The use of telehealth services is continuing to gain momentum, especially during the COVID-19 pandemic. With CMS announcing waivers for certain telehealth services (click here), more patients than ever are being directed to access care through this avenue to limit their exposure to infectious diseases in hospitals. (Click here for a complete list of covered telehealth services.) In fact, according to a study conducted by NYU Langone Health, virtual urgent and nonurgent visits at their organization increased by 683% and 4,345% between March 2 and April 14, 2020 in response to the current pandemic (click here for more information).
While virtual visits provide a great opportunity for hospitals to continue offering vital care services, ensuring that providers are confident in interacting with patients via telehealth is critical. The following tips seek to help providers offer high-quality telehealth services to all patients.
Tips for Conducting an Effective Virtual Visit
Although it is great that patients and providers can connect face to face, the video to do so is limited to the screen of a PC, laptop, or smartphone. Therefore, establishing good communication is critical to overcome this limitation and make an accurate diagnosis.
Making patients feel comfortable in sharing their concerns while maintaining professionalism can be challenging for providers during the initial use of telehealth. Developing a rapport requires effective communication and interpersonal skills on part of the providers. Some tips to get the conversation off on the right foot during a virtual visit include:
- Address patients by name to help them feel comfortable and open to the conversation.
- Introduce yourself and explain your role in their care to form a better connection with patients.
- Listen and validate patient concerns.
- Document the interaction and their care plans in the EHR.
- Follow up or connect patients with specialists if necessary.
- Collect feedback from patients to facilitate improvement.
Sharing an after-visit summary and progress notes with patients following a virtual visit also helps improve engagement and encourages patients to follow the physician’s advice. A few tips to help providers improve their note taking so it can be better understood by patients are highlighted in “OpenNotes Documentation Tips” that was shared with HBI by UCHealth (click here for HBI members).
Providers are given instructions on how to keep their language patient-centric and nonjudgmental so as not to worry or confuse the patient. For instance, rather than writing that “the patient refuses to take their pills,” physicians are recommended to write “patient has been nonadherent to therapy.”
Tips on Virtual Etiquette
Maintaining professional manners during virtual visits is also an important component to drive better visits. Adopting practices such as avoiding spinning in chairs, using a backdrop to create a better sense of professionalism when consulting from home, and wearing lab coats and name tags help providers and patients better settle into their roles during the conversation. (HBI members can click here for a webinar on conducting virtual visits.)
Additionally, implementing steps to convert a location into one that is HIPAA compliant cannot be overlooked when delivering telehealth services in an off-site setting. Some measures to keep in mind include:
- Confirm that patient consent was received prior to the visit.
- Discuss confidentiality with patients to make sure they consider the people who might be listening within their home environment.
- Consider the individuals sharing the physical space on the physician’s end to ensure conversations remain confidential.
- Introduce other staff members who might be participating in the call to patients before initiating an examination to avoid surprises.
Tips on Performing a Physical Examination
A challenging aspect of delivering virtual care is performing the physical examination of patients. However, telehealth still facilitates the assessment of a patient’s general appearance, respiratory effort, and environmental factors in their home. In addition to the general examination, several providers are also using additional tools to perform the examination.
For instance, using the Ottawa Ankle and Knee Rules (click here) can aid patients and providers in assessing any musculoskeletal injuries. According to the April 2020 article “The Transition from Reimagining to Recreating Health Care Is Now” in NEJM Catalyst (click here), other strategies that can be applied to perform assessments include guiding patients or their family members to feel and count their pulse out loud, or observing a directed caregiver examination of patients with abdominal symptoms.
Additionally, providers and healthcare organizations can also refer to the telehealth implementation playbook published by the American Medical Association (click here) for guidelines on developing and delivering patient care via telehealth. Pages 113-115 of the playbook include a telehealth workflow example and an etiquette checklist.
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