How to be a telehealth physician

Introduction:

The COVID-19 pandemic has seen a sea change in the way that physicians treat their patients and nowhere is this more evident that in the near-overnight implementation of telehealth across the health care industry.

As case counts began to rise in early 2020, public health authorities across the country implemented stay-at-home orders and moratoriums on nonemergency medical services in an effort to keep health care professionals from being overwhelmed by patients with COVID-19. With no other option, many health care entities were forced to step into the telehealth space with little experience and even less training.

The use of telehealth was barely a factor among physicians in 2015, with only 5% of physicians having used video visits to see patients. That trend was on the rise by 2019,with 22%, but the pandemic accelerated it, with 80% of physicians saying they had used video visits to see their patients in 2020.

This is expected to continue even after the pandemic ends, with 92% of physicians still expecting to use video visits when it is safe to meet with patients, according to telehealth provider Amwell.

Learning Objectives

• Proper understanding of the current telehealth rules and regulations.
• Getting paid for telehealth: solutions to common mistakes.
• Tips for improving your telehealth program to boost patient satisfaction, efficiency and more.

Meet the presenter

Mia Finkelston, M.D., Senior Medical Director Amwell Medical Group

How to be a virtual physician

While telehealth isn’t a perfect fit for every patient or service, Finkelston says some patients will ask for it because of challenges of meeting in person or just for convenience. Telehealth can be ideal for services like follow-up meetings with patients after a change in medication, wellness screenings or when going over ongoing care plans.

“When you think about medical care, so much can be done through a thoughtful conversation, a thorough history taking, an observation as to what’s going on in the background,” she says.

Before the visit begins, the physician should make sure their device is fully charged, turn off notifications, close conflicting software such as FaceTime or email, ensure the equipment is ready, test their internet speed and limit other activity on the Wi-Fi, which can consume bandwidth.

The physician should look professional, wearing a white coat and dress shirt. The camera should also be kept at the physician’s eye level, about 2 or 3 feet away. Their face should be well lit from the front and backlighting, which can make the physician appear in silhouette, should be avoided.

The biggest challenge in getting patients to embrace telehealth is technology or the lack thereof. Patients fear it won’t work or they won’t be able to see or hear their physician properly. Finkelston recommends that physicians learn some simple troubleshooting for when it appears the connection is faulty. If the physician and patient can’t connect, Finkelston says she sends the patient a text message or calls them to guide them through possible solutions to the technical issue.

When doing a video call with a patient, audio will often connect before the video feed. Finkelston recommends checking whether the patient can hear as the visit starts. She says the physician should also acknowledge and apologize for the patient’s wait as a courtesy. At the beginning of a telehealth visit, the physician should keep their hands in view of the camera and assure the patient that the physician is in a private, HIPAA-compliant space.

The telehealth visit should start with the patient’s chief complaint. Finkelston recommends against rushing this.

When treating adults over telehealth, the physician should check the patient’s surroundings: where are they calling from, how they appear, what their environment is like and how comfortable they are. If the patient lives in a state where the physician is not licensed to practice, the patient should be encouraged to find a physician in their area to avoid any legal issues.

When treating children using telehealth, Finkelston recommends keeping toys on hand to make the exam engaging, consider seasonal decorations for the physician’s telehealth space, addressing the child directly, encouraging them to hold the device the visit is taking place on and acknowledging what the physician is doing off screen.

During telehealth visits, physicians should ensure they are in a private space, with a locked door if possible. There shouldn’t be children, pets or food in the room with the physician. The physician should maintain eye contact by looking directly into the camera and explain what they are doing when off camera, according to Finkelston.

During the visit, vitals can be collected using wearable devices, but if the patient doesn’t own one of these devices the physician should feel comfortable referring them to in-person care. When examining the patient’s mental status, the physician should evaluate their speech and mental status throughout the interview, their eye contact and whether they are understanding cause and effect. When evaluating the mental status of a patient under 18, the physician must ensure a parent or guardian is present.

At the end of the visit, the physician should take time to ask whether the patient has questions, review next steps and ensure the patient understands them and review pharmacy information.

Solutions and takeaways:

• Ensure telehealth technology works before the visit.
• Prepare easy troubleshooting tips for when patients cannot connect.
• During a visit the physician should look professional, be in a secure, quiet room and look directly into the camera.
• Recommend in-office visits for vitals that can’t be collected by the patient.
• End by asking the patient if they have any questions.