Preparing a Patient for Telemedicine: An Onsite Clinician’s View

Editor’s Note: Rebecca Carter, APRN, nurse practitioner at Hospital District #6 of Harper County-Anthony Campus (formerly Anthony Medical Center), shares her perspective on the role onsite clinicians play in making telemedicine a success. Her story of how telemedicine has benefitted the facility, a critical access hospital in Anthony, Kan., was featured in our September 2017 blog post.

Telemedicine’s acceptance among patients and providers is rapidly growing across the country. Many factors have made it possible: the quality and value of programs like Eagle’s, the dependable “always on” technology that can deliver physician expertise to hospitals anywhere, and the widespread acceptance of technological devices in our lives today. All these things have helped make telemedicine a sensible choice for more and more hospitals.

The onsite team helps make it work

There is another important ingredient in the success of a telemedicine program: the onsite clinicians who serve as the local connection between patients and the telemedicine team. What we do and what we say when we introduce telemedicine to a new patient at our hospital can make the difference between an unsatisfactory telemedicine consultation and a great one.

One of the most important things we do is make sure the patient is comfortable with telemedicine. What’s the best way to introduce it to a first-time patient?

We’re not “turning over” care to someone else

The approach might be different in a big city hospital, but at our 25-bed facility, the biggest concern we encounter is a fear that we are going to “turn over” a patient’s care to someone else. We are a small hospital and rural health clinic in a town of just over 2,000 people. Our hospitalists, physician assistants, nurses and other staff know most of the people who come in for treatment. Maybe they went to school together, go to church together, or their kids play soccer together.

It doesn’t surprise me when some patients express a reluctance to be treated by someone they view as a stranger, a physician being beamed in from “somewhere else.”

My response is to reassure patients that the other members of the onsite clinical team and I will still be very much involved in their care. I explain that we are not turning over their care, but will be working collaboratively with the telehospitalists. I quell their fears that we might walk away from them once the telehospitalists enter the picture.

I also gently explain that, because of telemedicine, patients are far less likely to be transferred to a referral hospital in Wichita (60-plus miles away) to get the care they need. Being transferred away from their hometown hospital is another major concern of patients. When they understand the telehospitalists are often the reason they get to stay here, they feel much more positive about the experience.

Questions diminish over time

When we started our Eagle program three years ago, we held introductory meetings for the community. It was a great way to help Anthony residents understand the new program, our reasons for implementing it, and the benefits it would deliver. Those sessions helped people get comfortable with the concept of telemedicine before they (or family members) came to the hospital for treatment. And now that three years have passed, we get very few questions about telemedicine, and even fewer objections to it.

It has become part of “the way we do things”—so much so that I find I don’t have to be involved in every single telemedicine interaction. We don’t often use the videoconferencing cart—the robot, as we call it—for bedside consultations with acute care patients. Most of those are done via telephone with our telemedicine team. We use it most often when a patient is ready to move from our acute care level to our skilled nursing level.

Our beds are designated as “swing beds” for this purpose—meaning they can be used for either service—but it requires a doctor’s diagnosis and approval before the change can be made. In those instances, we have a case manager (who is a nurse) stand by during the consultation. Of course, if the patient shows any hesitancy at all, I will be there while the telehospitalist does the diagnosis.

The personal, hometown touch

Again, it’s usually a matter of assuring the patient that we are not simply “handing off” their case for someone else to handle. It’s another reason I appreciate the telemedicine service we offer: It reminds me every day how much our patients expect that personal, hometown touch along with the latest and greatest technological advances.