Lights, Camera, Action: Optimizing Virtual Video Visits to Provide High-Quality Care
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Harvard Medical School, Boston, MA, USA; 2New England Geriatrics Research Education and Clinical Center and Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA; 3Brigham & Women’s Hospital, Boston, MA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06278-z © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
INTRODUCTION: TELEMEDICINE WITHOUT THE TRAINING
The COVID-19 pandemic has fundamentally changed the way that patients interact with the United States health care system. As we seek to lower the risk of viral transmission and expand the capacity of health care facilities, live videoconferencing—the practice of conducting a synchronous, virtual, and interactive visit between a patient and clinician in place of an in-person clinical encounter1—has been considered as a possible solution to these issues2 and has been rapidly rolled out in many health care settings.3 Acknowledging the value of virtual visits in the COVID-19 era, Medicare has committed to expanding reimbursement for telemedicine services.4 The definition of telehealth is broad,5 and includes both remote clinical encounters and other virtual methods of care delivery such as remote patient monitoring or electronic consults. Telemedicine refers specifically to clinical interactions directly involving communication between a clinician and patient through a variety of digital methods.6 Using definitions offered by the American Telemedicine Association, we will specifically focus on the type of telemedicine delivered through live videoconferencing in the outpatient setting, during which a clinician and patient engage in a synchronous, interactive clinical encounter via video, which we will refer to as “virtual video visits” or “virtual visits.”1 Prior to the pandemic, the use of telemedicine was increasing gradually, especially for primary care and mental health care.7 Though video visits are associated with high patient satisfaction8,9 and may improve patient access and outcomes,9 many clinicians were not routinely offering video visits prior to COVID-19 and are likely conducting them for the first time during the pandemic. Moreover, formal training in conducting virtual visits is limited, even among those who may have some Sarah Onorato and Ashwini Joshi contributed equally to this work. Received July 1, 2020 Accepted September 28, 2020
experience with telemedicine,10 as few medical schools offer telemedicine education.11 Given the unprecedented need for connecting with patients virtually during the COVID-19 era, it is important to consider how clinicians can translate their experience with in-person visits to virtual visits. These skills are increasingly important as telemedicine becomes an integrated part of our routine care delivery system, both as a primary modality for outpatient visits and for triaging patients who may require in-person evaluation. Much like in-person visits, virtual visits include dist
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