Rapidly Integrating Telemedicine Visits into Primary Care Toolkit

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With the onset of COVID-19, primary care systems across the country are rapidly changing clinical operations to limit in-person ambulatory visits for infection-control reasons. At our institution, we quickly redesigned primary care to introduce telemedicine visits as a practical alternative to provide needed care remotely. Our innovation was the rapid development and implementation of workflows to standardize billable telemedicine visits in the primary care setting.

Our institution previously did not systematically use telemedicine visits in the primary care setting, including telemedicine visits conducted over the telephone or video. In the early phases of COVID-19, while essential face-to-face visits were allowed, providers were encouraged to conduct appropriate visits over the telephone, since they required minimal technology and vendor investments. This strategy dramatically reduced in-clinic primary care visits from over 2,400/day to under 350/day, while increasing the number of visits completed as telemedicine-phone visits. However, together these visit volumes were still a small proportion of the overall visit volume before COVID-19. It soon became clear that patients continued to need care for reasons other than COVID-19, and deferring visits would lead to care gaps and a large backlog when operations normalized. A Telemedicine Workflow was developed to promote and formalize the use of telemedicine visits—initially via phone and eventually with video—in primary care.

The Telemedicine Workflow includes several key components. It begins by identifying patients who would be eligible for telemedicine visits, and then creates steps for visit scheduling, key pre-visit planning activities, a remote check-in process, and provider billing and documentation. Several aspects of these workflows took into account the social distancing requirements necessary to make in-person services as safe as possible, although they could be modified as the need for social distancing is reduced and face-to-face services could be expanded.

Who should use this toolkit?

This toolkit is intended to be used by clinicians and health systems operational staff who are redesigning primary care to integrate remote telemedicine visits, either because of COVID-19 or to expand visit options for patients and providers over the long term.

Why use this toolkit?

The Rapidly Integrating Telemedicine Visits into Primary Care Toolkit can help organizations and clinicians—particularly those not previously using Telemedicine—to develop and implement workflows that respond to the need to provide primary care in a remote and safe way. These workflows can further be adapted to a post-COVID-19 future state that no longer requires social distancing but still wishes to include remote visits to allow for more expansive and patient-centered models of primary care delivery.

What does the toolkit contain?

This toolkit contains a downloadable PDF of the Telemedicine Workflow document.

Note: This toolkit will be updated in the future to include more materials.

How should these tools be used?

The materials in this toolkit can be printed and used or adapted to individual health systems to tailor the general workflow concepts to their particular needs.

  • The Telemedicine Workflow includes the basic steps which will help to identify, schedule, and conduct successful telemedicine visits in primary care. Clinicians and health systems leaders can use these documents to decide what steps and processes they need to adapt to successfully add telemedicine visits at their institution.

Development of this toolkit

The Rapidly Integrating Telemedicine Visits into Primary Care Toolkit was developed by researchers and clinicians (Primary Authors: Mark Micek, Maureen Smith, Sandra Kamnetz, Betsy Trowbridge) at the University of Wisconsin-Madison School of Medicine & Public Health.

Additional support was provided by the University of Wisconsin School of Medicine and Public Health’s Health Innovation Program (HIP), the Primary Care Academics Transforming Healthcare (PATH) collaborative, the Wisconsin Partnership Program, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 9 U54 TR000021 from the National Center for Advancing Translational Sciences (previously grant 1 UL1 RR025011 from the National Center for Research Resources). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.

Please send questions, comments and suggestions to HIPxChange@hip.wisc.edu.

Toolkit Citation

Micek M, Smith M, Kamnetz S, Trowbridge B. Rapidly Integrating Telemedicine Visits into Primary Care Toolkit. University of Wisconsin – Madison School of Medicine and Public Health. Madison, WI; 2020. Available at http://www.hipxchange.org/Telemedicine


About the Authors

Mark Micek, MD, MPH is a Clinical Associate Professor in the University of Wisconsin – Madison School of Medicine and Public Health, Division of General Internal Medicine. He is also a UW Health clinical service chief and medical director at the UW Health East Internal Medicine Clinic. Dr. Micek’s clinical interests include internal medicine, preventive medicine, provider burnout, and use of the electronic health record.

Dr. Maureen Smith, MD, PhD, MPH is a Professor in the University of Wisconsin – Madison School of Medicine and Public Health, Departments of Population Health Sciences and Family Medicine & Community Health and Director of UW Health Innovation Program as well as Director of the Community Academic Partnerships core of the NIH-CTSA funded Institute for Clinical and Translational Research. Dr. Smith’s research program examines the effectiveness of our health care system for aging and chronically ill persons.

Sandra Kamnetz, MD was a Clinical Professor and Vice Chair for Clinical Care in the University of Wisconsin – Madison School of Medicine and Public Health, Department of Family Medicine and Community Health. Dr. Kamnetz is also a Family Physician with the UW Health Yahara Clinic with special interests in pediatrics, preventive medicine and women’s health.

Elizabeth (Betsy) Trowbridge, MD was a Clinical Professor in the University of Wisconsin – Madison School of Medicine and Public Health, Division of General Internal Medicine. Dr. Trowbridge has been instrumental in the primary care redesign effort at UW Health and developed an innovative population-based compensation model for primary care. Dr. Trowbridge is the co-director of PATH (Primary Care Academics Transforming Healthcare), a multi-disciplinary writing group of physicians and change leaders at UW Health who write about UW Health system redesign efforts. Dr. Trowbridge’s clinical interests include preventative medicine, heart disease prevention, and general internal medicine.