As the use of telehealth and mobile devices in healthcare continues to expand, the number of medical virtualists — clinicians who use technology and the data from those tools to interact with and care for patients — proliferates as well.
Still, standardized training is sorely lacking for the industry, say Dr. Dana Schinasi, medical director for telehealth programs at the Ann & Robert H. Lurie Children’s Hospital of Chicago, and Dr. Mark Lo, telehealth and digital health director at Seattle Children’s Hospital. Speaking Monday at the American Telemedicine Association’s 2019 conference in New Orleans, Schinasi and Lo focused on the challenges still looming when it comes to virtual care and why training and education of clinicians cannot be ignored.
“At the end of the day, Mark and I will both tell you: Training is a nuisance, but we really firmly believe it is a necessity,” Schinasi said.
Experienced Clinicians Need to Buy In to Telehealth
For starters, Schinasi said, clinicians have not all bought in, particularly more seasoned doctors who are better equipped from a care experience perspective to help patients virtually.
“The ones who are close to retirement, who have been doing this the longest, those are the ones I wanted in front of a screen. The ones who could look across a room and say, ‘That child is sick. That child is not sick. This is what they need,’” she said. “But they’re the ones who turn and walk the other direction when they hear anything related to technology, saying, ‘I don’t even have a smartphone — I have a flip phone.”
On the flip side, Schinasi said, pediatric clinicians in their first year out of medical school are generally not ready to practice telemedicine because of the skill required.
“It has nothing to do with the fact that you’re extremely fast at using technology or you’re in that generation where technology doesn’t scare you,” she said. “Through training, you get to really hear what makes people tick, what makes them afraid, what makes them ready to come to the table.”
Providers Must Understand the Nuances of Remote Care
What’s more, Lo said, physicians must understand the nuances of caring for patients virtually versus in person. Recent incidents in which patients deemed the use of telehealth technology inappropriate for their circumstances have put a spotlight on the importance of training doctors about how and when such tools should be leveraged.
“We are not taught in medical school how to be in front of the camera,” Lo said. “In medical school, they teach you how to have bedside manner, how to look patients in the eye, how to convey empathy and show them that you’re listening to them. But all of those skills don’t automatically translate into the virtual space.”
Schinasi said that it’s often the little things that matter in training, such as considering the optics of taking notes on camera instead of looking into the camera, or of checking a smartphone for updates on a patient’s case during a visit.
“In this day and age, where everyone’s on the phone all the time, patients might think I’m disengaged,” she said. “Doctors need to know these things for situational awareness.”
Figure Out What Virtual Care Training Works
To that end, Lo said, it’s critical to figure out ways to make training less of a headache. Currently, no federal or state mandate exists for virtual training, and every organization approaches the task differently.
Lo and Schinasi said they often exchange feedback with each other about their approaches to training to determine what works and what doesn’t. Schinasi, for instance, said her organization — where practicing telemedicine requires privileges similar to those required of a clinician to go into surgery — mixes in roundtable sessions with one-on-one training. The first approach sometimes ends up serving as a focus group of sorts, inevitably leading to operations changes that might not have been discovered with only individual training.
“To get a telemedicine program off the ground takes time,” she said.
Added Lo, whose telemedicine program also requires privileges to practice, “We’re trying to coalesce something that we don’t have precedent for.”
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