ABSTRACT
Introduction: Prior to the start of the 2020 COVID pandemic, the use of telemedicine among family physicians was limited; telemedicine curriculum in undergraduate and graduate medical education (GME) was even more scarce. In response to the need for training, we developed synchronous and asynchronous versions of a telemedicine curriculum focused on documentation, communication, and virtual physical exam. As the evaluation of the curriculum, this study compares the documentation behaviors of the clinicians participating in the curriculum. Methods: We compared the documentation practice of asynchronous learners to those participating in synchronous learning over 1 month. We reviewed each clinical note for five practice behaviors: (1) consent for delivery of care via telemedicine, (2) time on the phone, (3) physical examination, (4) procedure code, and (5) billing code. Results: We reviewed notes from 11 interns (synchronous) and 22 senior residents (asynchronous). Notes written by an intern were significantly more likely to include documentation of consent and a focused exam. Notes written by senior resident were significantly more likely to include documentation of length of the encounter. We detected no significant differences for documenting the billing or procedure code. Conclusion: Our analysis determined that correct documentation behaviors can be taught through asynchronous mediums. Components requiring effective communication (consent for care and a virtual physical exam) are more effectively taught when there is deliberate practice and immediate feedback on the skills.
ABSTRACT
INTRODUCTION: With the emergence of COVID-19, many primary care offices closed their physical space to limit exposure. Despite decades of telemedicine in clinical practice, it is rare to find it used in small-metro and academic settings. Following the decision to limit face-to-face care, we tracked our practice's transition to telemedicine. METHODS: This was a prospective quality improvement project following Plan-Do-Study-Act (PDSA) cycles to optimize the use of telemedicine (both telephone and video in this practice) encounters. Central to the PDSA cycles was the use of a post-encounter questionnaire to track patient, appointment, and physician factors. Throughout the cycles, inferential statistics were used to inform process improvement. RESULTS: In Cycle 2, a logistic regression model showed length of encounter, need for physical examination, and physician satisfaction correctly predicted a physician's preferred medium (χ2(3) = 40.56, P < .001). In Cycle 3, a χ2 test showed the reason for visit predicted the preferred medium (χ2(4) = 47.30, P < .001). In cycle 4, week of telemedicine, need for physical examination, length of encounter and physician satisfaction predicted the preferred medium (χ2(9) = 172.52, P < .001). DISCUSSION: Using the variables that predicted preference for telemedicine, we were able to adjust our processes through PDSA cycles. CONCLUSION: Early use of the PDSA cycle allows for informed quality improvement at the local level. Our findings highlight factors to consider when implementing telemedicine such as need for physical examination and type or length of encounter. In addition, physician satisfaction can encourage use of telemedicine, and tools for learning and practicing telemedicine should be available.
