Who and How: Telemedicine Eligibility and Participant Guidelines in the Ambulatory Setting

Introduction: Telehealth use has dramatically increased due to the COVID-19 pandemic. Yet there are significant gaps in evidence regarding the clinical appropriateness of synchronous visits for ambulatory telemedicine that are under the umbrella of telehealth and defined as video appointments between patients and providers. As a result, there are few sensible guidelines for day-to-day practice, resulting in a lack of standardization and risk of suboptimal care. Methods: We developed patient inclusion/exclusion guidelines for use in ambulatory telemedicine. Complementary tools included guides on patient preparation, telemedicine physical exam, and provider etiquette. We analyzed telemedicine use by practice type and surveyed a subset of MaineHealth ambulatory practices regarding the applicability of the guidelines. Results: Volume and specialty distribution data show that although telemedicine volume increased significantly, use varied by specialty. Behavioral health providers used telemedicine the most, followed by primary care, medical specialties, and, finally, surgical specialties. Stratification intensified as restrictions on in-person care declined. Discussion: We observed the expected pattern of use by specialty type, given our inclusion/exclusion criteria. Although these criteria may be conceptually straightforward, implementation is not. We operationalized these concepts to ensure individual practices can adapt and implement these insights in a reproducible and predictable way, leading to increased standardization across the health system. Conclusions: Clinical teams need help determining how to best use telemedicine tools. Here, we provide practice-level guidelines focused on practical implementation. We hope this communication advances the effort to develop standards of care for telemedicine indications.