Telehealth Best Practices: Press Ganey On How To Best Care For Your Patients When They Are Not Physically In Front Of You

An Interview With Dave Philistin

If possible, include family members or personal caregivers virtually as well. Whether it’s a parent, child or spouse, including them can help improve care management by playing an active role in the interdisciplinary care team. If the patient is processing information, it’s helpful to have someone else listening and asking questions.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Jessica C. Dudley.

Jessica C. Dudley, MD, joined Press Ganey as Chief Clinical Officer in 2019. She leads efforts to support organizations in increasing clinician engagement and improving patient care outcomes, particularly among physicians. Her areas of expertise include leadership development, clinical care redesign through outstanding teamwork, addressing clinician burnout, and advancing professional fulfillment. Dr. Dudley also leads Press Ganey’s Workforce Well-Being Collaborative, an initiative designed to help health care organizations identify the varied and disparate needs of their workforce and enable them to respond to their physical, emotional, financial and operational needs in both the near-term and beyond.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

One moment has stuck out to me, especially over this past year as we are all working to address bias and create a more diverse, equitable and inclusive culture/society/work environment.

During my surgical rotation in medical school, a male surgeon said to me, “Where did you get that differential diagnosis from — Ladies Home Journal?” Though I knew it was completely out of line, I did not call him out. Later, my male friend and fellow student who was also there at the time, mentioned how inappropriate he thought that had been and apologized for not speaking out. We need to speak up for ourselves and each other, in the moment, when we see or hear bias in the workplace.

Medicine has come such a long way, and I am grateful for the work being done to address work/life balance and also gender imbalances throughout the industry at large and even in certain underrepresented subspecialties. I’ve seen many changes in career dynamics, which are all a stark contrast to when I started in health care over 25 years ago.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“The whole is greater than the sum of its parts.”

I played competitive sports throughout college and learned early on how important it was to work together to succeed as a team. I realized when I started my internship, as we were rounding on complex patients that required the input of all team members (pharmacists, nursing, physicians, social work) that medicine too was a team sport and that collectively we could achieve better outcomes than any one of us could do individually. That to work with other people, when to take the ball and when to move out of the way so your teammate could go to goal, being thankful for feedback so that you could improve.

Working as a team is so important in healthcare; making changes at scale is impossible to accomplish alone. It is so important to surround yourself with people you enjoy being around and who challenge you to be the best version of yourself.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

There is no one particular person. I am very fortunate to have such an amazing support system.

There are too many friends, family members, colleagues, coaches, mentors, and sponsors along the way who have been tremendously helpful in guiding me to really evaluate where I wanted to go in my career.

If I can narrow it down to two individuals, I would have to say my twin sister and my boss.

I have an identical twin sister. She’s had the most influence on my willingness to change my professional path. She is not a physician, and I love taking lessons learned from her career path to use them on my own. It’s always fascinating to take ideas from other industries and sectors to evaluate ways to do medicine differently.

Thomas Lee, MD, was my boss early on in my career, and by happenstance, is my boss today. 22 years ago, the concept of remote work didn’t exist. I was working full-time doing both administration and patient care. However, I wanted to be present with my daughter and he gave me the flexibility to take the day off or work from home. His leadership and openness at a time where that wasn’t the norm was key in my decision to stay in the workforce.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

I think there are two benefits of having a patient in front of you.

The main benefit is being able to physically examine the patient which can often lead to valuable information, especially when you find something during the exam that the patient did not bring to your attention.

Another benefit of in-person visits is the efficiency when additional testing is needed, which can be done at the same time and reduce the need for additional scheduling.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

The challenges I am most concerned about are regarding equity.

Telehealth has brought new barriers in equitable care to light. Historically vulnerable populations have lower rates of access, and we could cause further marginalization if social determinants of health are not addressed.

Limitations to technology and reluctance to allow video into one’s home create discrepancies.

Lack of integrated interpreter services can also be more difficult, though these can be difficult in person, as well.

Another limitation that comes to mind is the lack of assistive technology for individuals with disabilities. We need to account for what that experience is like for everyone, regardless of ability.

There is still work to be done to close gaps in telehealth equity.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You?

Since 2020, more than three million patient voices have been captured in the ambulatory medical practice space where both virtual and in-person visits occur. Of these visits, 12% were conducted virtually through June 2021, and more than one in nine returned surveys from Press Ganey clients were from virtual visits.

We’ve learned that patients have the same, and in some cases, stronger likelihood of recommending a provider who does telemedicine for a virtual visit. This is really great information as one of the concerns many people have about virtual care is the ability for patients to feel connected to their physicians.

We have also learned that patients are less likely to recommend a virtual visit than an in-person visit due to the logistics around the visit itself. This may include challenges with the audio or visual connection, etc.

For care providers to really want to succeed at it, you need to provide a great experience (both logistically and personally with their care provider) for the patient and ensure they’re getting as much as (or potentially even more than) what they would in person. Based on our data, here are my recommendations:

#1 — First, make a personal connection and be “present” with every patient interaction.

#2 — Engage patients before, during and after visits to ensure all questions are answered.

#3 — Lead with empathy. At Press Ganey, we follow a Compassionate Connected Care (CCC) model that includes the importance of acknowledging suffering, body language matters, anxiety is suffering, autonomy reduces suffering, care needs to be connected, and care transcends diagnosis.

#4 — If possible, include family members or personal caregivers virtually as well. Whether it’s a parent, child or spouse, including them can help improve care management by playing an active role in the interdisciplinary care team. If the patient is processing information, it’s helpful to have someone else listening and asking questions.

#5 — Take the time to review patient experience data including comments and reviews. We have heard from organizations that have used this feedback to address technical and other logistical challenges faced by patients.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide?

The benefits of telehealth are vast for both the patient and the provider.

On the patient front, it’s more convenient, flexible and reduces the risk of exposure. Patients can dial in from the comfort of their own home and there is an added level of convenience when eliminating the need to commute, find parking or arrange childcare.

Another major benefit is they can get in front of a specialist that they otherwise would not have access to due to geographical constraints. If there’s an expert in a certain area, but they’re located across the country and you can do a telehealth consult, you can get a more comprehensive second opinion.

I also don’t see telehealth going away post-pandemic because it provides access to specialists that some patients wouldn’t have access to otherwise, especially in rural communities.

On the provider front, you’re able to schedule patients in a much more consistent way. You can have staff virtually get the patient set up and ready to join to reduce workflow inefficiencies. There’s also less disruption than conducting the appointment from the office, and it can be done from anywhere.

However, I want to address in Press Ganey’s analysis, we see that there is still room for opportunity and that some patients would still rather go into the provider’s office. Advancements in virtual care will continue to close the gap.

In my opinion, while the majority of care continues to rely on fee-for-service reimbursement, comparable reimbursement for virtual visits (which occurred during the pandemic) will need to continue.

Before the COVID-19 pandemic, providers faced two major challenges as they prepared to deliver virtual care including regulatory restrictions/state licensing requirements and reimbursement. Both of these topics will need to be addressed for virtual care to be sustained while reimbursement remains fee-for-service.

If you could design the perfect Telehealth feature or system to help patients, what would it be?

I think about the innovations we see in other sectors, and features that enable simplification and convenience would be great to have in telehealth.

I would start with ensuring that the telehealth process is as seamless as possible for patients. There’s a lot of room for improvement in logistics and EHR integrations.

I want to see improvements in disparities of care and health equity. This will include ensuring that patients have reliable access to resources for telehealth visits, including integrated interpreter services.

Lastly, I would love to see more wearables being utilized to capture information and integrate it into the patient’s EHR. It would reduce the need for a visit to be required. We have the capability of measuring remote weight, EKGs, blood pressure monitoring, glucose monitoring — and being able to then integrate this information so that providers can efficiently access it is important.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

From the provider’s perspective, know it’s very challenging for us to only get to see our patients for a brief period of time.

My number one recommendation is to take time to write out your questions and concerns before your visit. If you’re doing a virtual visit, you can take the time you would have spent commuting to the appointment to do so. Put them down on paper or type them in a note on your phone so they’re easily accessible to pull up and you can double-check them before the visit is over to make sure your needs are addressed.

In the same vein, when you’re done with the visit, jot down what action items the provider requests you take.

I do worry that when patients log off their appointment, there needs to be clear direction on how to connect and follow-up if circumstances change. Explicitly ask “Should my next appointment be in-person or virtual, and should I follow-up with questions via phone or the portal?”

If you have questions, you can always reach out and ask outside of the formal structure of an appointment.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

I love the idea of being able to connect notifications cross-devices. As an industry, we’re just scratching the surface on what patients can monitor on their own through wearables. To be able to send push notifications and reminders is exciting. Developing systems for providers to be able to review this information reliably and in an integrated manner will be important.

Another thing I’m extremely passionate about is natural language processing. At Press Ganey, we’re able to sift through patient comments and feedback at scale. Health care systems can send cues to caregivers about patients’ preferences. We’re at the point where we can anticipate needs rather than react after the fact.

This is huge for providers and can really help shape the telehealth experience so we can pinpoint gaps in care in real-time.

Is there a part of this future vision that concerns you? Can you explain?

In my opinion, telehealth has a long way to go with interoperability. For example, I previously stated not all technology seamlessly integrates with EHR platforms. However, it doesn’t necessarily concern me; it’s just something I think will be resolved over time.

What does concern me about the future is provider burnout. When we introduce new technologies, we don’t always address the workflow implications, which may have a negative impact on providers. For example, when telehealth is implemented without system or work-flow re-design there is a risk of more administrative burden falling to providers. What I don’t want to see happen is advancements adding to provider administrative burden as this is already a major contributor to provider burnout.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

We must prioritize the overall well-being of our healthcare workforce. Clinician burnout is something that we as an industry have been aware of for years and have been working to address. Solutions will require real system and culture change.

The challenges of the past 16 months which include the physical, emotional, and financial toll of the pandemic, including addressing concerns with equity, have taken a toll on our entire healthcare workforce. All organizations are working to address these challenges.

At Press Ganey, we have established our Workforce Well-being Collaborative to help health care systems emerge from the pandemic and move forward together. We are bringing together organizations to share best practices and leveraging Press Ganey’s research and data resources to improve the measurement of well-being, and identify targeted solutions based on predictive analytics.

My hope is that collectively we can identify innovative ways to combat burnout and improve workforce well-being that will become best practices for our entire industry.

How can our readers further follow your work online?

Connect with me on LinkedIn or Twitter, @jessicadudleymd.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.