Telehealth, though incredibly useful, has some very important pitfalls to watch out for as it becomes more heavily utilized
Prior to the COVID-19 pandemic, telehealth was not a common method of evaluation and treatment delivery for physical, occupation and speech therapists. Most insurances did not cover it, and some state practice acts did not allow therapists to conduct these types of visits. Things quickly changed as our country went into a state of emergency. Many patients were under stay-at-home and shelter-in-place orders and were not willing to come into a therapy clinic. Rapidly insurances announced coverage of telehealth services, and rules were relaxed during the pandemic. Clinics scrambled to implement telehealth as quickly as possible, and clinicians needed to adapt to this new way of practicing.
As the world reopens we may see telehealth stay, at least for a while. Patients who are higher risk for complications if infected by the virus may prefer this method of treatment, and insurances might see the benefit of it and continue to provide coverage. While there are many advantages to it, there are also challenge that have come up. In order to maximize the patient’s experience we need to overcome these. Some of the issues that we have seen since starting it are:
It’s Not Hands-On
Many clinicians deliver “hands-on” care and see tremendous value for their patients in it. Obviously, telehealth makes this not possible. As WebPT’s Director of Product Management Scott Hebert, DPT, explained during a recent telehealth webinar, “For manual therapists out there who like to get their hands on a patient, this does take some learning. Ultimately, your creativity is what’s going to help you here.”
Hebert recommends taking advantage of functional movement assessments as well as patient-reported outcome assessments—and asking patients questions about their comfort and ease while performing each movement. “Basic functional movement patterns are super easy to utilize. Just by doing those things, we can identify, for example, if there’s weakness in one hip versus the other and start making recommendations for our ultimate assessment.”
For those patients who require hands-on treatment to progress, clinicians can overcome this by patient or care-giver education. Demonstration of techniques that the patient or family member can perform on their own will be the key to success for hands-on care with telehealth. Overtime this can empower the patient to become the driver of their own health and well-being verses driving dependency on the clinician. In fact, research indicates that passive treatments, if used as the primary focus of treatment, may actually reinforce your patient’s feelings of helplessness or powerlessness and put the responsibility for management of their condition in your hands, as their clinicians. By teaching patients from the start of care to manage this on their own we may see better outcomes in the long run.
Patient Buy-In My Take A While
Patients are accustomed to thinking of rehabilitative therapy in terms of in-person delivery. While some may see the value of it in terms of convenience and safety, others may be slow to adapt. Patients who have less experience and comfort with technology may be less likely to embrace telehealth.
One solution may be to create a hybrid program. Patients may want to attend therapy in person for some sessions and do telehealth for others. Generally, this works well if the patient comes to the clinic for the initial evaluation. At this session the clinician can show them to access the technology, and practice how to do so. It may be helpful to have an administrative staff contact the patient fifteen minutes prior to their first telehealth session to ensure a successful first virtual session.
Technology is wonderful…until it isn’t. Issues with technology are distracting to say the least during these sessions. Our communication with patients and their families greatly impacts their engagement, experience, and willingness to continue with the program.
In order to minimize these issues, it may be helpful to practice sessions prior to conducting them with patients. This will allow for problem solving of potential technical issues prior to working with clients so they don’t impact the patient experience.
It May Not Be Secure
With the onset of the pandemic insurance companies wanted quick and easy implementation of telehealth. During this time most are allowing technology that may not be as secure as others (such as Facetime and Zoom meetings). Starting in March the Office for Civil Rights announced:
“Today, the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency.
This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.
In support of this action, OCR will be providing further guidance explaining how covered health care providers can use remote video communication products and offer telehealth to patients responsibly.
“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” said Roger Severino, OCR Director. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities,” Severino added.”
While this is true, we do need to ensure that devices are connected to private and secure internet connections. If clinicians plan on keeping telehealth it will be important that the video platform meets all HIPPA compliance standards.
Change always brings challenges. Being aware of these challenges and having a plan to overcome them will create a successful experience for both the patient and clinician.
- Cosio, D., & Lin, E. (2018). Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management. Global advances in health and medicine, 7, 2164956118768492.