Concerns about the logistics of providing Telehealth services

These questions have been coming up over the past few weeks and I wanted to share the answers/responses from PICA with you. FAQs can also be accessed by visiting www.picagroup.com/covid-19

Question/Scenario: What is the liability for complications that arise during the pandemic? Example: Patient who was deemed as non-urgent (history of calluses but generally a controlled diabetic with mild neuropathic symptoms). The patient was taken off the schedule to be called when things return to “normal” but then developed some sort of complication (ulcer, etc.) that lead to hospitalization/amputation. 

Response: Ultimately, it is the practice’s responsibility to determine what patients may fall into an acute healthcare situation and those who would not. The practice can close the office if they feel their patients are not in need of immediate ongoing treatment that might be detrimental to the patient’s recovery. If they determine that they are closing, they need to contact the patients on the schedule and reschedule the appointments. However, the patients under acute conditions or post-surgical care, who could suffer from not being seen, either can be evaluated on a one-on-one basis and be seen or instructed to go to an urgent care or hospital if the condition needs immediate evaluation and treatment.  Your staff should be communicating with patients that they need to call if their callus/wound changes or go to an urgent care/hospital.  This should be documented in the notes. Telehealth/Telemedicine can be used to check in with the patient, if possible.

Questions: How are we handling consents for telehealth services? Is documenting in the chart note “Patient consented to telehealth services” enough? How would we get patients to actually sign a consent (many elderly patients wouldn’t have the technology or ability to do so)? I have seen the PICA telemedicine consent but if they did not sign when they came in before COVID-19, how do we get it signed?

Responses: Option 1: Email a copy of the consent form to the patient (download a sample form here) and ask them to print it, sign it, and either scan it and email it back or take a picture with their phone and send it back as an email attachment or via text message. Copies of the email and or text communications should be entered into the medical record. If they are unable to print it, have them reply to the email stating that they have read the consent form and agree to treatment via telehealth/telemedicine.

Option 2: Take a picture of the consent form, send it to the patient via text message, and ask them to reply with a confirmation that they read the consent form and agree to treatment via telehealth/telemedicine. Copies of the text communications should be entered into the medical record. Even if option 1 or 2 were completed, you should still do a verbal consent at the beginning of the visit and document that it was completed.