Table 3.

Identified telemedicine barriers and solutions

Barriers	Solutions
General issues
Limits to patient privacy and confidentiality	•Use of ZOOM chat feature •Patient use of earphones with provider use of yes/no questions
Limited provider comfort with sensitive examinations on telemedicine	•Patients can upload relevant photographs via EMR patient portals •Practices and national organizations will need to develop guidance about best practices related to the use of sensitive examinations in telemedicine.
Limited provider comfort with clinical decision-making in the absence of physical examinations and point-of-care testing.	•Point-of-care testing can be conducted in local laboratories or with nursing visits •Providers can share evidence-based guidelines of clinical scoring modalities possible with telemedicine examinations.
Inability to assess recommended anthropomorphic data for annual preventive visits	•Consider augmentation with nursing visits to collect vitals, high, weight, vision screening, hearing screening, STI screening, and blood work (lipids, HIV screening, and so on).
Clinical encounters no longer colocated with interdisciplinary colleagues	•Fully train social workers and registered diaticians to use telemedicine software. •Establish internal referrals to social work and dietitian staff with scheduling assisted by clinic staff.
Mental health
Need for ongoing screening and assessments of mood symptoms.	•EMR-based administration of PHQ-9 and GAD-7 before telemedicine visit.
Reproductive health
Limited provider comfort with sensitive examinations on telemedicine	•Patient can take still photos of visible lesions and submit them via the EMR patient portal •Practices and national organizations will need to develop policies about best practices related to the use of genitourinary examinations in telemedicine.
Need for in-person encounters for LARCs, Papanicolau smears, and acute pelvic complaints	•Hybrid model is needed with telemedicine visits to triage acute symptoms and in person visits for diagnosis and treatment.
Eating disorder care
Inability to assess recommended anthropomorphic data for eating disorder visits	•Train family members to collect weights at home. •Use hospital satellite clinics to collect vital signs. •Partner with local PCPs to collect weights and vital signs. •When possible, partner with therapists to trend weights from therapy visits.
Inability to assure parent privacy while disclosing patient weight or dietary recommendations.	•Have parents and patient call in from separate devices so that one can be “removed” from the visit to facilitate confidential discussions.

EMR = electronic medical record; GAD-7 = Generalized Anxiety Disorder 7; LARC = long-acting reversible contraception; PCP = primary care provider; PHQ-9 = Patient Health Questionnaire 9; STI = sexually transmitted infection.