Easy Collaborative Review of EMR for Telemedicine

One of the challenges we all face who do Telemedicine consults at many different hospitals or facilities is the need for an easy way to securely access information in the EMR without having multiple different passwords and logins.   In the absence of this, one has to ask for documents to be faxed back and forth, or ask a nurse to look through different aspects of the record and provide the information verbally,  then transcribe it. The nature of the interaction with an EMR in support of Telemedicine consults is different than for other aspects of care because the consult process itself is different—by definition it is a real time and/or asynchronous “collaboration” between a remote healthcare professional and a nurse, mid-level, physician other other enabling clinician at the patients bedside.  There are important roles each plays and the nature of the relationships unique.

A highly secure, highly private and very pragmatic method involves the same tools that would be used by “remote tech support” to assist with something on one’s computer.  While the specialist is on video with a nurse,  he or she launches a secure remote utility like Logmein, GoToAssist, TeamViewer or other….and asks the nurse to “open your EMR, go to this URL and enter the following security code”

Within a minute, the telemedicine physician is looking at the screen within the EMR for that particular patient.  Remember, the physician is also interacting live on video (or voice) with the patient and nurse and family  at the same time, in the same place. Therefore, one can easily argue this is MORE secure and private than having the nurse verbally repeating information to the doctor.  The physician can take over mouse control while the nurse or other on site clinician remains in total control over whether screen sharing is live, and they can work together to get to the right information at the right time. Everyone benefits, everyone is more efficient, and it is all done as an extension of the actual live consult.

Obviously in these new roles of Telemedicine, there are new behavioral norms one develops and follows……the remote clinician is not “typing content into the record” under someone else’s login of course!…and one is not “clicking around to view other patient records”…because the nurse on the other end is in control.

I would argue that if you step back and think about what we do now..having notes printed and faxed to other numbers, then phone calls back and forth, or other nurses making parallel phone calls to transcribe certain labs and vitals….that this is more secure, more reliable, and safer overall.

I personally use GoToAssist because it is rare for a hospital IT firewall or computer “lock down” to block this highly secure tool….as these are also needed for use by IT groups to help provide desktop support.  And I would argue, if you have an IT person controlling your desktop to fix something and you are not around and the EMR is logged in,  you have a big privacy concern also….so its all about the presumed real time collaboration and new norms of behavior around information to support new models of care.

Once you do this successfully at a few different facilities, as a telemedicine physician with high levels of accountability…..and the nurses love it, the patients and families love your deeper awareness of their core data, etc…there is no turning back



About Andrew Barbash, MD

Neurology Telemedicine affiliated with Specialists on Call Virtual Care Services

Posted on July 28, 2017, in Virtual Care. Bookmark the permalink. Leave a comment.

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