Ep #98: Telemedicine

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.

Sarah: Hey y’all, Sarah Michelle and Anna here. This episode we’re going to take it back a notch for a second. You know, when the pandemic hit in 2020 the awareness and the importance of telemedicine grew exponentially. But it wasn’t only designed to play a vital role in health care during global pandemics as a one-time thing. There are just really so many benefits to virtual care. And as technology continues to advance, telemedicine becomes an even more vital tool for nurse practitioners. 

And so in this episode, we want to talk about, okay, what is telemedicine? What are the benefits? What kind of tools are involved to make this happen? Some legal considerations, which is always top of mind when we’re thinking about telemedicine and really just best practices for nurse practitioners in this virtual realm because it’s not going away. 

I think everybody thought like, oh, Covid would be a blimp and then we’ll take a step back, but I think it’s only expanded the remote world and we’re going to be in this remote world for a long time. And so telemedicine will only continue to grow. And so let’s just start by understanding what telemedicine and really virtual care entails, Anna. Do you wanna start there? 

Anna: Yeah, so when I think of telemedicine, I really think of the use of technology to provide these healthcare services remotely. So it allows healthcare professionals, like nurse practitioners, to connect with patients, typically through video conferencing or phone calls. But this can also include our secure messaging platforms that I’m sure most of you are aware of. 

And it’s important to note that telemedicine and virtual care are often used interchangeably. There are a few subtle differences, but for the purpose of this podcast, we’re going to be mostly talking just about telemedicine. And, really, the concept of telemedicine, it’s not new. This has been around for decades. But advancements in technology, access to the internet, the need for more accessible health care, all of these things have just accelerated its adoption. And then the pandemic hit and now it is really, really widely used. 

Sarah: Yeah, I think hands down, by far, one of the biggest advantages, if not the biggest, of telemedicine, is just that increased access to care. Because patients no longer need to travel long distances or wait for weeks to be able to see an advanced practice provider. And it really helps just eliminate some of those geographical barriers and allow for our patients to receive care from the comfort of their homes. 

I’m definitely thinking, I grew up in Eastern Kentucky, and everything out there is so remote. And so having the ability to access healthcare via the internet is a really big deal. And hopefully, that means we’re going to see more early intervention and more people seeking care, et cetera. 

I think too, just convenience is another large factor, which gives us even more flexibility and even improved patient satisfaction. And, of course, improved compliance and engagement in their health too. 

Anna: Yeah, I absolutely agree. I live in rural Tennessee, and so we don’t have a ton of resources right by us. And at least by me, telemedicine also really enhances that continuity of care because we as nurse practitioners, we can follow up with patients a lot more frequently and even just send follow-up messages or results, which is particularly valuable for those who have chronic conditions, right? 

Letting us do this ongoing monitoring, this ongoing talking and communication with our patients allows us to intervene earlier, like you said, without the need for them to follow up in person, because that’s not always feasible. 

And I think you mentioned a little bit about engagement with patients, so I do want to touch on that too for a second because getting patients engaged and involved in their care is so crucial for them to have any type of positive health outcome, right? If they’re not engaged in their health care, they don’t know why we’re doing things, they’re not being proactive about it. They don’t see those same outcomes. 

But when they have easy access to their health care provider through virtual visits, this can just really, really increase. So I want you to consider a patient, they have a chronic condition and suddenly they have an exacerbation of symptoms. 

Rather than rushing into the office or not going to the office at all because they can’t get there, or going to the ER if it’s after hours or a weekend, the patient can simply schedule a virtual visit with their nurse practitioner. Not only saving time and resources, but it’s ensuring that the patient is receiving timely care. 

Sarah: And on the flip side too, I keep thinking with telemedicine over the last couple of weeks me and my daughter just had Covid and I wasn’t able to physically make it in the office for her to get her diagnosis of Covid because I was so sick myself. And so we did a lot of virtual care and then my husband took her in just for the swab. 

But what a big deal it was to be able to just text her cardiologist and text her pediatrician and be like, this is what’s going on. And everything happened so much faster and we were able to get her the care she needed so much quicker, just because of the access point. 

Anna: Yeah, I experienced that as well during my second pregnancy, just being so nauseous one day. I think I had a GI bug on top of being pregnant and literally could not get out of bed. So there was no way I was making it to the office. But doing a virtual call, being able to get something prescribed and my husband could go pick it up really made that so much easier on me. 

Sarah: Yeah, I mean, it’s wild. They were just like, “What’s Meadow’s oxygen?” I was like, “Oh, let me hook her up to the monitor real quick.” 

Of course telemedicine would not be possible without the right tools, so first and foremost, we have video conferencing platforms like Zoom, Skype for Business. And there are even specialized telemedicine software now that we use for virtual consultations. 

And these are great because they support the face to face interaction with patients, allowing for nurse practitioners to assess visual cues, build rapport, all that good stuff. So we’re still getting the human element, but we’re getting this increased access to care and all these other things we’ve been talking about. 

And electronic health records also play a pivotal role in telemedicine too because they allow nurse practitioners to access patient information, document encounters, and maintain really that comprehensive medical record. And seamless integration between the electronic health records and telemedicine platforms really just streamlines the entire process. 

Anna: Yeah, and don’t forget about remote monitoring devices, like you were just talking about with the pulse ox.

Sarah: Yeah, the pacemaker, the pulse ox. 

Anna: Yeah. 

Sarah: We have a pacemaker wand at home. 

Anna: Yeah, glucose monitors, like all of these allow patients and NPs to track these health parameters. There are even mobile health apps that people can use to put this data in, we can see it, they can be looking things up. So using these tools in practice are so valuable, we just want to consider factors like ease of use and, ultimately, security and privacy for our patients. 

Sarah: Yeah, it is kind of wild, my daughter has a pacemaker for those of you who don’t know. And we literally every three months, we just have a wand and it connects to an app and we hold it over her pacemaker and then it transmits the information from the last three months straight to her cardiologist. 

Anna: Wild. 

Sarah: It is wild. Like a decade ago, two decades ago, that wouldn’t have been a thing. And think about how much time it saves us and how easy it is for us to be able to get her cardiologist the information he needs. Yeah, it’s really cool. 

Speaking of security, like you were just a second ago before I got lost on pacemakers, we do of course have to touch on legal considerations because as wonderful as telemedicine is, it definitely still comes with legal and regulatory considerations that nurse practitioners must be able to navigate. 

And so licensure and state regulations are a significant consideration here. So nurse practitioners are licensed on a state by state basis. Remember, right now there’s not compact states for nurse practitioners, and so regulations regarding telemedicine are going to vary from one state to another and you definitely want to research the specific requirements in your state. 

And then in regards to patient privacy, I think that’s the one that usually comes to people’s minds when we’re talking about legal and telemedicine. HIPAA compliance, non-negotiable always. Protecting patient privacy and their data security are going to be paramount in telemedicine. And nurse practitioners must use secure platforms and follow those HIPAA guidelines to safeguard that patient information. 

Anna: Yeah, another one I do want to bring up too, that often people forget about, is just reimbursement and billing considerations. Both of those definitely come into play here. Now, telemedicine has gained pretty broad acceptance now, but I will say reimbursement policies and qualifications, they can just differ among insurances and different payers. So look into the proper billing codes and the requirements for telehealth services depending on what insurance you’re working with. 

And I know navigating billing and navigating all of these legal aspects of healthcare can be pretty challenging, especially at first. But it is so important to ensure that any practice, especially with telemedicine, but really any practice is in compliance with regulations. 

And keep an eye on this because as telemedicine continues to evolve, the legal landscape is going to evolve as well. And so just like with guidelines, just like with evidence-based practice, all of these regulations and legal aspects, NPs need to stay informed. 

Sarah: Well hopefully it evolves into compact states for nurse practitioners. 

Anna: I know. 

Sarah: That would be the goal. That would make things a lot simpler. 

I think to kind of finish out this episode, let’s just talk for one second about best practices if you are a nurse practitioner and you’re going to be engaging in virtual care. And it is 2023, almost 2024, I would say it’s almost undeniable that you’re going to be engaging in virtual care. 

So effective communication is the core of successful telemedicine. So nurse practitioners should establish clear lines of communication. And alongside that, boundaries. You want boundaries with your patients. I’m not a good example of this with my daughter’s cardiologist. But explain the virtual visit process, set the expectations up front of what that communication will look like. 

Oftentimes, if I were to send a secure message to my nurse practitioner, it’s like 24 to 48 hour return time, those sorts of things. Like auto replies, definitely just something to keep in the back of your mind because we live in an instantaneous world. 

Anna: Yeah, and just having those clear expectations with patients where if you send a message, yeah, you get that auto reply, they know when to expect a response, it’s going to make everything so much easier. 

And I will say conducting an effective virtual visit, it is going to take time. And so the physical assessment is just a little bit trickier virtually, so NPs really need to adapt those assessment skills to the virtual environment. You really have to pay attention to visual and auditory cues, and you have to keep in mind that not all concerns are going to be appropriate to be addressed in telehealth. 

So if there is something we cannot fully assess, we need to advise the patient to be seen in person. So any red flags for an emergent condition like chest pain, again, absolutely need to refer them to go to the ER. We cannot do telehealth for everything. 

Sarah: No, I wish. I think too, just building rapport with remote patients is essential. I think we all kind of feel the Zoom fatigue a little bit, so we really are going to have to work just a smidge harder to establish that trust and maintain that positive patient/clinician relationship. And we can do that through all of those therapeutic communication techniques that I know were drilled into you in nursing school at some point. But just kind of refresh on those a little bit as you enter into this virtual world. 

And then don’t forget too, privacy and confidentiality are always a priority here. A nurse practitioner should ensure that this virtual environment that we’re engaging in is secure and that patient data is protected. And then don’t forget about those cultural competency requirements too. Those are going to remain crucial in telemedicine. 

And that kind of wraps us up about telemedicine and virtual care. We’ll talk to you guys next week.

As an extra bonus, friends, if you’re looking for support no matter what phase of your nurse practitioner journey you’re currently in, I have communities available for both students and new nurse practitioners. In these communities, we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes. 

Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.