It’s time that organizations focus on the people who will truly make virtual care work.
This shift has been astoundingly rapid: In a single week, Lucile Packard Children’s Hospital Stanford saw its daily number of virtual outpatient visits jump from 20 to 400. Kadambari Beelwar, the California hospital’s telehealth manager, tells HealthTech that the number of visits surpassed 600 soon after that.
But this massive change in care delivery has had its challenges. With medical training traditionally centered around in-person care, there is now a need for specially trained clinicians — those who are well-versed in the technology and clinical protocols of virtual care.
“Clinicians have been thrust into taking a history, performing physical exams and generating differential diagnoses using telehealth without any proper training or competency, or maybe even touching the equipment,” Ann Fronczek said in a webinar panel as part of the American Telemedicine Association’s 2020 conference. Fronczek is an assistant professor at Binghamton University State University of New York’s Decker College of Nursing and Health Sciences.
The healthcare industry is becoming more aware of this need for training, and experts at the ATA2020 conference shared that they’ve already begun to implement training modules for their clinical staff.
“Clinicians doing the appropriate thing clinically is important,” said Dr. Jason Tibbels, chief quality officer for Teladoc Health. “But if a patient leaves that encounter feeling like the physician was curt, condescending or rushed, that’s not a good outcome. They might doctor-shop until they find what they need, and they reinforce negative narratives around telemedicine. So, it’s really important that we do a good job there.”
Training Approaches Should Change Along with Care Delivery
Simply not acknowledging that care delivery has changed can often be a major setback to properly preparing clinicians for virtual care delivery, said Tibbels.
“The behavioral dynamics have changed,” said Tibbels. “It’s different, and we shouldn’t act like it’s the same.”
Tibbels said that, while he’s seen some physicians struggle initially with telehealth delivery, it’s something that can absolutely be learned. The key: a robust infrastructure of education, coaching, outreach and good clinical guidance and feedback. Together, these things make it easier for clinicians to offer a consistent, high-quality experience for patients, he said.
Dr. Judd Hollander of Thomas Jefferson University echoed Tibbels’ call for proper education surrounding telehealth, noting that the solution’s success relies less on the technology than on the operations and workflows that make it work.
“We need to not expect telemedicine in a video visit to solve all the problems,” said Hollander, the associate dean for strategic health initiatives at Jefferson’s Sidney Kimmel Medical College. “We need to expect telemedicine — just like an ER visit, just like an office visit — to get you appropriately to the next accurate step.”
At Thomas Jefferson University Hospitals, Hollander said, advanced practice providers working in remote locations have been trained to successfully see patients seeking care at multiple hospital locations at the same time. The virtual solution, he noted, has made a lasting, positive impact on their patients.
“It reduces our door-to-doc time from something that’s way longer in an ER waiting room to an average of less than 10 minutes, including being seen and evaluated by a provider and having your tests started,” said Hollander.
Training Modules Must Be Designed for Clinical Staff
In the months leading up to the onset of the coronavirus pandemic, Thomas Jefferson University Hospitals were scheduling roughly 125 telehealth visits each month. When many providers were forced without preparation to adopt telehealth in March, Hollander mentioned that Jefferson was already prepared — and able to rapidly scale to over 6,000 virtual visits in that same month.
“The reason we were able to scale up during COVID is because we developed online training modules,” said Hollander. “In our video portal … we have video modules that are necessary for people to complete before they do telehealth, so that they can learn the basics of telehealth as well as the legal and regulatory requirements.”
And while virtual care training is certainly necessary for today’s clinical staff, academic institutions like Binghamton University understand the importance of educating tomorrow’s clinicians on this newer model of care delivery.
“We know there is a strong need to prepare nurses and nurse practitioners in telehealth technology and for virtual care,” said Fronczek.
Fronczek mentioned that preparation is well underway at Binghamton for training the next generation of nurses and nurse practitioners for virtual care. The academic institution has introduced its first telehealth course for students with the goal of preparing the workforce for where care is heading.
“What really helped me in developing some of our content is that the National Organization of Nurse Practitioner Faculties finally made a statement that they thought it was really important for APRNs going out into practice, that they have telehealth competency,” said Fronczek. “It’s been an uphill challenge, but we’re there.”