Table 1.

Telemedicine versus in-person considerations

	Factors Influencing Appropriateness for Telehealth Encounter
Telehealth specialty setting, place of service	• Outpatient—primary care, endocrine, cardiology, neurology, gastroenterology, orthopedic, urology, geriatrics, pediatrics, nephrology, pulmonology/sleep, pain management, rural care, urgent care, school, military • Emergency department (ED), prehospital emergency medical services • Nursing home/skilled nursing facility • Remote patient monitoring at home • Hospital, critical care unit • Behavioral health • Teaching/education (Shaheen et al., 2020; NCTRC, 2021)
Patient setting	Remote • Patient at home and provider at another location Originating • Patient at clinic/site with telepresenter (i.e., patient at a clinic or hospital with medical assistant or nurse and is assisting provider at another location with the appointment (Shaheen et al., 2020; NCTRC, 2021)
Provider factors	Regulations • License and certification • Confidentiality/HIPAA • Informed consent • Business associate agreement(s) • Understand telehealth legislation and reimbursement policies prepandemic, pandemic changes, and postpandemic • Telemedicine practices and documentation, dedicated telehealth space Education & experience • Telehealth didactic and/or hands-on training • Comfort level with technology • Telepresence competency • Triage ability • Ability to perform and interpret a virtual physical examination based on complaint type • Ability to select most appropriate telehealth modality based on presenting complaint • Ability to accommodate patients who are hard of hearing or have decreased vision Technology • Equipment, computer, software/applications • Electronic health record • Functioning camera, microphone • Internet, Wi-Fi, and/or cellular connection (Shaheen et al., 2020; Bashshur et al., 2020; Loeb et al., 2020)
Patient factors	• Acuity and severity of illness: nonurgent, low risk • Age • Gender/condition based • Preference for telemedicine • Level of comfort and familiarity with technology • Social/health disparities—“digital divide”  o Access to internet or Wi-Fi  o Access to functioning technology (smartphone or computer with camera and microphone)  o Insurance type  o Number of comorbidities  o Ability to describe symptoms and severity • Complaint  o Acute, common complaint (Shaheen et al., 2020; AMA, 2018; Bashshur et al., 2020; CDC, 2020; Kichloo et al., 2020; Loeb et al., 2020; Patel et al., 2021)
Category/encounter type	Provider–patient encounter • New patient—criteria for establishing a provider–patient relationship • Established patient • Specialist consult • Scheduled appointment • Unscheduled appointment • Follow-up Provider–provider encounter • Consultation (AMA, 2018)
Appointment type & modality for patients requesting telehealth	Acute appointment*—Triage required to assess patient acuity and appointment type should be matched with most appropriate telehealth modality or determine need for escalation • Audio and video encounter with digital medical kit (i.e., electronic stethoscope, electronic otoscope) • Audio and video encounter without digital medical kit • Audio only: no access to observational assessment Chronic care appointment or follow-up*—Triage required to match patient acuity with telehealth modality or determine need for escalation • Audio and video encounter with digital medical kit (i.e., electronic stethoscope, electronic otoscope) • Audio and video encounter without digital medical kit • Audio only: no access to observational assessment In-person • Triage tool and criteria needed to determine in-person vs. virtual encounter • Consider resources needed to address patient complaint Higher level of care criteria • Triage tool needed to assess need for escalation of care Consult (specialist, radiologist) • Synchronous audio and video • Asynchronous • Audio-only (Kichloo et al., 2020; NCTRC, 2021)
Patient acuity, severity, & resources	Triage method • Chatbot • Audio-only triage line • Synchronous audio and video consultation • Telehealth triage tool for safer telehealth • Electronic health record tool Severity of illness • Physical and psychological status of patient Resources • Number and type of resources necessary to address the patient complaint virtually versus in-person  o Laboratory and diagnostic studies  o Parenteral medication  o Special procedure  o Specialist consult (Brennan & Daly, 2009; Kichloo et al., 2020)
Telehealth utilization	• Telehealth as triage tool to determine appropriateness for telehealth, in-person, or escalation of care • Low-risk urgent care • Telemedicine to diagnose and treat a complaint/condition • Telemedicine as a follow-up—posthospital discharge, check-in • Telemedicine for specialty consultation (CDC, 2020; Kichloo et al., 2020; Portnoy et al., 2020; Sikka et al., 2020)
Physical examination	Audio and video • With digital medical kit • Observational assessment—no digital medical kit Audio only • No observational assessment or physical examination—requires a triage method for appropriateness of audio-only within scope of state and federal legislation (Kichloo et al., 2020)
Escalation or follow-up	Escalation • Improper functioning technology • High patient acuity • Number of resources required to treat patient Follow-up appointment • In-person, telehealth, or hospital discharge • Assessment of response to treatment plan and/or prescribed medication • Post-telemedicine virtual check-in (Sikka et al., 2020)

^∗Consider synchronous audio/video for an unscheduled telehealth appointment.