By Mary Butler
Gene Ransom is the CEO of the Maryland State Medical Society, a nonprofit association representing over 8,400 physicians, which has long advocated for adoption of telehealth services. He spoke with the Journal of AHIMA about choosing a HIPAA-compliant telehealth vendor, increased demand for telehealth services, and avoiding potential barriers to care during the COVID-19 pandemic. This conversation has been slightly edited for clarity.
JAHIMA: Is the current health IT infrastructure adequate right now to support the expected uptick in telehealth services in your state or nationally?
Gene Ransom: No, it’s not, but the good news is that I think we can get it up and running rather quickly. The infrastructure exists and a lot of the products are able to be implemented rather quickly.
Most physicians are not using telehealth services and are not accustomed to using the tools. They’re going have to get used to it very quickly because we’re going to be restricted in who our physicians can see given the national emergency. Telehealth is a good way to keep care going while physicians are trying to make sure people don’t get sick and the disease isn’t spread.
JAHIMA: How fast do you think you can do training to get providers comfortable with telehealth, and how do health systems go about choosing a vendor?
GR: Let’s talk about choosing a vendor first. While a lot of the rules around telemedicine have been lowered, you still have to make sure the product is HIPAA-compliant, protecting the patients’ privacy still remains paramount. I think one of the things that’s really important is that you pick a HIPAA-compliant product. Secondly, we are asking vendors to waive fees at least on an initial period. Some hospitals do have some telehealth services in place or have telehealth services tied to their EMRs, and those obviously can also be implemented.
A lot of these products are easy to use and are not complicated. The complexity will be in how you change your workflow, what you can and can’t do when you’re doing telemedicine.
For example, in Maryland you are still not allowed to write an opioid script for a telemedicine patient. So that’s something to understand. There are still some restrictions, even with the emergency orders that are in place. You have to understand what the limitations are when you’re providing telemedicine services.
JAHIMA: Many of our members work on coding and billing—are there any special considerations for how telehealth encounters are documented and billed?
GR: Document as you normally would. Again, this is another important question to ask when you’re picking health IT—how does that product integrate with the electronic health record (EHR)? With health information exchange (HIE)? For example, some of these products integrate well with the HIE. Others do not.
For the billing and coding piece, we are expecting additional guidance both from state and federal government and private insurers as to how that’s going to work. The order from the Centers for Medicare and Medicaid Services is pretty clear that the agency is going to allow expanded coverage and payment for telehealth.
JAHIMA: How often do you field questions about HIPAA from physicians and from patients?
GR: There are significant penalties for screwing this up.* That’s why we are urging people not use social media or other non-compliant tools, like FaceTime or something like that that is not HIPAA-compliant.
You also need to look at the other big questions, such as cost. Does it connect easily with the HIE, so if you want do something with that later on is that a possibility? How does it work with your EHR? And, I think, maybe most importantly is patient experience. If a large number of people in your practice are senior citizens, and if you have a product that requires a download to a computer or smartphone, that could end up being a new barrier to care.
JAHIMA: How can patients and stakeholders help support physicians and frontline caregivers right now?
GR: I think the first thing is that they really need to follow orders from health departments and the government. It is really important that they are listening to what the state and health officials are saying and pay attention. If they say be quarantined, be quarantined.
[Editor’s note: When it comes to telehealth, providers need to make sure they are connecting with patients over as secure a channel as feasible. OCR announced on March 20th that it would not bring any enforcement actions against providers who used non-public facing telehealth/video channels like FaceTime and Skype for the duration of the national emergency.]Leave a comment