The COVID-19 pandemic led to the widespread and rapid establishment of telehealth to maintain continuity of clinical care. IR practices of all sizes and types took part in this transformational shift in the delivery of healthcare in the United States. Although overall utilization has declined with gradual resumption of face-to-face outpatient evaluation and management services, there are many important roles still available for telehealth in the modern IR practice, particularly in expanding the scope and reach of small or rural providers.
Opportunities
Virtual consultations
IRs can offer virtual consultations to patients who may not be able to visit their physical clinic. This can be crucial given the large geographic catchment areas of many small and rural practices. Through video conferencing or teleconferencing platforms, providers can interact with patients, review their medical history and imaging studies, and provide recommendations or treatment plans remotely. Although dependent on the disease process, some of which may necessitate direct physical examination for the initial consultation, there are many pathologies treated by IR for which the medical history and imaging studies are sufficient to proceed with procedural scheduling.
Second opinion services
By offering remote second opinion services, IRs can collaborate with other healthcare providers or patients directly. Given that many rural community hospitals have essentially minimal to zero onsite IR coverage, providing these second opinion consultations can be critical to provide patients with the full breadth of minimally invasive treatment options with subsequent procedural treatment provided at the appropriate IR staffed facility.
Postprocedure follow-up
Telehealth can be used for postprocedure follow-up visits. IRs can assess a patient's progress, address any concerns or questions they may have, and provide necessary recommendations or adjustments to their care plan. The ease of access provided by this service can help improve patient convenience and access to specialized care, which is even more crucial given the number of patients with limited options for transportation to an IR provider clinic in the rural setting.
Collaboration and teleradiology
Telehealth enables collaboration with other healthcare professionals, radiology departments or medical facilities located in remote areas. Through teleconferencing or secure image-sharing platforms, they can consult on complex cases, provide guidance during procedures being done onsite by less experienced proceduralists and facilitate teleradiology services by remotely interpreting and reporting on imaging studies in which there may be an opportunity to offer a minimally invasive treatment option.
Flexibility
Many small or rural IR practices may have a limited number of physicians and minimal, if any, nurse practitioner or physician assistant support. Telehealth offers flexibility to these practices by providing a window of availability. This can allow for coordination of telehealth services without significant interruptions to the procedural workflow and limits the amount of blocked time required to conduct an in-person clinic.
However, telehealth is a supplement to, and not a replacement for, a full-fledged in-person IR clinical practice. For example, in my practice we schedule many of our telehealth consults and follow-ups during a normal procedural workday, providing patients with 2- to 4-hour windows in which they may be contacted as the IR physician or NP becomes available during room turnover or between inpatient consults or daily rounding.
Challenges
It is important to note that the specific implementation of telehealth services may vary depending on the regulatory guidelines and technological infrastructure available in the region where the IR practices. Compliance with patient privacy and data security regulations, as well as ensuring a high-quality telecommunication setup, is crucial to provide effective and safe telehealth services. The ability to provide telehealth services out of state depends on various factors, including regulatory requirements, licensing and professional guidelines. It is essential to consult the specific laws and regulations of the states involved and seek legal or professional advice to ensure compliance. There are several points to consider.
Licensing
In most cases, healthcare professionals must hold a license in the state where the patient is located to provide telehealth services legally. Licensing requirements typically involve obtaining a license or a special telehealth license from the state medical board. Some states have implemented special provisions or compacts that facilitate cross-state licensing or telehealth practice. It's crucial to research and adhere to the licensing regulations of the states involved.
Interstate medical practice
Some states have established regulations or agreements that allow for limited practice across state lines without obtaining additional licenses. For instance, certain states have implemented the Interstate Medical Licensure Compact, which enables qualified physicians to obtain expedited licenses in participating states. However, these regulations may not apply to all healthcare professions or states, so it's necessary to verify the specific requirements.
State-specific telehealth laws
Different states may have their own telehealth laws and regulations that specify the permissible scope of practice, patient–provider relationship, prescribing limitations and other factors. Familiarize yourself with the laws of the state where the patient is located to ensure compliance.
Professional guidelines and liability insurance
Professional organizations and medical boards often provide guidelines for practicing telehealth, which may include recommendations for providing services out of state. Additionally, ensuring appropriate liability insurance coverage is important to protect yourself in case of any legal issues or malpractice claims.
Informed consent
Regardless of the state, it's important to obtain informed consent from the patient before providing telehealth services. Clearly explain the limitations, potential risks, benefits and alternatives of telehealth consultations or treatments to ensure the patient understands and agrees to proceed.
Conclusion
Telehealth can have a true impact on rural patient populations and expand the scope of services for a small IR practice. With careful implementation and guidance, this technology can improve IR output and bring minimally invasive procedures to parts of the country that are in desperate need of care.
