Implementing team-based telemedicine workflows in safety-net primary care.

Area of Science:

• Implementation Science
• Health Services Research
• Digital Health Equity

Background:

• Telemedicine implementation faces unique challenges in safety-net settings.
• Limited research exists on pragmatic, team-based strategies for telemedicine in primary care for underserved populations.

Purpose of the Study:

• To explore facilitators and challenges of implementing team-based workflows for synchronous telemedicine (video and audio-only) in a safety-net primary care system.
• To understand the impact of these workflows on patient care and clinician experience.

Main Methods:

• Conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff.
• Analyzed interview data using modified grounded theory and multistage coding.
• Organized findings using the Practical, Robust Implementation Sustainability Model framework.

Main Results:

• A dedicated patient preparation role is crucial for patients with limited digital literacy.
• Standardized workflows and communication enhance healthcare maintenance during telemedicine visits.
• Telemedicine offers perceived benefits in flexibility and accessibility, despite some patient barriers.
• Clinicians and staff report positive impacts on work experience due to increased efficiency, though audio-only visits are less engaging.

Conclusions:

• Strategic team-based workflows can expand telemedicine access and ensure quality care in safety-net settings.
• Optimizing telemedicine implementation requires addressing digital literacy and standardizing processes to maximize benefits for vulnerable patient populations.