For many providers, the COVID-19 pandemic has accelerated the use of telehealth to serve patients and families. With that, this may be a developing skill set for many physicians and advanced practice professionals. Here are a few tips to ensure a successful video visit:
Determine if the patient is a good telehealth candidate
It’s up to each clinician to gather enough information to make appropriate medical decisions. Refer the patient to in-person care if you determine a video exam is not adequate to provide high-quality medical decision-making.
Here are some things to consider:
- Is the patient in a private location? Do not provide telehealth services when a patient or parent is driving or in a public location.
- Does the patient or family have access to the internet and a computer or mobile device?
- Do you have a medical license for the state in which the patient lives? Restrictions during COVID-19 have been waived but this may change.
- Is the patient and family able to help with the physical exam, testing and vital signs, if necessary? For example, do they have a thermometer and scale? Are they able to count respirations?
Prep your virtual exam room
Take a few steps to prepare your environment for an optimal video experience:
- Check for clutter and any personal health information visible in the camera frame. Consider activating the virtual background if necessary.
- Check your self-view and make any needed lighting adjustments so your face can be seen clearly.
- Be aware of the position of your devices. If you’re using two screens, ensure they are positioned optimally so you can look back to the patient frequently when documenting.
- Shut your door, if possible, and hang a sign indicating a video session is in progress.
- Once the visit begins, be mindful that any typing from charting or notetaking will likely be picked up by the microphone.
Perform some housekeeping
Once the session begins, you’ll need to start with a few housekeeping matters:
- Verify you are with the correct patient and family by using two patient identifiers such as full name and date of birth.
- Obtain consent for the telehealth visit from the patient and parent.
- Explain to the patient and family that the video visit is not recorded, meets HIPAA requirements, and cannot be posted or forwarded.
Ensure comfort and privacy
For both the provider and patient, this visit will certainly “feel” different than a typical encounter. Acknowledge that to the family and then take some steps to increase comfort:
- Your usual techniques to connect with families can translate well on video. For example, help your patient warm up by asking them to show you their favorite toy or book.
- To help the family feel more comfortable – particularly if the exam will require clothing to be removed – ask non-essential staff and family members to leave the respective rooms.
- If others are in the room, introduce everyone in the location. Ask the family to do so as well for anyone who is in the room but off camera and in the microphone’s range.
Double down on communication
Communication is always important – but doubly so during a video exam. Be engaging and encourage cooperation from the patient and parent throughout the exam:
- Be comfortable giving the patient and family direction to improve the experience. This could mean asking them to adjust lights; move closer or farther from the camera; remove objects obstructing your view; or speak more loudly.
- Let the patient and family know they may hear you typing but this is because you want to accurately document the visit.
- Make eye contact with your camera, not the patient’s eyes.
- Do not cover your camera or mute your microphone; this could make the patient and family feel you’re not giving them your full attention.
Ask for assistance from the patient and family
In the absence of physical proximity, you might need the patient and family to help you perform exam maneuvers:
- Direct them to remove clothing, as necessary, and remember to tell them when it is OK to put on their clothing again.
- Tell them how to palpate to localize pain.
- Explain how to perform range of motion maneuvers.
- Describe the landmarks you use in clinic to find the right location for an exam component, such as ribs or the pelvic bone.
- Watch carefully and ask them to repeat anything that appears questionable.
- Verbalize what you think you are seeing, allowing the patient and their parent to clarify as needed.
Find more resources for telehealth services.
