehealth is less well studied." Whether accurate or not post-pandemic, medical insurers view Telehealth visits as "f airly low risk from a medical malpractice liability standpoint." Prior to 2020, the number of liability claims resulting from Telehealth were very limited. The main concern is that the patient safety of Telehealth has not been studied as implemented on the scale we have seen in 2020 since the start of the COVID-19 pandemic. CMS has broadened the scope of providers permitted to utilize Telehealth visits and has implemented changes overall to " increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home." " Research has demonstrated that it promotes continuity of care, decreases costs, and improves patient self-management and overall outcomes, particularly in the management of discrete disease states." For certain patient populations, Telehealth creates access to care they would not otherwise have had due to geographic, mobility, or other limitations. There are many advantages to the boom in Telehealth. " Telecare generally refers to technology that allows consumers to stay safe and independent in their own homes," including apps and other tech tools. Telemedicine is defined as "using telecommunications technologies to support the delivery of all kinds of medical, diagnostic and treatment-related services usually by doctors." Telehealth also includes services provided by other health care providers like nurses, pharmacists, and social workers. Telehealth visits may also strip away a layer of security and patient safety ordinarily present in face-to-face medical care. Telehealth visits enable patients to avoid the doctor's office waiting room and the potential COVID-19 exposure that goes along with it. Thanks to the "new normal" of post-COVID-19 medical care, more patients are relying on Telehealth visits for their routine health care appointments.
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