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Telehealth and Team-Based CareImprove Patient Care and Team Engagement During Virtual Visits

Learning Objectives:
1. Explain the essentials of a team-based care approach to care delivery
2. Describe telehealth advantages and opportunities
3. Specify how to implement team-based care in telehealth
How Will This Toolkit Help Me?

  1. Explains the essentials of a team-based care approach to care delivery

  2. Describes telehealth advantages and opportunities

  3. Specifies how to implement team-based care in telehealth


Physician-led team-based care (TBC) is a cornerstone of practice sustainability. Over the past decade, physicians and practices made great strides in developing and implementing team-based care models to support traditional in-office medical practice.1-6 In the spring of 2020, the COVID-19 pandemic accelerated the adoption of telehealth (virtual visits) among patients, health care professionals, and health systems.7 While beneficial for patient and care team safety and convenience, this accelerated adoption and growth of telehealth led many practices to revert to the “doctor does it all” model of practice—an approach that is neither sustainable nor effective. Given that the use of telehealth will continue beyond the public health emergency, it is important for practices and health systems to revisit and optimize their existing telehealth workflows.

What Is Telehealth?

Telehealth is a broad term encompassing a range of technologies and modalities that enable clinicians to provide health care services from a distance. Figure 1 provides some useful definitions.

Figure 1. Virtual Health Care Delivery Methods Covered by Telehealth

What Is Team-Based Care?

A team-based care model (Figure 2) is a higher-efficiency practice model designed to:

  • Improve the quality of patient care

  • Increase patient access to care

  • Improve care team efficiency

  • Improve satisfaction and engagement for patients and health care professionals

Figure 2. What Is Team-Based Care?2-5
A comprehensive approach to health care delivery transformation, including:

A comprehensive approach to health care delivery transformation, including:

In this toolkit, we share team-based care workflows for synchronous telehealth visits based on recent institutional successes in the era of COVID-19. For more information on the adoption and optimization of telehealth in your practice, see the separate AMA STEPS Forward® Telehealth Integration and Optimization toolkit.

Four STEPS to Implement Team-Based Care Into Telehealth

  1. Define and Engage the Team

  2. Determine the Level of Team-Based Support Your Practice Is Able to Provide

  3. Implement Team-Based Workflows

  4. Assess and Optimize

STEP 1 Define and Engage the Team

Patient safety and quality of care benefit when teams leverage each other's skills and work together to complete the visit, and this is particularly true with telehealth. When building your team-based telehealth program, start with those team members you work most closely with every day. Identify and document current roles and how each contributes to patient care. Are there any gaps in roles that the practice needs to fill to proceed with implementing telehealth? Bring people together to discuss how to build a better way to care for patients. Value the perspective and experience of each person. Empower individuals in order to empower the team.

In addition to the physician, consider including:

  • IT partners

  • Nurse practitioners and/or physician assistants

  • Nursing team members

  • Medical assistants (MAs)

  • Administrative or clerical team members

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STEP 2 Determine the Level of Team-Based Support Your Practice Is Able to Provide

The level of team-based support can range from Level 1,no support (“doctor does it all”), to Level 7, continuous in-room support including virtual rooming, pre-visit planning, real-time documentation support, and after-visit education and planning (the “ideal patient care journey”). Just as with in-person visits, where your practice falls on this ladder will depend on resources and staffing levels.

Figure 3. Levels of Team-Based Support for Synchronous Telehealth Visits

Access Ladder of Team-Based Support for Telehealth Visits.

It is important to discuss with your entire team which “step” on the ladder will be most feasible. Commit together to give it a try, and learn from your collective experience, recognizing that you and your team can always make changes.

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  • Where should physicians conduct telehealth visits?

    The flexibility of telehealth visits during the PHE is an advantage. Physicians can conduct the visit in an exam room, office, or at home. The ability for physicians to perform telehealth visits from their home is useful during mild illness (COVID or other viral infections that may be contagious) as well as for convenience and work-life integration.

  • What telehealth platform should we use?

    Choosing or switching the right telehealth platform based on where your practice is on the ladder above is essential, as not all platforms will have functionality to accomplish the higher steps on the ladder, particularly if physicians and team members work from home (and are not co-located). The AMA STEPS Forward Telehealth Integration and Optimization toolkit has detailed information on choosing the optimal telehealth platform for your practice needs. Keep in mind that while some privacy and security regulatory requirements for telehealth services are waived during the PHE, these requirements may be enforced again in the future, which may impact the use of certain platforms.

    A recent American Medical Association survey (PDF) revealed that physicians use a variety of platforms for virtual visits, as illustrated in Figure 4 below.

    Figure 4. Surveyed Physicians Report Using A Variety of Telehealth Platforms
    Graphic Jump Location

    © 2022-2023 American Medical Association. All rights reserved.

  • How do patients react to having another person in the virtual “room”?

    We have found that most patients accept and welcome the additional medical professional helping with their visit if the physician explains that the medical assistant is there to ensure accurate documentation, order entry, and follow-up so the physician can remain focused on the patient. Many patients even see it as an opportunity to have another advocate for their health care and develop close relationships with the assistant over time.

    The introductory explanation is especially important for patients new to the team care process or new to telehealth. It may also be reassuring to let patients know that it is no problem if they want to be alone with their physician. In addition, if the physician or assistant senses that the patient is uncomfortable—such as during certain sensitive parts of the visit—the assistant may leave the virtual room.

STEP 3 Implement Team-Based Workflows

After you decide on the most feasible model on the ladder, develop and implement more detailed workflows. Look to adapt existing standard workflows as a starting point, and aim to mirror the patient experience with that of in-office encounters.

The process of developing a workflow should include:

  1. Creating a workflow diagram with specific tasks and responsibilities associated with each step in the patient journey

  2. Bringing the team together to discuss which role is most appropriate for each duty

  3. Clearly defining and assigning the roles and responsibilities of each team member

Access Creating a Process Map.

Two examples of telehealth workflows are illustrated below (Figure 5Figure 6).

Figure 5. Level 5 Workflow for Telehealth Visit with Team Members Off Site
Example courtesy of VCU Health.
Figure 6. Level 7 Workflow for Telehealth Visit with Team Members In Office (Co-Located)

Access Example Workflow: Team-Based Care Virtual Visits.

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  • How can this process be adapted for telephone visits?

    It is ideal if supporting team members can initiate the visit, then hand off the visit to the physician. As with video visits, it is helpful if they can stay present to provide EHR support during the visit. This allows the clinician to focus on the patient without distraction and increases efficiency. The physician can leave the visit once they set the care plan, and the team member can then enter or pend necessary orders, schedule the follow-up visit if needed, and reinforce the plan with the patient.

STEP 4 Assess and Optimize

Come together for regular team meetings. Be open and honest; freely discuss what works well and what needs work. Keep each other accountable and willingly submit yourself to process-related and personal feedback. Be patient and show grace to one another as you navigate this change. When things aren't going as well as they might, try something different. Be flexible. Mix it up, and remember to write it down—what you did and how it went—so you know for next time. Don't forget to use patient feedback at every opportunity. Finally, celebrate your wins together as a team.

As you iterate and optimize your model, here are some telehealth Practice Pearls that we have found valuable from our experiences thus far (Figure 7).

Figure 7. Ten Practice Pearls to Optimize Your Telehealth Team-Based Care Model
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  • What strategies can we use to ensure continual improvement in new processes?

    First, be willing to adjust your approach to best serve the team and, ultimately, your patients. It can be helpful to have whiteboards available so team members can write down questions or ideas for improvement. Ideally, feedback should be addressed daily. Regular care team meetings are also invaluable for reviewing the processes and workflows and getting ideas for refinement and ongoing improvement. Frequent check-ins like this help keep team members engaged.


One major effect of the COVID-19 pandemic was the accelerated adoption of telehealth. Telehealth has already proven to be a valuable patient care tool and gives clinicians another means to stay connected to their patients, with or without a pandemic. Early experience suggests that telehealth implemented without attention to workflow risks minimizing team-based care and introduces new barriers to efficient care. Therefore, practices should continue to adapt and build upon their experience with in-office team-based care as they develop new models of team-based care to support telehealth, even after the PHE is over.

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AMA Pearls

AMA Pearls

  • Involve all team members in the creation of a meaningful and efficient workflow for team-based care in telehealth

  • Implementation does not have to perfect from the beginning; give your team members and your patients time to adapt, grow, and learn from the process

  • When practices incorporate team-based care into telehealth, physicians waste less time and telehealth productivity increases.

Further Reading

Journal Articles and Other Publications

Videos and Webinars

  • Hopkins K. Telehealth and team-based care: the shift to telemedicine and navigating potential pitfalls. American Medical Association YouTube page. Posted December 11, 2020. Accessed July 19, 2022. https://www.youtube.com/watch?v=QLDbJCjmFVA

  • Jerzak J. Telemedicine and team-based care: how to engage support staff to implement team-based care in telemedicine. American Medical Association YouTube page. Posted October 29, 2020. Accessed July 19, 2022. https://www.youtube.com/watch?v=kElozl7cxIU


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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.

Participation Statement: Upon completion of this activity, learners will receive a Participation Certificate.


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