Health Care Team Workflows for Telemedicine

Once the decision to integrate telemedicine into routine care delivery is made, frontline care teams must begin to deliver telemedicine efficiently, safely, and equitably.

Here is one of the key considerations for frontline teams.

Staff Roles. Telemedicine necessitates multiple new staff roles and workflows, including program management, site coordination, clinical oversight, technical support, and more. It is critically important to build in staff expertise and adequate time for patients with varying levels of digital literacy to successfully join and participate in telemedicine visits. Many clinics are experiencing a higher visit volume with telemedicine and scheduling should account for this higher show rate. During a visit, it is critical that each team member know their role and the needed electronic medical record documentation practices.

Scheduling and Triage. Determining whether telemedicine vs. in-person care is more appropriate, is the first step in carrying out new telemedicine workflows. The resources below offer guidance on how to approach scheduling and triage with a telemedicine system in place.

Schmidt. NEJM Catalyst. 2020

Workflows. Delivering high-quality, equitable telemedicine care requires new workflows and protocols. Transitioning team-based workflows from in-person care to telemedicine is an ongoing challenge, and many health care settings are currently experimenting and innovating on how to do this well. The resources below offer real-world examples of how various health systems have approached these aspects of telemedicine implementation, including several examples from public and FQHC sites specifically.

  • West County Health Centers: Virtual Clinic Workflow Using Zoom Breakout Rooms — This workflow provides a “virtual clinic layout” for care teams using Zoom breakout rooms for telemedicine. It includes descriptions of different administrative and clinical team members’ roles in managing a Zoom clinic, from patients’ first check-in through the telemedicine visit itself and discharge. This tool was created by West County Health Centers — a Federally Qualified Health Center offering comprehensive medical, dental, behavioral health, and other specialty services to the communities of western Sonoma County, California — as part of their work through CCI’s Connected Care Accelerator.
West County Health Centers
  • Petaluma Health Center: Tech Volunteer Workflow — This is a workflow for volunteers providing tech assistance to patients prior to their telemedicine appointments. It includes steps such as checking whether patients have email addresses, eClinicalWorks patient portal access, and the Healow and Webex apps, and completing appropriate consent documentation. This tool was created by Petaluma Health Center — a Federally Qualified Health Center offering comprehensive medical, dental, mental health, and specialty care services for communities in Petaluma, California — as part of their work through CCI’s Connected Care Accelerator.
Petaluma Health Center
  • White Memorial Community Health Center: Video Visit Workflow — This is a workflow for scheduling and completing a video visit using Healow, an application from eClinicalWorks. It includes steps such as ensuring patients’ web accessibility, conducting pre-visit planning, sending text message reminders, and following up with patients after the visit. This tool was created by White Memorial Community Health Center — a non-profit health center in Los Angeles, California that provides primary healthcare services to children, adults, and seniors regardless of patients’ ability to pay — as part of their work through CCI’s Connected Care Accelerator. To learn more about how White Memorial improved video visit infrastructure and assessed patient satisfaction with telemedicine, check out this case study.
White Memorial Community Health Center
  • UMMA Community Clinic: Hybrid Visit Workflows — This collection of three workflows provides guidance for scheduling, confirming, and completing hybrid visits using and eClinicalWorks. Some sites have found hybrid visits useful if patients need to come on-site in order to access the internet, devices, or private space needed to complete a video visit as well as to access specialty care that may not be accessible locally. This tool was created by University Muslim Medical Association (UMMA) Community Clinic — a Federally Qualified Health Center and Patient Centered Medical Home in Los Angeles, California providing medical, behavioral health, educational, and other services to promote the wellbeing of the underserved, regardless of ability to pay — as part of their work through CCI’s Connected Care Accelerator.
UMMA Community Clinic
Velázquez et al. NEJM Catalyst. 2020