Prior to the COVID-19 pandemic, telehealth was primarily used in rural areas or where access to specialty services was limited. The practice of “healing at a distance” was just beginning to take hold. This led the Association of American Medical Colleges (AAMC) to convene a meeting of telehealth experts to further study its possibilities and potential downsides. What came out of the meeting was a consensus: “If telehealth were to be useful in the provision of high-quality care and be adopted by clinicians in a generalizable and sustainable way, providing training in telehealth to the clinician workforce would be essential.” The resulting Telehealth Advisory Committee developed the skills necessary for telehealth, which subsequently became domains of competencies.
Competencies and Level of Practice
Telehealth Competencies Across the Learning Continuum, AAMC’s report from its New and Emerging Areas in Medicine series published in March 2021, categorizes telehealth competencies into six domains:- Patient safety and appropriate use of telehealth. Being able to incorporate telehealth into care for a diverse set of patients and knowing when to escalate care to in-person treatment
- Access and equity in telehealth. Appreciating one’s own set of biases and being able to promote health equity and accommodate patient needs and preferences, including as they relate to social and cultural mores and values
- Communication during telehealth. Establishing a rapport with patients remotely; understanding the environment during telehealth, including eye contact and privacy; and assessing when that social support should be incorporated into healthcare
- Data collection and assessment in telehealth. Collecting health history, conducting the appropriate physical exam, and incorporating patient-generated data
- Technology for telehealth. Understanding technology and tools, including patient-owned devices, and being able to troubleshoot technology failures
- Ethical practices and legal requirements for telehealth. Adhering to appropriate local legal and privacy regulations and disclosing potential conflicts of interest
The report classifies practitioners into three levels: those who are entering residency, those beginning to practice, and experienced faculty. These are the competency levels for each of the three tiers:
- Recent medical graduates entering residency should be able to describe, explain, or define the ability or skill.
- Recent residency graduates entering practice should have the skill to demonstrate, prepare, and conduct.
- Experienced practitioners should serve as role models and teach the behaviors.
L&D’s Role in Helping Healthcare Practitioners
As telehealth grows and becomes more critical to the health and well-being of Americans, L&D practitioners can help healthcare practitioners expand their toolbox and develop and deepen their competencies. In “ Equip Healthcare Practitioners for Telemedicine,” Katie Voss Mohamed offers guidance and tools for L&D practitioners.Privacy and Ethical Concerns
To secure confidentiality during telehealth visits, healthcare practitioners and patients should be in private spaces and should use secure devices and connections. Voss Mohamed recommends that L&D professionals “offer HIPAA training that covers telehealth-specific HIPAA regulations and organizational privacy practices to ensure practitioner compliance.”
These HIPAA guidelines include but are not limited to:
- Only authorized users should have access to protected data, and all communications with such protected data should be monitored.
- A healthcare system must implement a secure and encrypted messaging system.
- A practitioner should close the door while conducting a telehealth visit and may want to hang a “do not disturb” sign on the door.
Organizational practices may entail:
- It’s a best practice for practitioners to wear a badge above their waistline or on their lab coat during visits.
- Medical personnel should advise patients that the telehealth visit is private and secure; it is not recorded.
- Telehealth practitioners should relay that no one else is in the room unless that person has been introduced and is critical to the visit, such as a clinician or therapist.
To augment training, an L&D professional can create checklists for healthcare practitioners of items to cover with patients during telehealth visits, such as letting the patient know about the privacy practices that are in place.
Communicating With the Patient
When conducting a telehealth visit, the healthcare practitioner should think and act as if the camera is on at all times. Medical personnel should eliminate as many distractions as possible in the camera background, on the desk, and in terms of other devices and notifications and ensure their camera is at an appropriate angle.
The medical professional should practice active listening and summarize what the patient has said and reassure them about their symptoms and diagnosis.
L&D professionals can use other training, such as role-play activities in which small groups practice diagnosing patients based on symptoms, a patient history, and what is going on in the community at the time.
Technology
During training, Mohamed recommends covering technical elements such as steps to accept and initiate telehealth visits. Further training can include adding embedded chat or documentation features that medical practitioners may use within the telehealth software program.
Mohamed further writes, “I like to create an Articulate Storyline Rise course. I can add videos, e-learning slides, images, and knowledge checks in the course and then—with a few modifications—publish the course as a PDF, which becomes a useful resource when healthcare practitioners need to quickly recall how to perform an action in the telehealth platform.”
Healthcare practitioners should be prepared for technology failures, Mohamed continues. To help them, L&D teams can recommend that medical professionals have a second device to use if the first one fails; prior to the facilitated virtual visit, secure a way to contact a facility where a patient is taking the telehealth visit in case of technology failure; and help the patient work through their technology issues.
Making Way for the Future
There are myriad ways L&D teams can work with healthcare professionals to increase competency and improve the telehealth experience—providing training, housing resources in a centralized location, and offering a means whereby healthcare practitioners can communicate additional needs. L&D can also provide checklists and tip sheets for patients that can be posted on a public-facing portal and sent to patients in advance of the telehealth visits.As telehealth grows, the time is ripe for such L&D-healthcare partnerships to provide a healthier future.
