Recommendations to Enhance Telemedicine in Nursing Homes in the Age of COVID-19

Abstract

Nursing homes (NHs) have been at the frontline of the COVID-19 pandemic. 1,2 Despite representing <1% of the US population, NH residents account for nearly 33% of all COVID-19 deaths. 3 The Centers for Medicare & Medicaid Services implemented sweeping telemedicine regulatory relief in an effort to reduce COVID-19 spread in NHs. Telemedicine activity in US NHs has expanded dramatically 4 but has not been without its challenges. Herein, we report 12 recommendations to enhance and sustain telemedicine (Table 1) from a telemedicine adoption study, certified as quality improvement by the UW-Madison Health Sciences IRB.A convenience sample of NHs (n ¼ 9) in south-central Wisconsin were recruited based on geography (rural vs urban), ownership, and profit status. Each NH had newly adopted or significantly expanded telemedicine during the COVID-19 pandemic. Key informants (n ¼ 27) involved in the structure and conduct of telemedicine encounters were interviewed or surveyed including NH staff, long-term care advanced practice providers, and regional health care subspecialist providers.Study participants identified 5 technology enhancement needs, including (1) improvements to connectivity and bandwidth; (2) an increased supply of telemedicine devices; (3) availability of sound amplification devices; (4) availability of telehealth-ready stethoscopes, and (5) enhancements to video quality. During the QI project, Internet connectivity and bandwidth as well as TM device availability improved in all participating NHs, although technology bottlenecks remained a problem in several facilities after the project. The volume capabilities of the telemedicine devices employed in NHs was often inadequate, and participants identified secondary sound amplification devices as a critical need for encounters with hearing-impaired residents. Although many telemedicine encounters did not require a heart or lung examination, advanced practice provider participants noted that having a telehealth-ready stethoscope available would further alleviate the need for face-to-face encounters when encountered with a scheduling conflict or a facility outbreak. Some respondents noted

Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic

“…Scheduling is complicated if the residents HCPOA desires to be involved in the encounter. A more effective scheduling process is needed to reduce redundancies and ensure consistency [25]. For example, some NHs ended up assigning specific time slots for different primary care physicians for purposes of scheduling telemedicine visits to avoid the ongoing challenge of scheduling these encounters.…”

There and back again: the shape of telemedicine in U.S. nursing homes following COVID-19

“…Health care systems including providers, hospitals, and nursing homes could address the identified challenges by implementing enhancements needed to make nursing home telemedicine encounters easier and more effective [ 32 ]. Some recommendations such as interoperability, appropriate equipment, and education and training align with existing recommendations related to telemedicine use in nursing homes [ 33 , 34 ].…”