Contributors include OntarioMD Practice Advisor Tania Hunt with recommendations from OntarioMD Physician Peer Leaders from our Virtual Care Webinar Series
This is part two of our blog series on virtual care for clinicians. Check out part one on Virtual Care: Preparing your staff and notifying your patients here.
In part one, we discussed setting up your practice for a virtual care environment, preparing your staff and notifying patients. With your practice set to go, and everyone prepared, let’s review some of the different virtual care options you may wish to consider for your practice.
Telephone visits are the easiest virtual care platform for most practices and will be part of your virtual care toolkit. All patients have access to a phone and do not need any instructions on how to use it. Phone visits are quick to set up, and do not use internet bandwidth. Remember to always use a private number when calling patients that will not be visible on the phone’s call display. To maintain privacy on the patient’s end when you call, ask them if they are able to speak to you privately without being overheard.
It is important that your staff tell the patient that when you call at the agreed-upon time, their phone will display ‘unknown caller’ so the patient knows to answer the call. When speaking to a patient, always confirm the patient identity.
If the patient needs lab work/DI, determine if it is really necessary or if it can be delayed to limit the patient’s exposure during COVID-19. If you and the patient both feel it is absolutely necessary, have the patient follow up with a lab to schedule an appointment.
When it comes to other virtual platforms, if it is difficult for you, it will be difficult for the patient and you will become tech support for them so pick a platform that you and your team understand and can operate smoothly. Purchase necessary equipment such as back-up headsets with built in speakers and a desktop camera. If possible, work with two laptops, one with the EMR and the other with the video visit tool (OTN, etc.). If multiple screens are not an option, leverage your smart phone for the virtual visit and keep your computer for the EMR. Remember, for both phone and video visits, you will need the patient’s consent before you begin the visit. See part one of this blog series for how to obtain consent.
When you start the video visit, it is always reassuring for the patient to have a quick scan of the room you are in so they see no one else is in the room while you communicate with them and their privacy is preserved. Ensure the patient’s privacy and security on their end as well. Ask questions like “Are you in a quiet room?” “Can you hear me properly?” “Is anyone else hearing this call?” “Do you feel safe having this discussion?” Look into the camera, not the screen, when asking questions. If a video visit does not work, revert to the telephone.
How can video visits be most helpful? They are especially valuable for patients with mental health issues. Connecting with them in their own home can be a more positive experience and put the patient at ease. Video visits are also helpful for patients with rashes, burns, cellulitis, etc. Use an app with imaging capabilities to capture an image of the patient’s issue for tracking and uploading to the patient chart for comparisons during future visits.
Video visits are a great way to learn more about patients by seeing their home, and meeting pets and family members. This will put patients at ease before you start the visit. Remember to always hang up the phone or disconnect the camera after a virtual visit. Turn the camera off when not using it or use a webcam blocker to avoid any unwanted visibility of your surroundings.
Be on time for your virtual appointments. The patient is not in the waiting room so they will not know if you have forgotten them or if you are behind. Be considerate of language barriers, and if you can, leverage a medical translation service during visits. This can be achieved by 3-way tele-conferencing, 3-way video conferencing, or having the patient on video and the translator on speaker phone. Regardless of the approach, consent should be obtained from the patient to use a translator and documented in the chart.
Some other tips for using virtual care in your practice:
- For specialist referrals, consider using eConsult instead of sending a referral by fax. You can get a response from the specialist in about two days and sometimes within hours. eConsults also helps avoid unnecessary visits (in-person or virtual) for patients.
- If your EMR allows for ‘stamps’, use them to prevent typing the same messaging repeatedly.
- Doing group visits? Google Hangouts for psychotherapy or used with diabetes patients works well and is free. You can conduct a video call with up to 10 people. A virtual environment can work well when patients who do not like talking or leaving their homes see other patients with similar issues.
Virtual visits are not appropriate for all patients. You will want to see some patients in person during COVID-19. You and your staff should be in full PPE when you are in the office. Our clinician Peer Leaders recommend that you try to set up your schedule so that vulnerable patient populations (prenatal, well-baby, geriatric, immune-compromised) come in only during protected time slots so that the risk of exposure to potential COVID-19 patients is limited. For more information on virtual care and tools to consider and other useful resources, visit OntarioMD.News, . For questions about a specific tool on this site, please contact the vendor directly. If you have any general questions about using virtual care tools, please contact firstname.lastname@example.org