Toolbox Module

Patient Preparation

What typically needs to be done to prepare a patient for a live, interactive telemedicine encounter?

Preparing a patient for a telemedicine consultation involves several steps. These include scheduling a patient visit at the remote site and usually registering them in the specialist’s billing system. If the patient is new, he or she needs to have an explanation of the nature of a telemedicine consultation and his or her written consent to participate needs to be obtained. He or she will also most likely need to be registered in the remote site’s billing and medical records systems. The referring physician, the reason for referral, relevant information from the existing medical record, and any preliminary physical examination findings as defined by the applicable protocol needs to be obtained. Once in the room the patient should be oriented to the videoconferencing equipment, physically prepared as necessary for the encounter and positioned so that the specialist has an optimal view of the patient.

What typically needs to be done to prepare a patient for a store-and-forward telemedicine encounter?

Preparing a patient for a store-and-forward telemedicine consultation involves several steps. These include scheduling a patient visit at the remote site and usually registering him or her in the specialist’s billing system. If the patient is new, he or she needs to have an explanation of the nature of a telemedicine consultation and his or her written consent to participate needs to be obtained. He or she will also most likely be registered in the remote site’s billing and medical records systems. The referring physician, the reason for referral, relevant information from the existing medical record, and any preliminary physical examination findings as defined by the applicable protocol needs to be obtained as well.

Why and where should a patient be registered?

Typically, a patient is registered at every location that intends to maintain a clinical record for the patient and/or intends to generate billing for that patient encounter. The decision about registration is made by each of the parties involved (provider site and remote site) as part of their business processes. If a location is just starting telemedicine, it will usually require discussions with the billing group to explain telemedicine and the procedures for billing for it.

What information needs to be collected from the patient?

The information that needs to be collected from the patient or their representative includes data required for registration such as demographic information and insurance data. In addition, additional clinical information as specified in the consultation protocol will likely need to be obtained. Finally, in several states, patient permission is necessary to share this information with the specialist.

Why are patient records important in the telemedicine visit?

A commonly accepted principle of medicine is that the more complete and thorough the clinical information, the greater the likelihood that the physician will make the best medical/clinical decisions for that patient. This is also relevant to telemedicine consultations, but is a bit more difficult to apply due to the geographic separation between the specialists and patients. Patient’s medical records are unlikely to be in the provider’s system. However, whenever possible, the specialist should have some kind of access to the patient’s medical record.

How is record information moved from a remote site to the specialist?

The primary method of transmitting medical record information today is by facsimile machine. This works well for sending information before the consultation. When information is required during a consultation, a document camera can be used at the remote site to display records information for the specialist. Ideally, the specialist should have access online to the patient’s records making the entire encounter more efficient.

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