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Paying attention to the preferences of individual patients and the needs of different groups can help avoid errors and ensure that the care provided through telemedicine services is safe for all. This can be achieved through effective co-design with stakeholders and, most importantly, with patients. The following is an adapted excerpt from the Institute for Healthcare Improvement (IHI) Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper.
Each interaction via telemedicine must meet the needs and honor the preferences of the individual patient. When implementing the framework presented in the Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper, it is essential to engage patients, families, and the health care workforce at the outset. The practice of co-design and co-producing care with key stakeholders in the process —patients, families, and care providers — can help build trust and foster connections.
Overall, patient acceptance of telemedicine has been high. Press Ganey Associates reports that patients rate telemedicine visits as highly as in-person visits, and other research supports this finding. Yet, patient preferences regarding telemedicine vary by individual. Patients prefer telemedicine for certain parts of the care cycle, and for certain disciplines or types of appointments. These preferences may not always align with provider preferences or expectations. Health care organizations must invest the time to co-design services with patients and clinicians and, through this process, work to understand how to continually improve. Co-designing telemedicine services requires attention to three important considerations:
- Patient needs and preferences: Individual patients’ needs and preferences for how they receive care, whether in person or virtually, may vary greatly. Large health systems that serve diverse populations, for example, are likely to identify starkly different needs among population segments. When designing telemedicine services, it is important to first identify patients’ needs and expectations and then create services to meet those needs. It is imperative that health systems engage patient representatives in codesigning services, from the outset and in an ongoing way, to ensure that these diverse needs are met.
- Equity is paramount: While telemedicine has the potential to bridge inequities, there is also the risk of inadvertently perpetuating or even exacerbating them. Not all patients, for example, have access to the necessary equipment or high-speed Internet for virtual visits, and some who do may not have the knowledge and skills to use the technology and require assistance from a caregiver. Some patients may need to conduct visits by telephone, which is also within the purview of telemedicine. Other patients may not have a private space in which to conduct televisits.
A co-design process that engages patients, families, and clinicians can identify and address issues such as these that may impact equity in telemedicine. Both clinical and office staff, particularly schedulers and triage staff, need to be involved in the co-design process. It is also important to engage patient safety officers who can help incorporate quality and safety considerations into the design and implementation of telemedicine services.
- Partner with community organizations: Health care organizations are encouraged to partner with community organizations (e.g., a trusted pharmacy, church, school, or community center) to provide support in the form of knowledge of the community, physical space (e.g., to house telemedicine kiosks), technological infrastructure, and assistance that can facilitate televisits. These types of collaborations can provide additional expertise that may help health care organizations appropriately design telemedicine services for their patients and the community.
Ultimately, telemedicine is not “one size fits all.” Providers, in consultation with patients and families, need to assess the most appropriate use of telemedicine to meet care delivery needs. A patient’s health and medical conditions are dynamic, and thus the care provided must also be dynamic to meet the patient’s needs. It is essential, therefore, to include patient and family representatives as partners in the co-design of telemedicine services.
To learn more about the Framework for Ensuring Safe, Equitable, Person-Centered Telemedicine, download the free white paper.
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