By Dean J. Tullis

As telemedicine becomes more popular, especially during the COVID-19 pandemic, EMR companies are coming up with their own embedded versions. Most of these telemedicine companies are brand new, many of them upstarts of former managers or employees of the EMR company that they partner with. Most of them are highly leveraged with investor money carrying millions of dollars in debt, and these investors expect a return on their investment.

So now, these EMR companies that have created embedded telemedicine platforms are pushing hard to convince you that you need an embedded product to have the best experience. But it's clear, the real reason is they make more money if you buy their embedded solution.

After looking at most of these solutions, I realized that very few have the workflow, features, and functionality you need in a telemedicine platform.

For example, think about going to your doctor's office, what is one of the first things you do? You probably go up to the front desk, and they hand you some paperwork to fill out. The same thing should happen in a telemedicine visit. When you sign into the telemedicine session, it should present you with the documents that you would typically get at the front desk. You should be able to fill them out, and even sign them electronically so the process shouldn't be any different from an in-person visit. Next, you should be able to pay your copay, so the telemedicine product must have the capability of presenting you with a payment method.

Another example is most physicians' offices allow walk-in patients. How is this handled with most telemedicine products? Very few of them have this capability. They would need a virtual waiting room where, just like in an in-person waiting room, patients are seen in the order they show up. Most embedded telemedicine solutions do not have this capability.

There are some reasons to integrate some of the functionality of the telemedicine product with the EMR such as integration to the patient portal to let your patient's create a telemedicine appointment by selecting their physician, a date, time, etc. But again if you have the right functionality this can be done with something as simple as a patient forward-facing calendar that some telemedicine solutions offer that can easily be accessed through the patient portal without a major expense in integration.

I have found that telemedicine solutions that are not embedded offer more flexibility in the way you interact with your patients. For example, we have one large healthcare entity that has more than 24 different workflows based on what type of patients they are seeing or what departments, such as the ICU, Emergency Department, or Stroke Unit. These all operate slightly differently to accommodate the needs of the department and patient.

It's critical that the telemedicine vendor can create a workflow and different solutions to effectively interact with your patients. At the same time, your practice should emulate the same experience for your patient and your physician.

There is more telemedicine than that -- you should also consider integration to medical carts and devices. When you look at rural America you realize there is a need for specialists daily. Most of the facilities have an arrangement with different specialists who visit every 2-3 weeks and see these patients at the rural facility. Obviously, the problem with this is that not everybody can wait 2-3 weeks to see their specialist. With telemedicine, the specialist could literally see patients any day just like a scheduled appointment in the office. With the integration with medical devices and medical carts, almost everything that could happen in a doctor's presence can happen with telemedicine.

For example, a cardiologist would be to listen to a patient's heart, view their EKG, check blood pressure, etc. With the right telemedicine solution, this works the same way as if they traveled to the physician's office, while patients visit their local rural hospital instead. There, a nurse facilitates all the medical devices to be used for that patient. The same would hold true for dermatology, diabetes, obesity etc. Even pre and post-surgery appointments can be addressed by telemedicine.

So the next time you're considering whether you need an embedded telemedicine solution, think beyond your EMR and consider the workflow you're trying to achieve. Many times embedded telemedicine solutions limit the way you can use them. Embedding telemedicine is not the answer to everything.