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

Abstract

Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19.

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

“…The current study utilized the SEIPS model to describe the steps of the telemedicine encounter revealing that it is a complex multistep process. The SEIPS model has been employed to identify human factors involved in the implementation of telemedicine encounters in NHs during the COVID-19 pandemic [17] and identify work system enhancements in NHs that had newly adopted telemedicine [18]. The creation of process maps, as done in this study, can help identify barriers and opportunities for improvement [23,24], and shows that there are multiple opportunities to enhance the effectiveness and efficiency of telemedicine encounters.…”

“…Much of the prior work on telemedicine in NHs has focused on its impact on reducing hospitalization [9,10], its potential for expanding resident access to sub-specialty care services [4,14], and regulatory/policy barriers to its greater use in NHs [10,15,16]. While there has been some work examining preconditions for successful deployment of a NH telemedicine program from the perspective of the clinical staff [17] and telemedicine work system enhancements [18], robust descriptions of how telemedicine encounters are conducted in NHs are lacking. Consequently, the objective of the current study is to characterize the telemedicine work system in a convenience sample of NHs that had newly adopted telemedicine using a system engineering framework.…”

Telemedicine Visits in US Skilled Nursing Facilities

“…Telemedicine use was also highly concentrated among a small group of clinicians, suggesting that staff and clinician preferences were likely an important driver in the magnitude of telemedicine implementation. In a small qualitative study, SNF staff deemed that telemedicine visits of routine care were inferior to a physician actually visiting the facility and noted that telemedicine encounters increased staff workload because of new and redundant tasks that were not offset with reduction in other responsibilities . In interviews, physicians practicing at SNFs also noted that while organization resources are critical, staff time to prepare for and facilitate a telemedicine encounter is an even larger bottleneck .…”

Telehealth in long-term care facilities during the Covid-19 pandemic – Lessons learned from patients, physicians, nurses and healthcare workers

“…Before the pandemic, an Australian study found that patients aged 65 years and above expressed willingness to use telehealth services that offered all aspects of care, particularly among those living in remote areas with limited access to hospitals or clinics [ 4 ]. A U.S. study reported that the participating nursing homes preferred to continue using telemedicine post the Covid-19 pandemic, particularly in urgent assessments during residents’ acute change in conditions or cognitive-based sub-specialty consultations [ 5 ]. Similar suggestions were reported in a U.K. study that recommended the adoption of video consultations in settings such as nursing homes and remote areas due to video offering relatively more significant clinical advantages over phone consultations [ 6 ].…”