#1: Nurse Practitioners Are Expected To Offer The Same Standard Of Care As They Normally Would
- A nurse practitioner must be as competent a professional virtually as she/he is required to be in person.
- A nurse practitioner must perform her/his job to the same standards as other persons in the nurse practitioner profession within the same or similar community.
- This counts just as much virtually as in person.
- The legal standard of care for medical professionals still applies even if a patient is not physically in the office.
#2: Include How You Will Conduct Telemedicine In Your Collaborative Practice Agreement And Policies/procedures
- It should be written in the collaborative practice agreement how telemedicine will be conducted by the supervising physician and nurse practitioner, at what facility will the physician and nurse practitioner conduct telemedicine, what equipment will be used to conduct telemedicine, and who has what responsibility.
- Office policies and procedures for staff should outline what staff position is responsible for what step in the telemedicine process.
- For example, which staff position is responsible for confirming the patient’s identity and how will that staff position confirm the patient’s identity?
- Make sure staff has fully explained to the patient what telemedicine is and have the patient voluntarily opt-in in writing.
- Since this is all being done virtually a staff member is probably not going to be able to get a signature in person, but there are many online services available for electronic signatures that have signature verification.
#3: Train Your Staff (And Patients) Properly
- The use of technology does not come easy to everyone.
- Don’t assume that a staff member or patient knows how to use a camera or microphone.
- It is the responsibility of the supervising physician and nurse practitioner to make sure that their staff is up to date on using the technology necessary to make telemedicine work.
- If the nurse practitioner has a supervising physician that is not in the same geographical location, then responsibility of keeping the staff up to date on the technology is squarely on the nurse practitioner as the NP will be the one physically with the medical facility’s staff.
- There can be few things more frustrating than being ready to see a patient and technical difficulties arise.
- Sometimes those technical difficulties are not the fault of the nurse practitioner’s staff or NP.
- Create a very simple guide for patients to follow so they can log in and make their appointment on time.
- Confirm patients’ email addresses so they will have a link to their appointment.
- Remember, not everyone is tech savvy.
- Make things simple and find telemedicine software that is user friendly.
#4: Continue To Be Hippa Compliant
- A major part of being HIPPA compliant is confirming a patient’s identity.
- If a patient’s identity is not confirmed and the supervising physician or NP discloses medical information to someone other than the patient, even accidentally, then the disclosure might be a HIPPA violation.
- Confirming a patient’s identity is potentially more of a challenge using video and audio as compared to the patient being physically present in the medical office.
- However, an office staff member can confirm a patient’s identity if he/she has a checklist to go by.
- This checklist should include, but not be limited to, requiring a patient to submit a valid form of photographic government identification (driver’s license, passport, military ID card, etc.) when the appointment is first scheduled, making sure you have the patient’s social security number and date of birth on file when the appointment is first scheduled and making sure the patient correctly reiterates the DOB and SS # to the staff member when they “arrive” for their virtual appointment.
- Make sure you can actually see the patient on camera so you can match the photo from their ID to their face on the camera.
- Ask the patient if she/he is alone for their virtual appointment. If not, does the patient give consent for the third party to be privy to the patient’s appointment?
- Note the patient’s consent for the third party’s presence and get the third party’s name as well.
#5: If Technical Issues Arise, Schedule An In Person Follow Up
- The camera and microphone your office purchased may be the top of the line, but the camera and microphone the patient has might not be.
- A patient or office that has sub-optimal equipment may cause issues with proper diagnosis and treatment.
- When a physician or nurse practitioner cannot see a patient clearly, then she/he may miss out on some clues that would normally lead to a proper diagnosis and effective treatment.
- If it becomes apparent that technical difficulties will hamper the ability to come up with a proper diagnosis and effective treatment for the patient, then measures should be taken to ensure that the patient is seen in person at your office or at another licensed medical professional’s office.
*THIS IS NOT A COMPREHENSIVE LIST OF EVERYTHING THAT NURSE PRACTITIONERS CAN DO TO PRACTICE ETHICAL TELEMEDICINE.