The American Health Information Management Association (AHIMA) recently reviewed the “nuances of health information and telehealth” in ambulatory care from the perspective of nurses, physicians, and overall management of health information.  The pandemic vaulted the use of telehealth; however, the rapid increase in utilization brought with it challenges in implementation, acceptance, privacy, and security.

Nursing Perspective

From the perspective of nurses, the pandemic has forced many positive increases in the use of telemedicine, particularly remote patient monitoring.  Nurses have indicated their patients are experiencing some challenges, including socioeconomic and technological, when utilizing telehealth.  While monitoring patients remotely can be a key to successful treatment between office visits, nurses note that not all patients have access to smartphones, a computer, or Wi-Fi connections.  Nurses reported many benefits of telehealth applications including:

• Ability to reach a large patient population
• Bridge the gap between in-office visits
• Access to real time data to assist with management of diseases
• Reduction of ER and/or hospital visits by addressing patient needs proactively
• Improvement of patient engagement, empowerment and outcomes through personalized health coaching and education
• Patients reported “peace of mind”

Physician Perspective

Physicians noted many challenges with telehealth, most notably reimbursement.  Zoom is the most frequently used platform for conducting telehealth visits as most physicians surveyed indicated they were not able to conduct telehealth via their current electronic medical record systems.  Physicians reported an improved connection with their patients, which was reiterated in another recent study which revealed that the majority of patients over age 65 want telehealth visits with their PCP as an option in their overall care.  The other primary benefits of telehealth recognized by physicians included:

• Opportunity to impact patients’ behavior through remote monitoring
• Focus on disease prevention instead disease management
• Ease of providing second opinions through a telehealth visit

Physicians noted several examples of effective technology tools including mobile stroke units, ICU robots, home monitoring, implantable devices, and wearable devices.  Many of these tools allow physicians to deliver treatment sooner and ultimately improve patient outcomes.

Health Information Management Perspective

From the perspective of health information management, telehealth presents many challenges.  As a result of the public health emergency (PHE), many rules surrounding the use of telehealth modalities have been waived by CMS and regulations vary state to state.  The permanency of these waivers post PHE is still being debated.  Key telehealth issues related to the management of health information  include:

• Privacy and security: AHIMA notes the challenges in telehealth security can be viewed in three ways: environmental, technological, and operational.
  • Environmental factors such as the patient’s living conditions can impact the ability to have a private space for virtual visits, and accessibility can be based on socioeconomic factors. Providers should assist patients in ensuring a private location as well as in using appropriate tools (i.e., text, email, headsets).
  • Technological factors include data security, internet access, and overall patient understanding of the technological tools. Best practices by healthcare providers includes incorporating telehealth into privacy and security policies, procedures, and workflows.
  • Operational factors include reimbursement issues and training of healthcare staff.

• Documentation: providers must standardize documentation for telehealth services and ensure it meets all payer requirements. The Government Accountability Office (GAO) released a report on telehealth in September 2022 with recommendations on documentation for billing and quality in telehealth services under the pandemic waivers and beyond.

• Credential and licensure requirements based on provider and patient location: CMS allowed for flexibility of where the patient receives services and where the services originated during the PHE.  Once the PHE ends, pre-pandemic restrictions on location will be enforced.  Policies, procedures, and documentation will be critical in instances of ongoing care which overlap these requirements.

Excelas continues to monitor legislation and advances in telehealth technology, including the implications of documentation, privacy, and security surrounding integration in the electronic health record.