Integrating EHRs with Telehealth: Enhancing Remote Clinical Care
A persistent challenge with telehealth care delivery is fragmented care when patients see unconnected providers across visits. For instance, a patient with heart failure may see their primary care doctor, cardiologist, and nephrologists across in-person and telehealth visits. Lack of communication between providers often leads to duplicative testing, risky polypharmacy, and clinical errors.
An integrated EHR system with appropriate record sharing capabilities helps overcome this fragmentation. All clinicians across a health system get access to the same unified EHR record for each patient. This gives any treating provider real-time access to high-value data including current medications with dosages, medication allergies, active problem lists, recent vitals, diagnostic test results, hospitalization history, procedures, and imaging.
Such data sharing ensures any provider can make informed clinical decisions aligned with the patient’s larger care context, avoiding misaligned treatments. It may prompt critical medication reconciliation or prevent redundant CT scans. Preserved continuity of care across telehealth visits prevents “re-baselining” patients each time. This makes integrated EHR access with appropriate permissions a powerful facilitator of care coordination and patient safety across in-person and virtual care teams.
Comprehensive Documentation of Telehealth Encounters
As telehealth use accelerates globally, proper clinical documentation is crucial for virtual visits. Carefully capturing details into the integrated EHR creates a complete medicolegal record and facilitates follow-up care.
For telehealth visits, key elements to comprehensively document into the EHR include:
- Signed provider notes on subjective complaints and objective assessment
- Any images or recordings from the live video encounter
- Physical exam findings performed by remote guided examination
- New or modified problem lists and diagnoses
- Any orders placed for labs, imaging, procedures
- Medications prescribed, changed or discontinued
- Level of care and billing codes for telehealth services
- Patient consents, care plans and instructions provided
- Patient questions answered and education given
- Follow-up actions needed including referrals, home health, or next appointments.
Detailed telehealth documentation like this ensures accurate coding and billing for virtual care delivery. It also maintains continuity by updating the patient’s ongoing health record. Any subsequent providers can review previous telehealth visit details like prescribed medications and ordered follow-ups. Thorough EHR documentation is key to leveraging telehealth’s potential while avoiding gaps in care.
Telehealth Technical Capabilities Enabled by EHR Integration
Tight EHR integration powers a range of capabilities that improve the virtual care experience for patients and enhance clinical workflows for providers. Some examples include:
- Integrated e-prescription workflows allow sending new prescriptions directly to the patient’s preferred pharmacy.
- Patient waiting room queues in the EHR interface improves workflow management.
- Digital intake forms submitted by patients ahead of visits populate directly into the EHR for quick review.
- Patient chat features allow follow-up questions after the visit within the EHR portal.
- Automated appointment reminders and visit summaries integrated with the EHR.
- Integrating with hospital EHRs facilitates telehealth consultations for admitted patients.
- Multidisciplinary conferencing for virtual care collaborations between physicians, nurses, pharmacists, social workers etc.
These kinds of functionality enabled by tight EHR-telehealth links can enhance providers’ clinical efficiency, work-life balance, and the overall quality of virtual care delivery.
In summary, thoughtful integration of EHRs with telehealth systems has immense potential to improve remote clinical care in the modern era. EHRs can fill information gaps during virtual visits, enable care coordination across modalities, preserve continuity across providers, and allow comprehensive telehealth documentation. Realizing such benefits through deliberate EHR interoperability will be key for the effective large-scale implementation of telehealth.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320051/
https://telehealth.hhs.gov/providers/planning-your-telehealth-workflow
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053680/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590973/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10252887