5. Create a treatment plan.
An essential part of any medical visit is creating a treatment plan for the patient that contains not only a medical strategy, such as what type of medication the patient should take and for how long, but also a larger continuity of care strategy. Components of this should include having in place resources that the patient might need beyond what you can offer, such as emergency services. One consideration might be whether you plan to continue treating the patient following the lifting of social distancing and the resolution of the COVID-19 crisis. Part of the discussion with the patient should include this longer-term question and what referrals you can make if you will not be treating the patient after the public health emergency has ended. Of course, this is especially important if your patient is not located in your state and you will be precluded from seeing him or her when the ordinary licensing rules are reinstated.
6. Appropriately document the care you are giving the patient.
This may sound elementary and unnecessary to bring up, but some clinicians I have worked with have regarded telemedicine patients as requiring a lower level of documentation, compared to their in-person patients. I would like to emphasize that no patient has a “junior” status merely because he or she is being seen via telemedicine. The same type of documentation is required and should be entered into the patient’s electronic record. This is important not only for the patient’s health but also to protect you legally in the event of any type of malpractice litigation and to ensure continuity of care so that any other provider who treats the patient has access to your chart notes.
7. Talk to your insurance broker.
Make sure your professional liability provider knows that you are seeing patients via telemedicine and also if you are treating patients located in other states. You may then be subject to the liability laws of the state in which the patient is located. For example, in my home state of Indiana, we have a cap on liability, but I am located 10 miles away from the Illinois state line, and in Illinois there is no similar cap. For this reason, malpractice insurance is much more expensive in Illinois than it is in Indiana.
Cyber-hacking is another issue. This has been an ongoing concern and especially now, cyber attacks have increased.6 For this reason, you need specific cyber-insurance. Different companies have different varieties of cyber-coverage, and most professional liability policies come with a certain amount of cyber-protection in case EMRs are hacked, but are probably not as much or as robust as you might need right now. So I encourage providers to talk to their broker to make sure you are fully covered.