Ob-Gyn Coding Alert

Use these tips for showcasing bedside manner through telehealth.

Even though using technology to provide medicine has been on the horizon for a while, the public health emergency (PHE) has suddenly made virtual encounters a necessary service and tool for providers and patients. With social distancing guidelines in place at the local, state, and federal levels, respectively, providers and patients can probably expect that virtual medicine will be the new normal for a while.

During in-person encounters, clinicians and other medical personnel can use different forms of expression to communicate with patients and conduct examinations. The abrupt switch to virtual-only encounters has left many clinicians in the lurch on how to connect with patients, how to offer reassurance, and even how to reach a diagnosis without the benefit of a physical exam.

Know Which Technology You Can Use

The U.S. Department of Health & Human Services (HHS) recently issued a notice outlining which video chat applications are suitable for telehealth visits and which should be avoided. For better or worse, the PHE exceptions mean that apps that aren’t HIPAA-compliant — but which may be more familiar to patients — can be used right now, which may help patients feel more comfortable and less intimidated during virtual encounters.

“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” said Roger Severino, HHS Office for Civil Rights director. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities.”

You can relax a bit, in terms of complying with the HIPAA, too. “The Office of Civil Rights (OCR) will ... not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency,” OCR said.

During the PHE, these apps are OK to use:

• Apple FaceTime,
• Facebook Messenger video chat,
• Google Hangouts video, and
• Skype.

HHS also notes that communication products that “are HIPAA-compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products” are also acceptable. Some of these products include:

• Skype for Business/Microsoft Teams,
• Zoom for Healthcare,
• Doxy.me, and
• Google G Suite Hangouts Meet.

Important: Do not use Facebook Live, Instagram Live, or TikTok to communicate with patients, as none of these services are public-facing. Also note that Zoom has recently had issues with cyberattacks.

Rely on Empathy

Everyone is in this whole new world of virtual-only encounters together, but patients may be looking to providers — especially providers with whom they have an established, trusting relationship — for reassurance, both medical and emotional.

Displaying empathy during a virtual encounter may be a challenge at first but figuring out how to do so is crucial; empathy is an important aspect of the patient-provider relationship.

Some researchers and other stakeholders have been pushing for medical education to include training in empathy, and digital empathy especially. The coarseness and vitriol often on display in (nonmedical) interactions on social media, etc., really highlights how people may struggle to connect without the signs and signifiers of tone, body language, or eye contact.

“Mobile and social media use has transformed when and how individuals interact with others. The ability to instantly share thoughts, feelings, and behaviors with the rest of society via digital channels can occur in mere seconds, often without the empathetic social filter that accompanies traditional communications. Moreover, digital communications are devoid of many of the emotional signals and cues experienced in face-to-face settings, often leading to more impersonal interactions,” say Christopher Terry, PharmD, and Jeff Cain, EdD, MS, in their article “The Emerging Issue of Digital Empathy,” which was published in American Journal of Pharmaceutical Education.

“These changes in modern technology present challenges to the evolving socio-communicative aspects of health care and require an understanding of the emerging construct of ‘digital empathy.’ We offer a definition of digital empathy as the ‘traditional empathic characteristics such as concern and caring for others expressed through computer-mediated communications,’” Terry and Cain say.

Expressing Vulnerability May Help

Acknowledging the unprecedented circumstances — and the inconvenience of meeting virtually — can be a good first step in both maintaining trust and helping patients feel comfortable.

“One of the most important things is to acknowledge the uncertainty of this time up front, to thank patients for being flexible in agreeing to video/phone visits, and to explain why this is necessary right now — yes, some people are insisting that they be seen in person. I like to let people know where I am — at home, just like them — and that if an in-person evaluation is needed, this will be arranged,” says Dominic Decker, MD, MS, general internist at Allina Health in Minneapolis, Minnesota.

Patients may look to clinicians as a source of reassurance, especially since the pandemic is rooted in public health, and it’s easy to offer reassurance during an encounter.

“I’ve also been telling people that I’ll look forward to seeing them in person once this is over, which I think imparts some sense of hope. Overall, I’ve tried to show some humanity by being home and vulnerable, just like them,” Decker says.

It’s also OK — and probably helpful — for clinicians to acknowledge to themselves the grief they may feel at the changes in procedure and the discomfort surrounding those changes.

“All that being said — virtual visits are so inferior to in-person ones. I really miss seeing and examining people. Providing reassurance over a video chat is one thing, but actually sitting next to someone and placing your hand on their arm or shoulder is something completely different, and I miss that so much. It takes part of the enjoyment away from my job,” Decker says.