Table 2.
Multi-level factors affecting optimization of the telemedicine visit and ideas for implementation and integration of telemedicine into primary care*
| Visit optimization | Example quotes |
|---|---|
| Pre-visit preparation (telemedicine instructions) | |
| Technology training | “Pre-visit preparation to determine optimal mode for [telemedicine appointment] – telephone/video.” (PCP2) |
| Coordination with caregiver | “If [patient] >65 is not as technology savvy it helps for them to have a family member set things up, particularly if a video visit is going to be done well.” (PCP51) |
| Medical assistant check-in/virtual rooming process | “Separate appointments with medical assistant to ensure subspeciality notes, labs, imaging, screenings are up to date.” (PCP13) |
| Operationalizing equipment at home | “Making sure everybody has a [blood pressure] cuff and can check their sugars.” (PCP16) |
| During visit | |
| Live virtual support (MA, technicians, operations, IT) | “Virtual support that is live with the MD/NP.” (PCP62) |
| Functional caregiver presence | “It helps to have a family member present, which is what most of my patients over 65 (and especially if older than 70) have been doing.” (PCP134) |
| Need for objective data (e.g., vital signs, labs) | “Devise a way to obtain vital signs, labs, etc.” (PCP6) |
| Support to transition visit | “Telemedicine is great for “routine” follow up of less complex patients and for initial triaging of new problems. However, there should also be an easy “exit ramp” to quickly get people into the clinic for in person [evaluation] if it is determined that telemedicine will not suffice.” (PCP71) |
| Post-visit support | |
| System for check-out management | “Need to develop more efficient effective systems for management of check out. Provider is left doing visit plus a great deal of the care coordination.” (PCP61) |
| Implementation/integration of telemedicine | Example quotes |
| Better for chronic disease management than acute care | “This is a useful modality for maintenance and surveillance of chronic conditions, however without in-person care, new diagnoses are difficult to assess fully.” (PCP83) |
| Needs to be made more efficient | “Implementation needs to be simple, single click sign on with minimal technology knowledge required.” (PCP51) |
| Video is essential compared to phone | “Video essential for all [telemedicine] visits- enhances understanding and trust and collaborative care to make eye contact, note body language, also [assessing] home [background is] helpful.” (PCP4) |
| Opportunities to make care more patient-centered | “This [has] been an incredible convenience for patients who can't travel to the practice or are fearful of coronavirus. This has also created a larger geographic footprint for patients who can come to my practice.” (PCP3) |
| Advance preparation is needed for Medicare Annual Wellness visit | “Can be quite hard going through all the necessary paperwork.” (PCP95) |
| Need for continued reimbursement | “It will have to be appropriately reimbursed and supported by office staff.” (PCP73) |
*Abbreviations: IT = information technology; MD = medical doctor; NP = nurse practitioner.