COVID-19 has ushered in a new period of social distancing, self-isolation, and remote work. Hospitals around the country are reaching or exceeding their capacity, and many doctors have been summoned to the front lines to help control this virus and slow the spread.
Many physicians, patients, and entire hospital departments themselves are being asked to #StayAtHome and canceling appointments. Some practices have made the incredibly difficult but important decision to temporarily close their doors. The good news: If you fall into this camp, you can begin offering telemedicine services to see many of your patients from the comfort of their own homes — and yours.
The novel coronavirus has turned a new spotlight on telemedicine, which has already piqued many physicians’ interest. The number of healthcare professionals requesting telemedicine training has jumped more than 200%, according to some reports. To successfully practice remotely, you will have to conduct appointments differently than a traditional visit. Here are some tips to get you started.
In light of COVID-19, there is an increased demand for telemedicine services. But if you’ve only recently folded virtual visits into your practice, your patients probably don’t know they have the option. Add notes to all of your profiles on third-party sites, including your Google My Business and Facebook profiles, and consider using ad banners to broadcast the message. Using one-to-many communication tools, spread the word to current patients that you can continue to meet with them virtually. Make sure your website, answering machine, and auto-reply email messages are updated with this information.
The Office for Civil Rights at the Department of Health and Human Services announced that it is loosening HIPAA regulations to let doctors meet with patients using common audio and video technologies — like Zoom, Google Hangouts, and FaceTime. Many of these are free and easy to implement, but they come with a few caveats.
One major sticking point for physicians is that these free, widely available tools make keeping your personal phone number or email address hidden from patients difficult to impossible. Another is that it requires your patients to be on a particular operating system (i.e., Apple or Android) and often require a software download.
Consider Doctor.com’s free, secure, and HIPAA-compliant telemedicine solution, VirtualVisit. Its patient-friendly interface is easy to use, and the platform is compatible with all internet-enabled devices.
The most common frustrations that arise during telemedicine appointments relate to the technology itself. The internet drops. The video freezes. The audio cuts out. Make sure your internet connection is fast and secure. You may need to upgrade your internet service to enable effective virtual appointments, but it will be well worth the cost. To see where you stand, test your internet speed here — just click “Run Speed Test” to get started. HealthIT.gov recommends a minimum bandwidth speed of 4 megabits per second (Mbps) for a single physician to effectively monitor patients remotely.
Your house or apartment has different distractions than your office, where focusing on each patient may come more naturally. Designate a room or area of your home for conducting appointments. This will help you more easily convert from “home” mode to “work” mode. At the end of the day, having a dedicated space also helps you emotionally distance yourself from work when you’re off the clock.
In your dedicated work area, keep diversions to a minimum and try to anticipate potential interruptions. For example, if you live on a busy street, find a space toward the back of your home if possible to curb traffic noise. Remove clutter from your workspace and background to help keep you — and your patient — focused on the appointment. Mute or power off unnecessary devices, set your camera at eye level so your face is in frame, avoid too much movement, and try not to look at your own picture.
Sometimes an extraneous noise or distraction is inevitable. So what do you do if your kid interrupts you, your Wi-Fi cuts out, or your dog starts to lose it in the background? Apologize and simply move on. Patients understand that we’re in uncharted territory. Since many of them are also working remotely, they will be all too familiar with the challenges of an at-home office.
When you’re working from home, relaxing your dress code is tempting. (You will probably see a few patients in PJs themselves.) But you should think of a virtual visit like any other appointment — and dress the part — to convey that the experience is business as usual and your patient is getting appropriate care.
Securing patient consent is a requirement in many states — and a best practice for telemedicine regardless of your location. Tell patients their rights, explain what the telemedicine process entails, and educate them on their responsibilities. Lay out the associated benefits as well as potential risks, like data breaches or technology breakdowns. Set a contingency plan in the event that something goes wrong.
The American Telehealth Association has examples of forms to acquire informed consent, or reach out to your regional telehealth resource center for sample templates. Have your patient print out, sign, scan, and send the form to you, or use a service like DocuSign or JotForm to obtain consent 100% electronically. As always, make sure you stay up to date on your state’s telemedicine policies. Check the National Telehealth Policy Resource Center for more information.
Telemedicine is new for patients, too. They might not understand how the experience will differ from a traditional, in-office appointment or what is and is not possible through a virtual visit. Some conditions — including allergies, rashes, respiratory infections, and sports injuries — are well suited for diagnosis and treatment via virtual appointments. Other specialties might use telemedicine for post-op check-ins, consultations, remote monitoring of known conditions, or counseling. Educate patients on what services you can and can’t provide through a virtual visit so they don’t sign off feeling dissatisfied with the experience.
An even better way to set patient expectations is to gather feedback and reviews after your initial successful visits, specifically regarding their virtual visit. New or new-to-telemedicine patients will find this to be extremely valuable.
One of the most common issues tied to negative patient sentiment stems from breakdowns in communication. When you can’t be physically in the same room as a patient, it’s important to go above and beyond to engage them remotely and make them feel heard. Look right at the webcam when you are speaking, and make eye contact with the patient when they are. If you need to take notes, signal that you’re still listening by nodding your head or repeating what your patient said back to them.
When it comes to follow-up instructions for care, overcommunication is key. Don’t rely on the patient to write down everything during the appointment. Even if you’ve been abundantly clear with your diagnosis and course of action, technological snafus, stress, or distractions might cause something to slip your patient’s mind. Send patients detailed notes after the appointment with next steps. Check in down the line to make sure they’re adhering to your instructions (this also demonstrates that you care). In a time of crisis, empathy is more needed than ever.
Know why the patient requested an appointment and have their chart nearby. Understanding their chief complaint ahead of time not only sets the tone for the appointment, but it also helps focus the conversation and saves everyone time. Encourage your patients to be as detailed as possible when booking online, and train any staff members scheduling appointments over the phone to collect specific information about the nature of the visit.
Depending on the speed of your internet as well as your patient’s connection, you may experience lag time and audio hiccups during your conversations. A general best practice is to pause a couple of seconds before you jump in to make sure your patient has finished speaking and you’re not talking over each other.
There’s no one-size-fits-all solution in medicine, and a virtual appointment isn’t appropriate in every situation. Severe symptoms may require an in-person exam, and true emergencies will always necessitate a trip to the ER. Use your best judgment to decide what’s right for each individual patient and clearly explain why you’re recommending one course of action over another.
COVID-19 has launched us into a new era, and it’s natural to feel a little unsteady on your feet as you grow comfortable with a new technology. The good news is that it’s also a very forgiving time. For many patients, having any sort of engagement with their healthcare providers is simply enough. If you want to ease your way into telemedicine, consider starting with a “beta group” of current happy patients and expanding to more as you establish workflows that are appropriate for your practice.
Expanding your practice to encompass virtual visits can seem daunting at first glance. But with the right technology, a measured approach, and the appropriate expectations in place, telemedicine can be a highly effective method of caring for patients during the COVID-19 crisis and later on. For help setting up telemedicine at your practice, reach out to a Doctor.com consultant here.
Erin Kitchen
VP, Marketing and Communications
The original version of this page was published at: https://www.doctor.com/blog/dos-and-donts-of-kick-starting-telemedicine-at-your-practice
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