Table 1 Nursing home leadership staff perceptions about the value of telemedicine

Primary Care Encounters

Representative Quote

(A = agreement)

(D = disagreement)

Telemedicine is not a good substitute for routine on-site encounters

Of the 9 facility interviews, agreement was identified in 6 transcripts, agreement and disagreement was identified in one transcript, and the remaining two transcripts were silent

(A): We certainly don’t want them to be a replacement for the physician being in the building. (Facility A)

(A): It’s important for them to see, have a face-to-face, onsite assessment with that physician, … because we do have a lot of complex patients, and … the doctor really needs to put their eyes on them. (Facility E)

(D): Perhaps just those routine visits where they’re reviewing their blood sugars, …  [and] blood pressures, they’re doing those things that wouldn’t otherwise require a physician visit. It’s probably just as helpful. (Facility A)

Telemedicine can enhance the efficiency and effectiveness of acute resident change-in-condition assessments

Of the 9 facility interviews, agreement was identified in 5 transcripts, disagreement was identified in one transcript, and the remaining three transcripts were silent

(A):.If there’s anything that’s urgent, like a cellulitis … we want to quick get in a Zoom visit for, not necessarily have to send someone out, let’s treat them here. Those are very effective for telehealth as well, … and negate transfer to the hospital or an ER visit. (Facility B)

(D): Prior to the telehealth, they would call and say … do this … but now with telehealth,  [it is] like a special visit that we had to do so that they  [provider] could see it. … I don't know that that is a fact …, but I think that they tried to do more telehealth visits than were necessary. (Facility C)

Using telemedicine to conduct a routine encounter is preferable to off-site face-to-face encounters

Of the 9 facility interviews, agreement was identified in 5 transcripts and the remaining 4 transcripts were silent

(A): It’s a burden on the resident to have to leave the facility to go to a doctor’s appointment, … For our residents, they have to be picked up at a certain time. The vans are on a schedule as well. … And then it’s … making sure that they get into that appointment safely. So  [telehealth] removed that out of the picture, and they can just be seen in their room, so certainly much easier (Facility H)

(A):  [Provider] will not come in the building either, so then we have to send people out. And those are the cases where this telehealth has been amazing not to have to send them out in the community right now for their compliance visits. (Facility H)

(A): … especially the dementia residents that we have where it’s hard to get them out to the clinics. It’s better for them just to stay in the … atmosphere that they know… (Facility G)

Having PCPs on-site provides benefits that extend beyond the individual clinical encounter

Of the 9 facility interviews, agreement was identified in three transcripts and the remaining 6 transcripts were silent

(S): Other things happen … when physicians come, aside from just seeing the resident. There’s a lot of … staff education that happens when physicians are here. We’re asking them questions. They’re educating us about why things are happening. (Facility A)

(S): I think it was very limiting in terms of doctors aren't on the unit. They're not sensing what's going on. (Facility C)

Sub-Specialty Encounters

Representative Quote

(A = agreement)

(D = disagreement)

Telemedicine can enhance resident access to sub-specialty care

Of the 9 facility interviews, agreement was identified in 5 transcripts and 4 transcripts were silent

(A): … if you call and say this person needs to be seen because they had this skin issue, getting in sometimes can be six weeks, … where a telehealth visit can be a quick five minutes, and they can see what’s going on … and …we’re on to the path of recovery much sooner that we would have been. (Facility D)

(A): Especially as in, I mean, rural areas, it’s getting harder and harder to find physicians that come out. (Facility A)

Intensity of the physical exam is a determinative factor in whether telemedicine can be substituted for a face-to-face encounter

Of the 9 facility interviews, agreement was identified in four transcripts and the remaining 5 transcripts were silent

(A): But if you need that pulmonologist to listen to your lungs, that’s what you miss out on. (Facility B)

(A): It changed what they were actually doing during the, our visits. I'm sure they were listening to heartbeat and respirations and bowel sounds and all of that, and that wasn't occurring. (Facility C)

(A): I think we’ve seen a lot of infectious disease visits be telehealth and then be easier to obtain. You know, sometimes ID is hard to get into, and having that telehealth option, biweekly or whatnot, reviewing those labs, that kind of thing, is very positive. (Facility B)

Telemedicine can enhance information exchange and collaboration between the sub-specialist providers and other care team members

Of the 9 facility interviews, agreement was identified in three transcripts, disagreement was identified in one transcript and the remaining 5 transcripts were silent

(A): Some of our skilled patients have more than one doctor … following them. So … you’re not having to go in and out … you’re able to just put them all together and, whether it be orthopedic and a heart doctor … because several of our patients are more complex, so you deal with several comorbidities at the same time. (Facility E)

(A): I have the PT  [and] …. the nurse there. I got to see the person, got to get input from both of them. And had she come in my office, she couldn’t have told me any of that information, so it was actually a better visit for me than it would’ve been in the clinic (Facility D)

(A): And so I think it helps  [providers] … have better communication actually with the nurses than it is having them out and then seeing if they come back with paperwork. … And we’re also able to give … our little speech of what’s going on, little summary of how they’re doing, … (Facility E)

(D): … [the] whole connection is also lost when you need to do … a palliative care consult and … all of these other end-of-life decisions, and the providers only saw … them via telehealth. To me, that's a huge issue, so, and we're missing a whole group of the treatment plan. (Facility C)

Telemedicine can reduce interruptions in needed rehabilitative care when scheduled appropriately

Of the 9 facility interviews, agreement was identified in three transcripts and the remaining 6 transcripts were silent

(A): … our focus is rehab, getting better. If you have to go out to the doctor for a  [visit]… it kind of shoots your whole day for therapy services. (Facility B)

(A): A lot of times there was physical therapy going on, and we were sort of going in the middle of it. And … we sort of trumped them so then they'd have to just sit down and wait for us to get finished. Many times that was nice, but it… disrupted their schedule and … their ability to do what they had to do as well. (Facility C)