Apart from “COVID-19,” the term “telehealth” has probably been one of the most used buzzwords of 2020. Telehealth and telemedicine have been thrust into the limelight due to the Coronavirus outbreak and the healthcare sector’s effort to attend to patients, regardless of their location.
Telehealth visits will undoubtedly be a novel experience for many patients, but it will soon become the operative norm moving forward as we approach a post-COVID-19 “new normal.”
In preparation for telehealth adoption as part of the new normal, healthcare service providers worldwide have committed to invest in new technologies. As they rush to meet this demand, though, there are critical issues to consider, which we will comprehensively explore in this post.
How Common is Telehealth?
Telemedicine has been around for decades. Nevertheless, telemedicine has remarkably grown over the past few years as more healthcare providers and patients embrace technology.
- As per the Global Market Insights’ report, the telemedicine market will be worth about $175.5 billion by 2026. These extraordinary numbers undoubtedly indicate the need for telemedicine now and in the future.
- A 2018 study by Behavioral Health Workforce Research Center found that 47 percent of people interviewed used telehealth for behavioral healthcare.
- According to the American Hospital Association (AHA), about 76% of healthcare institutions used telehealth in 2017.
- From 2014 to 2018, based on the data by FAIR health, provider-to-patient employment of telehealth in nonhospital settings increased by about 1400%.
- According to a study conducted by the American Telemedicine Association (ATA), telemedicine services are as good and of high-quality as those delivered via traditional in-person consultations.
Benefits of Offering Telemedicine Services
Embracing the latest telemedicine approaches can help your practice attain countless benefits. You can drive up efficiency and revenue, lower healthcare costs for patients, offer your patients improved access to healthcare services, and in the long run, get happier patients who are loyal to your clinic.
1. More Timely and Accessible Patient Care
In today’s healthcare setting, convenience matters a lot. Adding virtual care or telemedicine services to your practice offers patients easy, on-demand care – without the typical wasted time and costs associated with in-person visits.
Patients who reside in remote areas or who are homebound can quickly access care virtually. Smartphone apps, video conferencing, and online management systems connect providers with patients in a convenient way, never seen before.
2. Cost-Effectiveness and Healthcare Savings
Remote monitoring solutions and electronic data storage considerably cut healthcare service costs, saving lots of money for you, your clients, and insurance firms. Telehealth also reduces unnecessary non-urgent ER visits and gets rid of transportation expenses for regular checkups. According to a 2015 study conducted by AHA, telemedicine programs saved 11 percent in costs and more than tripled Return on Investments (ROI) for investors.
Besides these typical cost-savings, telemedicine can help increase revenue by attracting new patients, converting on-call hours into billable time, reducing no-shows, and overhead expenses for doctors who occasionally opt to switch to a work-from-home arrangement.
3. Extended Healthcare and Access to Specialists
With telehealth, patients in remote or rural locations benefit from quicker and convenient specialist access. For every 100, 000 patients located in rural areas, there are about 43 medical specialists available. Unfortunately, these patients undergo long appointment commutes and have difficulty accessing lifesaving consultations for chronic diseases.
Telemedicine facilitates better access to more specialists. Patients can be referred to any specific specialist they require, regardless of the location.
4. Improved Patient Engagement
Engaging your patients via telehealth can help them maintain care schedules and appointments. Also, it reassures patients that their preferred providers are available and concerned about their wellbeing.
Most importantly, it makes it much effortless for patients to reach out with queries, report early warning symptoms, and schedule a follow-up appointment to ensure they are on track.
5. Enhances Physician Satisfaction
There is no doubt today’s doctors are more burned out and exhausted than ever before. This can put a significant bump on patient satisfaction and quality of healthcare delivery, too.
Telehealth could be the solution to the rising doctor’s burnout. It can improve physicians’ job satisfaction by reducing administrative chores they have to do, and making meetings with clients effortless. Even better, physicians and other medical specialists take advantage of telehealth to strike a more positive work-life balance.
Telemedicine Legal Issues: Informed Patient Consent and Privacy
Getting patients’ consent is a critical aspect of any telehealth program. Not only is informed consent a recommended best practice by the ATA, but also a requirement in most States.
Since, to some extent, telehealth is a new way of delivering healthcare services, it is vital to let patients know how it works. What type of technical equipment do they require for a virtual visit? How do patient privacy and confidentiality work? What should they expect in regards to scheduling, canceling, and billing processes?
Although it up to you to decide how much information you can divulge, there a few basic requirements patients should be aware of when it comes to telemedicine policies, particularly the signing of written policies.
State and Payer Requirements
Getting your patient’s consent can be a condition of getting paid or a legal obligation in the State you are residing in. You can confirm your State’s requirements here. Just click on your State’s name and scroll down to the part labeled “Consent.” You can tell from that whether you are to obtain informed consent from patients.
Some states, though, don’t have any requirements in place. Others require only verbal consent. Still, others need medical professionals to obtain written consent and securely store it in the patient’s medical record.
Patient Informed Consent Best Practices
What kind of information should physicians include on the informed consent form? The ATA recommends you should:
- Notify patients of their rights when getting telehealth, including the right to refuse or stop treatment
- Inform patients about their responsibilities when getting telemedicine treatment
- Describe the potential benefits and risks (like security and privacy) of telemedicine.
- Have a formal grievance or complaint process to resolve any potential ethical issues that might crop up as a result of telehealth
- Notify patients of what will ensue in the event of equipment or technology failures during telemedicine sessions
- You may also wish to elucidate some of your basic telehealth policies around scheduling, billing, cancellation, etc.
Conquering telehealth legal issues can be an overwhelming process – but they are in no way insuperable. Simply being aware of your state’s telehealth legal landscape can give you a huge leg up.
Verifying Patient Identity During Telehealth For Purposes of Compliance and Fraud Prevention
Know your patient is a phrase that correlates to financial service organizations. While there are evident parallels, the health industry, and in particular the telehealth sector, has a considerably more complex service delivery environment.
Health care heavily relies on multiple parties, each with varying data requirements, to offer patient care. For instance, a patient suffering from a particular disease might require the services of a physician, laboratory, pharmacy, specialist, care agency, insurer, and more.
Each of the above parties needs to know the patient’s true identity to ensure they are attending to the right individual. Since health info is so sensitive and private, they must ensure that it is protected and shared only with the identified patient and appropriate healthcare providers. Keeping proper records connected with true identity is essential for effective telehealth treatment and recovery.
Verifying patient identity for HIPAA
HIPAA (The Health Insurance Portability and Accountability Act) has regulations in place for handling patient data. Usually, HIPAA is designed to facilitate effective creation and flow of e-records while maintaining appropriate controls over the integrity and use of such records.
Any institution that handles protected health information (PHI) must ensure that they have apt privacy protection in place to protect patient data in all forms, including emails, test results, raw data, and documentation. These protections include usage policies, security measures, record-keeping requirements, access controls, and communication protocols.
Is Telemedicine HIPAA Compliant?
Telemedicine can be compliant with HIPAA security and privacy standards as long as providers follow the stipulated guidelines. However, it poses considerable risk to the security and safety of electronic protected health info (ePHI); thus, physicians must be careful when implementing a telemedicine service for the first time.
For example, during an in-person clinic visit, there are things usually documented by signatures; let’s say signing informed consent forms. How then are these administrative and ethical aspects handled in telehealth?
The first thing during the implementation of a telemedicine service is to make sure that it is secure. This translates to doing the following:
- Establishing how virtual consultations and associated communications will be secured during transit.
- Establishing how recorded consultations and all related clinical data and documentation will be stored and validated
- Putting in place ongoing monitoring of telehealth-related communications and efforts to thwart malicious data breaches involving ePHI.
When you are shopping for a technology platform to help you deliver telehealth services, it is vital to confirm how the service achieves the criteria mentioned above.
If it is an electronic signing solution, how does it secure data in storage and transmission? Does it guarantee the confidentiality and privacy of patient information as recommended by HIPAA?
HIPAA compliant electronic signature
Physicians delivering telehealth services opt to sign documents virtually (e-signing), especially when signing a notice of privacy for patients. However, before they can do so, they must make sure that the software they are using conforms to HIPAA guidelines. That begs the question, are electronic signatures HIPAA compliant?
A crucial factor in establishing whether or not an e-signing platform is HIPAA compliant is the readiness to commit to a business associate agreement (BAA). E-sign platforms that are not ready to commit to a BAA cannot be used when it comes to PHI.
A BAA is a document that requires all the involved parties to have measures in place to secure PHI. Also, it requires each signing party to manage their HIPAA compliance.
Other considerations for HIPAA compliant electronic signatures
For an electronic signature to be HIPAA compliant, it should abide by the Federal Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (EUTA). Basically, it should meet the following criteria:
Legal compliance –
electronic signature laws differ depending on the State that the physician or hospital treats patients in. Before a physician chooses to use electronic signatures, they should read and understand their State’s regulation in relation to HIPAA rules. Also, documents must always be available for patients to get copies in the form of printed copy or via email upon request.
User authentication –
Physicians must invest in a system that can validate the identity of patients. In other words, the system must be able to authenticate that patients being treated virtually. For instance, are they who they claim to be before entering into any agreement?
Mechanisms such as answering “secret knowledge” questions, two-step verification, implementing specialized e-sign software, and voice/phone authorization can resolve this issue. Message integrity – The physicians must implement a system to check any digital tampering of the documents after they have been signed to guarantee the integrity of the information both in transit and in-store. This condition is very similar to the HIPAA security rule measures and must be handled with the same level of gravity. Authorities may be on the lookout for electronic signature risk assessments when performing the next round of HIPAA audits. And remember, violation of HIPAA rules carries a heavy penalty.
To make sure that the patient cannot deny having signed a document, electronic signatures used under HIPAA guidelines should include a time-stamped audit trail showing location, dates, times, and the chain of custody. This makes sure that the documents involved are legally enforceable and that consent for the disclosure of PHI cannot be contested later. Providing the signatory with an emailed or printed copy for the agreement is one step to preventing repudiation.
Ownership and control –
Doctors offering telemedicine services should ensure PHI is well protected. To achieve this, they must keep all proof or evidence supporting the electronic signature’s legitimacy, on the same document/agreement retained under their ownership and control. Any other copy – except those belonging to the signatory – must be destroyed or deleted. No copies should reside on the servers of electronic signatures service providers.
How does eSign Genie support HIPAA compliance within its platform?
Using eSign Genie increases the integrity, availability, privacy, authenticity, and reliability of signatures and records. eSign Genie’s technology allows users to digitally sign documents in full compliance with HIPAA, ESIGN, and EUTA.
eSign Genie is also ISO type II certified – a satisfactory level of information security assurance globally – and employs a reliable architecture that allows access on almost any internet-enabled gadget from anywhere. All data is encrypted at rest and in transit. Most importantly, each transaction executed via eSign Genie includes a traceable, tamper-proof, and court-admissible audit trail.
Here are documents that can be electronically signed with eSign Genie during telemedicine sessions:
- Informed consent form
- Patient onboarding form
- Notice of privacy practices
- The transition of care documents
- Lab reports
- Drug prescriptions
- Insurance claims processing
How to sign an Informed Consent Form online:
- Create an account with eSign Genie.
- Upload your Telehealth Informed Consent Form.
- Add signers, drag and drop signature and other fields for each signer.
- Send to the signers to sign the Informed Consent Form.
- Each recipients can sign PDF in series or parallel.
- Obtain a digitally signed copy after patient and required all signers sign the Telehealth Informed Consent Form.
The future of telemedicine
Telehealth is no longer a futuristic concept, rather an area that has significant potential to revolutionize health care access and delivery. Usually, it meets patients’ needs via multiple expedient channels and delivers health care services to where they are.
Over the years, technology has helped make telehealth easier to use, more accessible and affordable for patients. And with the advent of more cutting-edge, ore agile, and snappier technologies like Big Data, IoT, and AI, the future of telehealth is brighter than ever.
In short, a quick peek at the statistics on the future rise of the industry shows that telehealth will cause an enormous shift in how patients view and get care.
Like we have already seen, telehealth is driving a massive change within the healthcare sector and provides amazing opportunities for technology-led virtual medical services.
By understanding the critical privacy and security risks, practices can focus on improving their patients’ safety and privacy while still protecting themselves from unnecessary ramifications of fraudulent system access or data breach.