The Growing Importance of Telemedicine Standards

As the work of medical virtualists grows in importance and impact, formalized practices should be standardized.

Dr. Dana Aronson Schinasi is a physician in pediatric emergency medicine and medical director of telehealth programs at the Ann & Robert H. Lurie Children’s Hospital of Chicago.

Mark Lo

Dr. Mark Lo is a pediatric emergency medicine physician and medical director of telehealth and digital health at Seattle Children’s Hospital.

High-speed internet connections and mobile technology have increased convenience in medical care for patients and providers alike. Videoconferencing via devices such as smartphones, tablets and PCs has become mainstream, and telehealth — the delivery of medical care through these platforms — has followed suit. This trend has led to the rise of a new role for healthcare providers: the medical virtualist.

Medical schools devote entire curricula to training and reinforcing bedside manner for healthcare professionals, but “webside manner” is an entirely different skill. The medical virtualist often must establish trust and a therapeutic relationship in a short time frame. Delivering quality healthcare in telemedicine, similar to an in-person visit, requires more than just conveying data or facts. Medical virtualists must convey professionalism, trust and empathy while representing their healthcare organization.

A lot is at stake in each telemedicine encounter, as medical virtualists may be called upon to provide clinical support in critical situations, deliver bad news or provide reassurance, all in the context of meeting the patient’s expectations for convenience and customer satisfaction. The increasing importance of telehealth to patients, professionals and healthcare organizations creates a need for telemedicine standards to be established for this practice.

Why Some Providers May Resist Telemedicine Standards

Training for other modalities of care delivery and communication (such as crucial conversations, bedside rounding and patient hand-offs) has been formalized at many institutions and is required for physicians and nurses. But the training of medical virtualists is neither consistent nor standardized throughout the industry. A movement is growing to make this a part of standard telemedicine practice.

Professional telemedicine associations such as the American Telemedicine Association recommend specific training for provision of virtual care. Legislatively, some states are passing laws recommending standardized training for medical virtualists. Accreditation bodies such as The Joint Commission are considering requiring telemedicine training but do not yet have specific requirements defined. When we train providers in uniform practice in telemedicine, we optimize the delivery of virtual care and ensure the sustainability of our programs.

Medical schools devote entire curricula to training and reinforcing bedside manner for healthcare professionals, but ‘webside manner’ is an entirely different skill."

Dr. Dana Aronson Schinasi Dr. Mark Lo

Providers may already be reluctant to adopt change, which adds to resistance for engaging in telemedicine practice. Despite remarkable advances in technology, provider adoption of telemedicine lags much further behind consumer desire, with training cited as a primary barrier. Forcing providers to jump through one more hoop may be a deterrent to adoption. Training itself also requires specific resources in the form of time, personnel, financial commitment and auditing, which may further deter organizations from developing formalized programs.

Provider acceptance of telehealth hinges on ease of use and perceived usefulness, and training has a large influence on perceived ease of use. For one, providers familiar with technology are more inclined to use telemedicine. Health care providers tend to be reluctant to accept change, but the formal opportunity to have questions answered and to practice telemedicine in a training environment may be a valuable means to overcome this. In addition, formal telemedicine training can be linked to assignment of hospital telemedicine privileges, and this may be instrumental in delegated (or proxy) credentialing agreements with partner hospitals.

INFOGRAPHIC: Discover if telehealth offerings are meeting patient expectations.

Nuisance or Not, Training Is Necessary

We propose the following training strategies to encourage provider acceptance:

Leverage adult learning theory. This is grounded in experiential learning, which is more effective for knowledge retention in adults.
Automate whenever possible. Asynchronous methods of conveying knowledge, such as online learning modules and multiple-choice questions, can be effective at teaching the medicolegal, billing or documentation specifics of telemedicine.
Allow room for in-person interactions. Role play, discussion and simulation work well. Identify the stakeholders and the specific environments to allow for open-ended questions and relevant, realistic training.
Balance the opportunities for training. Some providers will need more hands-on experience to get familiar with technology and workflow, while others will do well with just-in-time training before an encounter.

Whichever modality you select, the goal is to convey a level of authenticity, professionalism, empathy and presence. Training and practice will make the technology invisible, so the medical virtualist can connect to the patient directly, leading to a safe and high-quality experience that leaves everyone feeling good.

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