Virtual Care Tips and Tricks

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, cellulose, 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 support@ontariomd.com

Virtual Care: Preparing your staff and notifying your patients

Contributors include OntarioMD Practice Advisor Tania Hunt with recommendations from OntarioMD Physician Peer Leaders from our Virtual Care Webinar Series

With the onset of the COVID-19 , clinicians have quickly adapted to physical distancing with their patients and using virtual care to avoid unnecessary trips to the office. You may decide to make this change in how you practice medicine an ongoing option for your patients beyond the current global pandemic.  The change to a practice that offers virtual care options can be done easily and efficiently by selecting a virtual care platform that’s right for you and your patients. There are many virtual care tools on the market and the choices may seem overwhelming. OntarioMD has facilitated your review of virtual care tools available to Ontario clinicians by bringing them all together in one convenient spot, OntarioMD.News. This site contains lists virtual care tools for video visits, direct-to-patient interactions, virtual clinics, EMR-integrated tools, and more. The tools have been curated, but not endorsed by OntarioMD. Please contact the vendors directly for product-specific questions.

You may wish to delegate the task of finding a virtual care platform to one of your staff who will also be using the tools and you can also ask your family and friends for recommendations. Involving staff is an opportunity to keep them feeling needed and invested in any new tools for your practice. A critical success factor for virtual care is being able to network with colleagues on similar platforms for support and advice so you may wish  to select tools that colleagues in your social network, study groups, etc., are using.

The transition to offering virtual options might be challenging for some staff. You can leverage Zoom or similar platforms to train staff on the benefits of the virtual tools. You may also want to consider an Interactive Voice Response (IVR)system to route phone calls for staff working from home.

Before you adopt a virtual care tool, a good idea is to keep your schedule flexible when you start using it and until you and your staff get used to the tool. This will help to ease stress, give you and your staff space and plenty of time to learn from using virtual care tools. You can see what works well and how your patients like the tool.

One of the most frequent requests from patients is for online appointment booking. Online booking is a great way to introduce your practice and your patients to virtual care tools. Check out the options for an online booking platform. Online appointment booking will cut down on phone calls asking for appointments. This frees up your staff to do other things. You should allow for some same day appointments, and leave only options video or phone options for the patient to choose from. Work with a nurse or your admin to triage who you need to see vs. who you can treat over the phone or eVisit.

So you’ve prepared yourself and your staff to use virtual care tools. Now it’s time to notify your patients that your practice has gone mostly virtual. Your staff can implement the IVR and voicemail system so patients are informed that your clinic has gone virtual when they call. If your staff are booking appointments over the phone, ensure they ask the patient what virtual platform they would like to use (phone or video). If they are booking an appointment from your website, change your website to only show the video visit or phone visit options. Let patients decide which technology they are most comfortable with. Once an appointment is booked, have staff confirm the patient phone number and email so you have the most up-to-date information. It’s also a good idea at this point to obtain the patient’s consent in advance of the virtual encounter. This can be done by admin staff.

A consent statement that your admin can read to patients over the phone was prepared by OMA and OntarioMD Legal teams and vetted by the CMPA.  It should be posted on your website and in your office for your patients to read. You can also obtain consent by email. In both cases, record consent for each patient in your EMR. Instructions for how to obtain consent to initiate a virtual care encounter and the consent statement are available on OntarioMD.News.

If you use Facebook, a newsletter or another method to communicate with your patients, try and get the word out on how patients can reach you and provide links to resources if they have traveled outside of Canada or think they may have developed COVID-19 symptoms.

Search your EMR for patient email addresses and send a mass communication to notify patients of clinic updates, COVID-19 updates and that they can email you. This “keeping the door open” approach has proven to be popular with patients.

All the best as you move forward with your virtual practice.

This is part one of a two-part blog. Part two will focus on virtual care tips and tricks.