insights

Many clinicians are continuing to adapt their practices to meet the needs of patients outside of a traditional office setting. Telemedicine has historically been used as an emergency response tactic to offset overutilization of health services.¹ Through its capacity for effective remote assessment and triage of patients, unsurprisingly, telemedicine saw a dramatic rise in demand during and after the COVID-19 pandemic. In 2020, approximately 20% of all healthcare visits were conducted via telemedicine, according to a Doximity report;² telemedicine utilization increased 766% during the first three months of the pandemic alone.³ Telemedicine is a critical mode of healthcare delivery during emergent health crises as clinicians are able to work remotely with patients, which frees up critical clinic and hospital space.¹ In turn, it helps lessen the burden on front-line healthcare workers in hospitals.⁴ But even post-pandemic, it continues to be a popular practice modality for its flexibility and quality of care.

Patients have more access to healthcare services than ever before. Telemedicine is a convenient option for at-risk populations, such as the elderly or immunocompromised, who can seek care at home and minimize risk of exposures. Virtual visits help patients stay connected and offer peace of mind between regular visits. Research on the impact of telemedicine reveals that traditionally underserved communities such as those in rural areas, older adults, and BIPOC individuals report higher utilization of telemedicine services.^5,6 Increasing access to care through virtual visits and reaching more traditionally underserved patients, the uptake in telemedicine usage in patients may be one factor in bridging the gap of healthcare inequities.⁶

Adopting telemedicine as a practice modality allows clinicians to expand the scope of their practices without having to relocate or incur high operating costs. Studies suggest that telemedicine visits may be as effective as in-person consultation,^7,8 and patients report high satisfaction with the quality of the communication with their clinician and their perceived time and money saved.^5,9,10

In the following video, Cynthia Worden, DO, discusses her practice model and the advantages of telemedicine, for both patient and clinician.

Dr. Worden is board certified in family medicine by the American Osteopathic Board of Family Physicians and is a diplomate of the American Board of Integrative Medicine. After practicing integrative family medicine for over 10 years, Dr. Worden opened her own practice, Bloom Functional Medicine, which serves the greater Portland, OR, area. In addition to telemedicine, she also offers group visits with a focus on cardiometabolic disorders and their prevention.

Creating an Effective Telemedicine Practice

Functional medicine stresses the importance of a strong patient-practitioner relationship, which can facilitate the transition to telemedicine. Many touchpoints of the diagnostic workup and medical interview can be done virtually, including filling out the functional medicine timeline and matrix. Follow-up appointments can be useful to track the progress of a lifestyle or dietary change and do not require much additional time when employed through telemedicine. Clinicians have many options for conducting virtual appointments through video or phone calls, secure messaging via patient portals, and remote patient monitoring. If you haven’t yet added telemedicine to your practice, here are a few key questions to consider:

Is the software I’m using compliant?
Many telemedicine platforms offer integration with patient electronic medical record portals and secure encryption to protect personal health data. Choose a software that is appropriate for the type of visit you will conduct and confirm that it meets both state medical board and HIPAA regulations. There are a variety of telehealth service providers out there; make sure that the platform you choose features a user-friendly interface that integrates with your existing software and matches your technology skill level.

Can I see patients from out of state?
Practicing telemedicine increases access to care for patients across the country, but every state has different policies and may require additional licensing. Many states make exceptions for out-of-state providers to render care specifically via telemedicine. You will also need to consider whether or not you have the authority to write prescriptions in other states and how you obtain consent for treatment as these laws also vary state to state. Review the cross-state licensing requirements from your state’s medical board.

How can I increase my practice efficiency?
Decide what kinds of patients you will see for telehealth visits. If they will require lab testing or in-depth examination, an office visit may be simpler. If they are receiving follow-up care or medication management, or present with conditions that can be easily diagnosed remotely, telemedicine may be more suitable. Allow patients to book appointments online and establish time boundaries for the type of appointment and care required. Use digital intake forms to maintain records and other electronic tools to track, analyze, and assess patient data. Automating your practice operations using a telemedicine platform can save you time and reduce the burden on your front office staff. IFM partners with LivingMatrix*, a cloud-based patient information management application that works in tandem with existing electronic medical records to increase the efficiency and effectiveness of functional medicine practices, including telemedicine.

As mentioned above, adopting telemedicine services into a practice model may allow clinicians to expand the scope of their practices without having to relocate. This allows clinicians to scale the growth of their practices at a rate that is comfortable for them while also providing greater access to care for patients who live in rural areas. Telemedicine is a convenient way to streamline appointments with patients, and the range of digital therapeutics that can be offered has potential for significant improvements to health and quality of life outcomes in the future.

*LivingMatrix has made the difficult choice to close their organization, effective August 15, 2023.

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References

1. Portnoy J, Waller M, Elliott T. Telemedicine in the era of COVID-19. J Allergy Clin Immunol Pract. 2020;8(5):1489-1491. doi:1016/j.jaip.2020.03.008
2. 2020 State of Telemedicine Report: Examining Patient Perspectives and Physician Adoption of Telemedicine Since the COVID-19 Pandemic. Doximity. Published September 2020. Accessed June 14, 2023. https://c8y.doxcdn.com/image/upload/Press%20Blog/Research%20Reports/2020-state-telemedicine-report.pdf
3. Weiner JP, Bandeian S, Hatef E, Lans D, Liu A, Lemke KW. In-person and telehealth ambulatory contacts and costs in a large US insured cohort before and during the COVID-19 pandemic. JAMA Netw Open. 2021;4(3):e212618. doi:1001/jamanetworkopen.2021.2618
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7. Speyer R, Denman D, Wilkes-Gillan S, et al. Effects of telehealth by allied health professionals and nurses in rural and remote areas: a systematic review and meta-analysis. J Rehabil Med. 2018;50(3):225-235. doi:2340/16501977-2297
8. Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The empirical foundations of telemedicine interventions in primary care. Telemed J E Health. 2016;22(5):342-375. doi:1089/tmj.2016.0045
9. Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients’ satisfaction with and preference for telehealth visits. J Gen Intern Med. 2016;31(3):269-275. doi:1007/s11606-015-3489-x
10.  Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. doi:1136/bmjopen-2017-016242