Managing the Risks of Practicing Telemedicine

Telemedicine as Usual: Advice for Old-Fashioned Telephone Use

Anne Huben-Kearney, vice president of risk management at ProMutual Group in Boston, said that 100 percent of the physicians insured by her group practice telemedicine.  That doesn’t mean they’re all consulting with patients via videolink or over a secure, customized web portal – talking on the phone counts, too. And there are some common sense dos and don’ts of phone consultations that many doctors forget.

First, said Huben-Kearney, doctors’ offices need to maintain a good triaging system.  “We prefer that the best practitioner in the office be the triage person,” she said. “It absolutely should not be the secretary or receptionist. If there’s a clinical concern, it should go immediately to a higher level, preferably a registered nurse.” Additionally, she said, every telephone communication with clinical relevance needs to be documented, just like a consultation in the office. And if there are two calls for the same problem within a finite period of time, the patient should be seen.  “When I mention documenting phone calls,” she added, “I’m talking about afternoon and weekend calls as well.”

The volume of calls in some practices, such as pediatricians after hours, is so high that they can miss how important it is to document everything, even when it’s telling a patient to go the ER. The right systems help with documentation, and the best systems are frequently the lowest tech. “We recommend having a piece of paper by your bed in case you’re called in the middle of the night,” said Huben-Kearney. “Something readily accessible so wherever you’re taking the call, you can write down the time, the name of the patient, the nature of the call and the advice you gave.” Another suggestion is having a back number for the office that has an answering machine.  “That way [the provider] can literally finish the call, call the back number and record it all onto the answering machine to be transcribed by the staff in the morning,” Huben-Kearney advised.

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