Expert discusses challenges and barriers to conducting telemedicine visits

In this video, Helen L. Bernie, DO, MPH, discusses challenges in conducting telemedicine visits. Bernie is the director of sexual and reproductive medicine at Indiana University and an assistant professor of urology at Indiana University School of Medicine in Indianapolis, Indiana.

Transcription:

What are some challenges or barriers to conducting telemedicine visits?

I think with telemedicine, as with anything, it's trial and error, and it's really a learning process for all of us. Things that I have found, that are kind of problem areas are first making sure that you don't have virtual visits in between your clinic, because inevitably something is going to happen and your clinic is going to run late. If you're sitting there on a phone, and your patients are waiting, you just get backed up. So again, I think the most important thing is setting set times, whether it's early in the morning before clinic or after clinic are staggering a couple of visits in between your OR cases to talk with them. But other areas that we found initially and are still working through are where patients don't answer or they didn't log in for their virtual visits. That ends up being a wasted visit and wasted time for you. In Indiana, we have different time zones, so sometimes we didn't realize that we would tell someone we're meeting at 7:45 am, and that was 6:45 am for them. What we do to troubleshoot that is that my admin will call patients and try to either reschedule them the same day so that I can either call them after clinic if we don't get them before or vice versa; if I don't get them afternoon, we'll call early in the morning. [Another issue is] not having the labs or semen analysis for the visit. The purpose of the visit is to review those with them, [so not having those] would lead to wasted time. So now my nurse looks about a week ahead of time, and she scans through all the virtual visits and she looks to make sure that all of their labs and anything that we're going to be discussing is back. If it's not, she has time during that week to either try to get it and reach out to the patient. Sometimes, they've done the lab work; it just didn't get forwarded over or sent over for you to check. [There are also] no-show visits where an encounter doesn't get cancelled. If you're like me, you'll get that little ding where it will say, 'You have incomplete notes," and it wasn't an incomplete note, it was just an encounter that maybe didn't get cancelled from a patient that you tried calling and weren't able to reach. So now, we just leave a small note that says, we tried to reach the patient and schedule them and will reschedule them. Also, some patients take longer than we anticipate, and that's both in the clinic or in telemedicine. I think it's important to try to mix up your visits with patients that you think might be a little shorter, like a vasectomy consult, vs a new patient visit for infertility that may take a little bit longer, so that you don't run over time. That's a learning process. With other patients, there may be a bad connection or they're not as internet savvy, and the benefit to that is that you can just pick up a phone, and we can talk to them and do telemedicine through a telephone visit. I've made a lot of templates, so that it's really easy to document. We also have virtual scribes in our office, so after I see a patient, I can pick up my phone and I can dictate the note right away so that it can get typed up. But again, it's really been a learning experience for everyone, and I think the more we start to do it, we find new solutions and ways to go through it. I think all of the panelists at the QI Summit had great tips and tricks, but again, there's nothing that's so hard or difficult where you can't or that you shouldn't incorporate telemedicine into your practice. We're all really hoping at the AUA Advocacy Summit, which I'll be at as well as many of the people that spoke at the QI Summit, to really advocate for telemedicine being continued past 2024, because it's something that's really important, and it adds value for our patient care.

This transcription was edited for clarity.