As a risk manager and a patient during the pandemic, I experienced and observed many risk exposures, and how they were handled in physician, hospital and ambulatory surgery center practices. ASHRM’s focus — Safe and Trusted Health Care — is aimed at safer delivery of care through the promotion of effective and innovative strategies and professional leadership. Initially and now with the continuation of variants, there is a critical need to create, train and implement a “new normal” in care delivery processes, particularly related to telehealth.
The first, and one of the most frequent issues I observed, was how information was provided to patients to update them on the new processes for care delivery during the pandemic. As patients were exiting one live visit and scheduling the next, I noticed that some questioned why one visit was live, but the next one would be a telehealth visit. They were often told to check a website, find a message in their patient portal or “use the app.” They were not asked about their access to or abilities to use the internet or a smartphone. Once when I was in line at a pharmacy, a customer had a question and was told to “just check the website,” to which customer responded, “I don’t know how to do that.”
Lack of technology access and skills
A 2020 study of Medicare beneficiaries revealed that 41 percent did not have access to a desktop or laptop computer with high-speed internet and 40 percent did not have a smartphone with a wireless data plan (1,2). Even when patients do have access, there can be issues with their lack of experience, their ability to troubleshoot technical problems or their level of digital literacy and ability to adapt to digital communication.
These problems are not limited to elderly patients. In a study by the U.S. Department of Health and Human Services, more than one in six persons living at the poverty level had no internet access in 2019. People living in nonmetropolitan areas had less access to the internet than those in metropolitan areas. People in low-income families living in nonmetropolitan areas were less likely to have access to the internet than those in metropolitan areas (3). Health care providers can mitigate their risks by establishing an assessment of their patient’s digital literacy, and documenting other options offered to patients to provide them with information.
The second issue observed was the lack of information being exchanged among the health care providers and the patients to prepare for the next visit, whether in person, via telehealth, ambulatory or in-patient.
In reviewing several surveys (4,5), one key issue identified in 2019, prior to the pandemic, was the timeframe for the length of telehealth visits, which was reported as being between five and 20 minutes. The pandemic led to a significant increase in the use of telehealth, and some people who had never experienced a telehealth visit shared that the time was “short and I wasn’t told what I needed to know.”
Also, patients who could access information in their patient portals, including myself, found that information shared verbally on a telehealth visit was not always documented or was not documented accurately. Communication and documentation have long been two leading risk exposures in patient/provider interactions. Health care providers can mitigate their risk by completing a written summary of the telehealth visit, keeping in mind that due to the 21st Century Cures Act 2021, the patient accessing the record may be reading more information than was previously available. Another risk mitigation tool for improved communication with the patient is to implement a teach-back during the telehealth visit to confirm that the patient understood the information shared, and document that the teach-back occurred.
Here is a summary of actions I compiled through my patient experience, which health care entities can implement to decrease risk exposure and make a patient’s journey somewhat easier in the new care delivery processes during the continuing and ever changing worldwide pandemic (6,7).
- Determine the digital literacy of the patients, as well as their internet access.
- Determine if the patient has family or friend support to assist with the digital demand.
- Establish multiple avenues to deliver information to the patient separate from digital communication.
- Create useful checklists for patients to aide them in preparing for live and virtual appointments. These should include medical history, medications and any questions for the visit.
- Create a checklist for surgical and diagnostic patients with what to bring to the health care facility and expectations for after care.
- Provide timely responses to patients with inquiries. Review all documentation prior to responding.
- Create a log for data to guide management in identifying opportunities for improvement.
(1) Roberts, Eric MD, & Mehrotra, Ateev MD MPH (2020, August 3). Assessment of disparities in digital access among Medicare beneficiaries and implication for telemedicine. JAMA Internal Medicine. Retrieved September 2021 from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768771
(2) Robeznieks, Andis (2021, August 7) Why so many patients still can’t connect to doctors via telehealth. AMA. Retrieved September 2021 from https://www.ama-assn.org/practice-management/digital/why-so-many-patients-still-can-t-connect-doctors-telehealth
(3) Swenson, Kendall, & Ghertner, Robin. (2021, March). People in Low-Income Households Have Less Access to Internet Services – 2019 Update. Office of the Assistant Secretary for Planning & Evaluation – U.S. Department of Health & Human Services. Retrieved September 2021 from https://aspe.hhs.gov/sites/default/files/private/pdf/263601/internet-access-among-low-income-2019.pdf
(4) Wheel. (2019, July 31) Master Guide to Telehealth Statistics for 2019. Retrieved September 2021 from https://www.wheel.com/blog/master-guide-to-telehealth-statistics-for-2019
(5) Centers for Disease Control and Prevention. (2021, October 20) Telemedicine Use. Retrieved October 2021 from https://www.cdc.gov/nchs/covid19/pulse/telemedicine-use.htm
(6) MedPro Group/Cascella, Laura. (2021) Overcoming Telehealth Barriers and Engaging Older Adults in Virtual Care. Risk Management Tools and Resources.. Retrieved September 2021 from https://www.medpro.com/telehealth-barriers-for-older-adults
(7) Chaput, Mary. (2021. March 13) How Should I Prepare for a Hospital Stay During COVID? Capital Gazette. Retrieved September 2021 from https://www.capitalgazette.com/lifestyles/ac-cn-caregivers-corner-2021314-20210313-welciwjmvnfhlbkn573uqn2f3e-story.html
Author Melanie Osley, RN, BSN, MBA, CPHRM, CPHQ, CPPS, ARM, DFASHM, has been a risk/quality/patient safety professional for over 25 years. A member of ASHRM since 1995 and on the ASHRM Board of Directors 2018-2020, she has spoken at ASHRM conferences and in webinars; authored contributions to the Forum and the Risk Financing Playbook; served on chapter and national committees; and is a past-president of the ASHRM Connecticut chapter.