How to do Telehealth
The ability to conduct a thorough evaluation and diagnosis of a patient using Telehealth technology is often a misunderstood process. Providers recognize the value of adopting a virtual avenue for their patients as part of the new healthcare delivery norm. However, how to do Telehealth can be a bit daunting even for the most tech comfortable clinician. Not because they do not understand the technology, it is the simple fact that they are not used to providing clinical care in the medium that Telehealth technologies offer.
Improving the virtual healthcare you provide to your patients requires doing a little pre-work and planning to be successful. This article will help providers new to Telehealth understand and prepare for how to do Telehealth initially.
Designate someone on your team as the Telehealth Coordinator
It is well worth your office staff’s effort or designated Telehealth Coordinator to be proactive and educate the patient on how to do a Telehealth virtual health visit. Selecting this person should be your very first step, especially before choosing a Telehealth platform. Engaging your Telehealth Coordinator in the decision-making process will help identify areas in your practice workflows that need to be considered when providing virtual care. They often have insight into the practice administration workflows that the physician is not knowledgeable of because their focus on providing patient care. By designating a person in your office as the Telehealth Coordinator you will also have by defacto a Telehealth subject matter expert to lead the next critical steps to start your program.
Prepare Your Patients for ‘How to do Telehealth’
Introduce your patients to how the Telehealth visit will work before the actual appointment.
When doctors first hear these suggestions, they think, “where am I going to find the time to educate the patient before the appointment.” The short answer is you do not. One of the Telehealth coordinator roles can be to ensure that they reach out to the patient before the appointment and connect with the patient using the office Telehealth platform.
Ideally, the Telehealth Coordinator schedules a time to call the patient over the phone when the patient is physically going to be during the virtual appointment.
The American Medical Association, in their Digital Health Implementation Playbook, emphasizes that an initial call to your patients before their Telehealth visit results in the patient feeling “a strong personal connection” with the practice team.
While on the phone, the Coordinator walks the patient through how to do Telehealth as a patient. Preferably, you want the patient and the Coordinator to connect over the Telehealth system to test the audio and video properly. Also, explain to the patient how to make a Telehealth doctor appointment and what to expect during the visit, and what things the patient should have available or completed before the appointment.
For many patients, teaching Telehealth may take just a couple of minutes, while others will take a little longer. Once the Coordinator and patient connect over the Telemedicine system, you will want to ensure the video and audio are working on both sides. Once that is confirmed, hang up the phone and finish the patient training using the system. This last step is important because it will give the patient a few minutes to be on the system and experience the upcoming virtual visit.
Have the patient gather needed medical information prior to the visit.
The standard information you want all of your patients to have available for traditional face-to-face visits is also part of a virtual visit.
Examples of things to remind the patient to do before the appointment:
- Patient Questions – Encourage the patient to write down any questions they have.
- Ask the patient to gather or do the following before the visit
- Temperature – Take their temperature before the visit and write the number down.
- Weight – Weigh themselves on their home scale and write the number down.
- Current Medication List – List of their medications if not already available by the doctor.
- Blood Pressure – At the doctor’s discretion, there are a few options
- For many routine visits for your patients without hypertension, doctors can decide that a current blood pressure reading is not clinicall required for the office visit.
- Home Blood Pressure Kits– For patients with home blood pressure kits, ask that the patient take their blood pressure just before the visit and document it with their temperature and weight. Or doctors may prefer that during the visit the patient actually use the home blood pressure kit and take a reading during the visit so that the doctor can see the results over the video.
Local Pharmacy – Most pharmacies have free blood pressure reading machines. During the Telehealth Coordinator’s initial call or when the patient schedules the appointment, it is generally not unreasonable that a request is made for them to obtain their blood pressure at their local pharmacy.
3. Intake Forms* – If your typical clinical protocols include the patient completing some intake form make sure to educate them on the process of how to do this remotely.
Many providers have valid concerns about having a set of current vital signs for every patient visit. And for patients where recent vital signs are a critical component of ensuring an accurate evaluation, the doctor should consider requiring them to come to their office instead of using Telehealth. Both patients and providers need to recognize that Telehealth is not a replacement for all face-to-face visits. Telehealth has many advantages but replacing a hands-on evaluation by a doctor for those with severe health conditions is not one of them.
The American Medical Association (AMA) conducted a presentation panel on how to do Telehealth specifically to help Doctors to support patients with hypertension remotely.
*Note on Intake forms – Having your patients emailing your office completed medical intake forms over unsecured email is a clear violation of HIPAA regulations. Many providers have adopted HIPAA compliant systems (See our article “HIPAA Compliance Tips“), whose sole function is to secure file sharing between patients and providers.
However, most reasonably priced Telehealth platforms will have secure file-sharing functionality as part of their standard system. Telehealth platforms with integrated secure file sharing will improve overall office efficiency and provide a safe medium to maintain a complete record for both you and your patient on all visits. In short, your Telehealth platform should function not only as a way to see your patients virtually but also as a secure patient portal.
Preparing them for the virtual "exam room."
This is an often overlooked but critical component of ensuring a positive experience for your patients during a virtual exam. Ensure that you check before the visit on your webcam that your webcam is working and that what the patient sees is a positive reflection on you and your practice.
- Check your lighting – Ideally, you do not want to have any windows or bright lights behind you during a virtual visit. The reason being is that it often results in your face being shadowed and hard to see by the patients. Generally, if you have a light built into your webcam, that normally provides good lighting by itself; if not, you will want to have lighting set-up in front of you (behind the camera) and light on the right and left sides of your face. This will eliminate shadows and glaring of the skin.
- Cleaning up your workspace – Ensure that the patient does not see a cluttered desk or items in the background that do not naturally belong there. You want the patient-focused on what you are saying, not the jacket hanging over your chair in the back of the room.
- Put on a lab coat or wear what you usually do in a routine visit – If your patients are used to seeing you in a lab coat, then it’s a good idea to throw one on before your visit.
- Make sure your office door is closed – Just like a standard office visit. The patient expects to have privacy with you during the visit. During the exam, you should be alone, and the patient should not be able to hear people talking in the background even if the staff is in another room. Microphone technology has improved tremendously and can pick up many sounds that the patient may hear, and you may not even notice.
- Look at your webcam when the patient is speaking or as often as possible. Everyone tends to look at the image of the person they are talking to on a video call. However, it can appear that you are distracted and not paying attention to the patient. It takes a little practice, but purposely remembering to keep your eyes looking into the camera as much as possible and at the end of your evaluation -can make a positive difference in the patient’s experience. Making an effort to look into the camera is a bit uncomfortable at first for everyone, but will greatly enhance the overall patient experience. The eye-contact perceived by the patient from you will help to ensure them that you are focused on their issues and help make them more at ease.
Taking the above steps to implement a Telehealth protocol (Telemedicine FAQ) and becoming comfortable seeing your patients over video can feel justifiably uncomfortable. But with a bit of practice, you, your staff, and most importantly, your patients will find that a Telehealth visit will become the norm rather than a rare event.
Note on article "How to do Telehealth"
In our article, we purposely left out the development and implementation of a Telemedicine Tool Kit. Our nation is facing a massive healthcare crisis at the time of writing this article, with COVID-19. For this article, we have done our best to create a crash course in Telehealth implementation for Physicians and practice Administrators.
Use a Telehealth kit to document all needed policies and procedures and have your Telehealth Coordinator responsible for establishing this process. Every practice is different in how their workflows function, whether they be clinical or non-clinical. A tool kit will give you a guidebook on your practice on how to do Telehealth that covers areas to review and processes put in place for Telehealth.
Tool Kits vary based on specialty type, what state your practice is located as well as if you are a Medicare provider or not. However, they share the same outline of questions that medical practices will want to answer and plan to launch an effective Telehealth program. See our article “Telemedicine History and Definitions.”
Our next article in the series on how to do Telehealth will be “How to do a physical exam of your patient virtually.”
Below are links to excellent resources for practice to find toolkits for their way.
Great Plans Telehealth Resource Center – Startup Guide and Clinical Resources
American Medical Association – Telehealth Implementation Playbook
American Medical Association– Ethical Practice in Telemedicine
CMS: General Telemedicine Toolkit
University of Arizona: Telemedicine Checklist
CMS Medicare: Telemedicine Health Care Provider Fact Sheet