Remote working has grown considerably over the last few years. From 2005 to 2017, there was a 159% increase in remote working.[1] As of 2016, 43% of employees worked remotely in some capacity and 69% of employers offer remote work on an ad hoc basis to at least some employees.[2],[3] As a result of the coronavirus (COVID-19), many companies have had to rapidly implement remote working capabilities out of necessity. This is unchartered territory, and the risks might not be fully appreciated.
Regardless of COVID-19, your practice should have an emergency plan (business continuity plan -- “BCP”) in place to address a crisis. If you don’t have a BCP, now is the time to develop and implement formal policies and procedures. Talk with other colleagues about their processes and seek legal guidance, if necessary. If you are working in a hospital, make sure you are aware of the policies which are in place.
In addition to a BCP, there are a number of steps to keep in mind when implementing remote capabilities in your practice:
- Notify all of your patients of the change in practice. Ensure you notify all patients of your change in practice or of any cancellations. Ensure that when you contact patients, you maintain confidentiality and privacy
- Communication via email. Email is widely used to communicate with patients. Consequently, you need to know and adhere to state and federal privacy laws. Even in these challenging times, you are still obligated to protect your patients’ privacy. Understand that if you email your patient at his/her work email, this is not confidential. The email belongs to his/her employer. It is recommended to communicate via the patient’s personal email address, not his/her work address. For more information on communicating with patients by use of email, please see our earlier Blog entry: “Risk Management Series 1- Documentation in Allied Healthcare, Tip # 12: Documentation Involving Email Communication”
- Communication via text. If you engage in communication with patients via text, it is important you are aware of the risks in doing so particularly during this time. Many of us are in close proximity in the home setting. A patient’s cell phone could be left unattended, and should you communicate with a patient via text, your patient may not be the only one seeing it. For more information on communicating with patients by use of text, please see our earlier Blog entry: “Risk Management Series 1- Documentation in Allied Healthcare, Tip # 12: Documentation Involving Text Communication”
- Informed consent remains critical. This is an emergent issue, and you may not have an option of providing in-person treatment versus distance/remote treatment. It is important to notify the patient of the change in the way you will be delivering services and ensure that he/she provides informed consent to engage in treatment under these circumstances. Ensure that you document consent and retain it within the patient’s medical record
- Protect data. Working remotely entails additional challenges. Keep in mind that not all systems (e.g., computer, VOIP, telephones) meet the privacy and security standards required by HIPAA; it is essential you use one that does. Ensure your patient has a secure internet connection and that you assess his/her technical competence. It is also important that your patient can participate in therapy in privacy. The U.S. Department of Health and Human Services (HHS) has user-friendly information online which we encourage you to review.[4] Keep in mind network and software security must be in place to maintain patient confidentiality as remote working poses a significant security risk of breaches. Your practice should have protocols to guard against inadvertent disclosure
- Keep conversations private and confidential. While working remotely, you may be near others. Be aware of others who may overhear your conversations. Protect your patient’s privacy the same as if he/she were in your office and remind them to be aware of their surroundings as well
- Ensure your office IT system has the capability to operate remotely. Emergency procedures should be implemented to maintain business operations. It is important to have a system in place that minimizes interruptions. Should you or your staff require IT assistance, it is important to know who to contact
- Ensure insurance billing obligations continue even when operating remotely. To the extent you bill for services through insurance, your obligations regarding timely billing and documentation will continue. If there are any anticipated delays, it is important to contact third party payors to inquire how they are handling business during this time. This is of particular importance if you have a contract with an insurer
- Maintain connection with support staff and clinical employees. To the extent you have support staff and/or supervise/employ clinical staff, make sure you remain connected with them while they work remotely. Consider having routine, scheduled meetings, either via video or by phone.
Additional Resources
The following additional resources are available when working remotely during this time. It is important to note, however, that you should be aware of current applicable state and federal regulations.
Conclusion
We realize this is not an exhaustive list but rather is an overview of some of the issues to consider when working remotely. We will post additional blogs in the coming days.
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Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.
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NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of The Trust is strictly prohibited.