Telehospital Medicine Obstacles and Pitfalls (Part 2)
Written by Sarah Suleman and Andrew McWilliams
In our last blog post, we highlighted a number of obstacles that can stand in the way of implementing a successful telehospitalist program, such as reimbursement, licensure and credentialing, and electronic health records. In this post, we go on to address a number of less-concrete issues, including the need to “humanize” telehospitalist services and overcome certain common stereotypes about telehospital medicine.
The “Human Touch”
Telehospitalists need to learn how to create the same kind of doctor-patient relationship they would in-person. Not surprisingly, verbal communication becomes a more important part of the patient visit. For example, the telehospitalist may need to spend a little extra time talking to the patient about personal things in order to know the patient better and put them at ease. The telehospitalist should also make an extra effort to know who is in a patient’s room and ask the nurse to introduce everyone.
Finding hospitalists with the necessary interpersonal skills and attitudes is not always easy. Fortunately, some of these skills can be taught. The better telehospitalist service providers spend considerable on training, including bedside etiquette, and media skills like tone of voice and facial expression. Some telehospitalists need to be taught to look at the camera, not at the computer screen, and if they have to review notes, to say something like, “Excuse me for a minute while I review your labs.”
Physician-patient interactions are not the only area in which the “human touch” is crucial to the success of a telehospitalist program. Telehospitalists work closely with nurses and other on-the-ground assistants, whose skills and commitment to the telehospitalist program are crucial to the program’s success.
A nurse or other care professional at the patient’s side assists the patient during the examination and “presents” them to the remote telehospitalist. The “telepresenter” introduces the physician to the patient and any other people, such as family members, who are present in the room.
The rest of the presentation may be as simple as doing vital signs, or manipulating medical devices such as an otoscope for the physician. However, it often involves more complex tasks such as interpreting smells and other physical cues for the physician, who cannot sense them through the video camera. These tasks place a great premium on the presenter’s experience and intuition.
Hospitals need to provide training for telepresenters and opportunities for them to practice under multiple scenarios, from an emergency to daily care. Administrators also need to work alongside telepresenters to become familiar with the telehospitalist technology and processes, answering questions and removing any process obstacles that arise during the training. The telehealth partner can help administrators to navigate these change management tasks.
Telehospitalists need to appreciate the key role played by the telepresenter and the challenges of the telepresenter’s job. It is particularly important to ensure that the telepresenter doesn’t feel rushed. By taking a little extra time, asking a few more questions, the telehospitalist can usually get the patient information they need to rule in or out whatever conditions and provide the same high level of care as if they were attending the patient personally.
Some of the biggest obstacles to a successful telehospitalist are not real conditions in the hospital, but misconceptions. Suspicion is a common response of clinicians to telemedicine.
Often, the biggest skeptics are physicians. Sometimes their skepticism is simply fear of the unknown and of change, even of potentially being replaced by a robot.
On a more rational level, some doctors may believe that they won’t provide the same care remotely as they do in person, which usually boils down to the need to rely on the telepresenter to act as the physician’s virtual set of hands. Elsewhere in this post, we discussed the need for training and sometimes process modifications to ensure a close working relationship between telehospitalist and telepresenter. Enhanced training and process improvements are also one of the best ways to mitigate some potential telehospitalists. concerns about how they will be able to handle emergency situations when something goes wrong with the patient or the technology.
Sometimes it's not the telehospitalist who needs reassurance that an exam is complete, but a colleague such as a surgeon. In these cases, the telehospitalist may have to use all their tact and creativity to secure their colleague’s buy-in.
Another common misconception is that patients, especially older ones, are not tech-savvy enough to accept telehospital medicine. This misconception may mirror doctors’ own unease with telehospital medicine. In fact, patient responses to telehospitalists have been overwhelmingly positive, as shown by both satisfaction surveys and anecdotal evidence.
Patients sometimes even request telehospitalist care, partly due to its novelty, partly due to an appreciation that it gives them access to the best quality care. There are anecdotes about patients asking delay the physician encounter until family members are present to see the technology in action, or requesting a few moments to freshen up their appearance before they appear on video.
Hospitals that design and implement their telehospitalist programs keeping in mind the obstacles and pitfalls discussed in this pair of blog posts are much more likely to realize the expected benefits. Although the solutions are not always straightforward or easy, professional help is available, particularly from the hospital’s telehospitalist partner.